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​It’s Only A Little Tear…Will the CQC Inspectors Even Notice?

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It has become apparent that GP practices all over the country are struggling with what they need to focus on next, when improving infection control within the practice. With the mounting costs of ‘wipe clean’ chairs, new couches to replace damaged ones and a variety of other ‘next on the list’ bits of furniture and disposable curtains, it is not surprising that GP practices are not sure where to focus next.

From our experience, we have found that recognising areas that need tackling is the first hurdle, followed by making a plan and a corresponding timeframe, before raising funding and actually carrying out the purchase of new furniture. This quick three-step risk assessment will assist in prioritising which furniture needs to be replaced and how quickly potential issues need to be resolved.

It is very common to think that if an issue is ignored, it might not be noticed or may not be an issue. From reading past CQC reports, we have realised that this is not necessarily the case. In fact, noticing issues and putting a plan to rectify them seems to be a positive thing. “We found examination couches in two consulting rooms were damaged with small splits in the impermeable fabric. This presented a lowrisk of cross infection. The practice had not recorded that the examination couches were damaged. There was no plan to repair them.


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NOTE: There is one thing to watch out for when delegating. If you do make an action plan, update a procedure or document an issue, make sure this is followed up on, carried out and most importantly logged. “We saw quality checklists showing the practice manager had reported that blinds required cleaning in two consecutive months. However,we found the venetian blinds in two consulting rooms were not clean.” “The practice manager and GP we spoke with told us the training had taken place. There were no records confirming this. Patients were at low risk of contracting an infection due to poor hand hygiene because there was no evidence to confirm staff were trained in good hand hygiene.

Follow up visits are made to check what progress has been made. Effective action is noted as a positive change for your practice. “Actions arising from an infection control audit had been completed with the exception of replacement or repair of damaged furniture. We saw a plaster couch with a tear, a treatment couch with a small hole and several chairs in waiting areas that were damaged. This put people at risk of cross infection. After our inspection, the manager sent us written confirmation that they had ordered replacement parts for the couches and removed the furniture from use until it was repaired.

It isn’t something that will on its own ‘put you in the red’, however the small, almost ridiculous, things are often what gets logged.

We found some areas where improvements could be made. For example, we saw that the surface to one of the examination couches had a slight tear. Having such a tear means germs and dirt can get inside the couch and make it difficult to carry out a full clean. A small number of surfaces appeared a little dirty, and the frames to some of the examination couches were a little dusty. We spoke with staff about who was responsible for cleaning the couch frames and there appeared to be a potential for them being missed as some cleaners might consider them as being part of the clinical area and therefore outside their remit. In the disabled toilets, we found there was no sanitary bin but when we pointed this out to staff it was immediately rectified. One metal surface in a clinic room had some old cellotape stuck to its surface which could catch both dirt and germs, and make it harder to carry out a full clean.

The positive remedial actions give a much nicer read. “During our observations of the environment, we saw that the previously damaged couch in the nurse treatment room had been replaced. The new one appeared clean and in a good state of repair. We saw that a previously damaged curtain rail in the same room had been repaired and the adhesive tape holding it together removed. We checked four privacy curtains and saw they were all dated and within their required date of disposal.

Please note all quotes have been taken from actual reports, which have been chosen purely for education and do not reflect the full report for each practice.

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