Table 1

Minimising infection risks and improving environmental sustainability

Action	Infection prevention and control (IPC)	Environmental sustainability
Ensure that all healthcare workers have demonstrable and, as a minimum, annually validated IPC competencies for the roles they undertake.	Lapses in IPC practice are cited as the chief cause of contamination, particularly in the reprocessing of endoscopes.	Improvements in IPC reduces infection rates, staff absence and bed days as a result of hospital-acquiredinfections (HCIs)
Provide robust patient information and preassessment to screen for infection	Postpone all but critical procedures when infection identified to limit spread.	Reduce need for high level PPE and deep cleaning of environment between cases/before or after lists
Ensure ventilation and temperature systems comply with the relevant Health Technical Memorandums and involve IPC teams and estates before procuring equipment	Mitigate the airborne risks to staff and patients including those from chemicals, drugs and micro-organisms.	Install systems that are verified to provide the lowest lifecycle environmental cost. Switch off or set back systems when not in use. Monitor systems regularly to ensure running efficiently.
Prepare and draw up drugs for patient administration as required for each patient.	Reduce the risk of aerosol or staff contamination of equipment prepared and left for long periods	Reduce waste of unused single-use equipment
Ensure that PIVC packs contain only the equipment required for each cannulation with additional equipment available if needed	Mitigate the risk of direct entry of microbial contaminants into the bloodstream	Reduce waste of unused single-use equipment.
Do not stockpile equipment that is unlikely to be used before its expiry	Remove the infection and litigation risk if equipment is used beyond its expiry date	Reduce waste of unused equipment. Purchase wisely from manufacturers. Ensure they are at least matching the commitment of the NHS to achieving Net Zero.
Keep safely stored and do not open single-use items until required for use	Mitigate the risk of contamination on sterile packaging rendering the item unusable.	Reduce waste from contaminated and unused equipment.
Items marked as ‘single patient use’ should be used as such unless risk assessed.	To mitigate against the infection and litigation risk if single patient items are reused	A risk assessment involving the IPC teams may allow some items in certain clinical scenarios to be reused.
Ensure all work surfaces are in good repair and of medical grade wipeable quality.	Reduce the risk of contaminated surfaces from poor repair or inadequate cleaning regimes.	Stop use of disposable surface coverings.
Ensure that privacy curtains are fit for their intended use.	Reduce the risk of cross contamination from poorly maintained curtain systems	Ensure that the curtain systems used have the smallest environmental impact.
Ensure that water used in endoscope irrigation and flushing devices is sterile or at least of the same quality as washer disinfector final rinse water.	Reduce the risk of microbial and viral contamination and biofilm build up.	Risk assess if changing from sterile water and ensure that water is tested weekly to check TVC and ensure free from coliform as a minimum. Ensure that all plastics are recycled.
PPE use should be reviewed and revised where possible using the principle of reduce, reuse and recycle. Ensuring that staff adhere to IPC precautions.	Ensure that the health and safety of staff and patients remains paramount at all times.	Reduce use of some PPE such as gloves. Move to reusable items where guidance and risk assessment allows. Recycle unused PPE items. Ensure adherence to IPC precautions to reduce staff sickness, cross contamination and bed days resulting from HCIs.

GIRFT, Getting it right first time ; HTM, Health Technical Memorandum ; IPC, infection prevention and control; NHS, National Health Service; PIVC, peripheral intravenous cannulation; PPE, personal protective equipment; TVC, total viable count.