This article deals with the requirements for infection control and instrument sterility for practices providing minor surgery under the directed enhanced services (DES) scheme. For other details of the scheme, see separate articles Minor Surgery in Primary Care - Procedures under a Direct Enhanced Service and Minor Surgery in Primary Care - Basic Procedures.

Sterilisation and infection control¹

• Minor surgery in general practice has a low incidence of complications.
• It is important that practices providing minor surgery operate to the highest possible standards.
• To maintain high standards practices should:
• Have approved sterilisation procedures that reflect national guidelines
• Obtain sterile packs from the local central sterile supply department (CSSD).
• Use disposable sterile instruments.

Infection control guidelines

The recommendations of the National Institute for Health and Clinical Excellence (NICE) are divided into three broad recommendation headings:²

• Hand hygiene: hands must be decontaminated immediately before each and every episode of direct patient contact or care and after any activity or contact that could potentially result in hands becoming contaminated.
• The use of personal protective equipment: gloves must be worn as single-use items. They must be put on immediately before an episode of patient contact or treatment and removed as soon as the activity is completed. Gloves must be changed between caring for different patients and between different care or treatment activities for the same patient. In a recent study, only 33.1% of GPs reported wearing gloves during minor operations.³
• The safe use and disposal of sharps.

The Department of Health (DH) has also published a code of practice on the prevention and control of infections which is relevant to all practices providing minor surgery (and for that matter any service which requires the use of sterile instruments).⁴ The code requires that:

• A designated person is responsible within the practice to manage and monitor the control of infection.
• An infection control policy should be instituted by the practice, which should say:
  • What infection prevention and control measures are needed in the practice.
  • What policies, procedures and guidance are needed and how they will be kept up-to-date and monitored for compliance.
  • What initial and ongoing training staff will receive where appropriate.
• The practice should keep a list of contacts who can be contacted for advice.
• An annual statement should be prepared, available to anyone who asks to see it, detailing:
  • Known infection transmission event and actions arising from this.
  • Audits undertaken and subsequent actions.
  • Risk assessments undertaken for prevention and control of infection.
  • Training received by staff.
  • Review and update of policies, procedures and guidance.
• Premises should be furnished taking account of national guidance and rooms with specialist functions - for example, minor surgery.
• Appropriate arrangements should be in place for the safe disposal of clinical waste.
• Clothing should be 'clean and fit for purpose'.
• Practices should make sure that any biological samples sent for histology are transported in non-leak containers and in a manner that is consistent with current legislation.

Decontamination⁴

The DH defines decontamination as 'the combination of processes (including cleaning, disinfection and sterilisation) used to make a reusable item safe for further use on service users and for handling by staff.

The DH Code of Practice requires that:

• A decontamination lead is appointed by the practice (this can be the same person as the infection control lead) with the responsibility to devise a decontamination policy and monitor all aspects of the decontamination cycle.
• The decontamination policy should be consistent with national guidelines and legislation.
• Premises should be cleaned and managed to facilitate infection control (The National Patient Safety Agency (NPSA) has published detailed guidance for maintaining cleanliness in primary care facilities).⁵
• Records of decontamination should be kept.
• Decontamination of reusable medical devices should follow national policy where available. Single-use medical devices should not be reused. Equipment used for decontamination should be routinely inspected, maintained and validated.

Document references

1. Minor surgery - Specification for a directed enhanced service, British Medical Association
2. Infection control, prevention of healthcare-associated infection in primary and community care, NICE (2003)
3. Coulter WA, Chew-Graham CA, Cheung SW, et al; Autoclave performance and operator knowledge of autoclave use in primary care: a survey of UK practices. J Hosp Infect. 2001 Jul;48(3):180-5. [abstract]
4. Code of Practice on the prevention and control of infections and related guidance, Dept of Health (2008)
5. The national specifications for cleanliness in the NHS, National Patient Safety Agency 2010

Internet and further reading

• No authors listed; Wound care. Department of Emergency Medicine, University of Ottawa; Useful advice and pictures of wound closure, dressings and skin cleansing

Acknowledgements