Purpose
This annual statement is published each year in December in accordance with the requirements of The Health and Social Care Act 2008, Code of Practice on the prevention and control of infections and related guidance. This will summarise:
- Any infection transmission incidents and any action taken (these will have been reported in accordance with our significant event procedure)
- Details of any infection control audits and actions undertaken
- Details of any risk assessments undertaken for prevention and control of infection
- Details of staff training
- Any review and update of policies, procedures and guidelines
Infection Prevention and Control (IPC) Lead
Infection Prevention and Control is the responsibility of all staff at Oaks Healthcare.
Oaks Healthcare’s Infection Prevention and Control (IPC) lead is practice nurse Chloë Johnson, who is supported by both the practice management and clinical teams.
Chloë originally completed her infection prevention and control training in 2020 and continues to maintain her knowledge through attendance of Hampshire and Isle of Wight Integrated Care Board (HIOW ICB) IPC webinars, forums and online module courses.
Infection Transmission Incidents
Infection transmission incidents are investigated in detail to understand what can be learnt and changes that can be implemented that will lead to future improvements. All practice incidents are reviewed weekly by the practice management team and the outcome of these reviews are shared at monthly governance meetings where learning is cascaded to all relevant staff.
In the past 12 months there have been three incidents relating to IPC standards. These incidents are outlined below with the learning points and prevention of reoccurrence:
- Immunisations have been administered past the expiry date. The manufacturers were contacted, and re-administration of immunisation occurred within 48 hours. This event was reported via the practice’s incident reporting process, reviewed by the practice management team and cascaded to all members of the clinical team in attendance for the December 2024 governance meeting. Slides are available for all staff members at Oaks Healthcare.
- There have been two separate incidents of overfilled sharp waste containers in the past 12 months. These were reported to the IPC lead who delivered feedback and additional training to newer clinicians that were involved.
Infection Prevention Audit and Actions
The annual Infection Prevention and Control audit was completed by Chloë Johnson in April 2025.
As a result of the audit, the following things have been changed in Oaks Healthcare:
- All damaged chairs or non-wipeable chairs have been replaced in all clinical rooms.
- Phlebotomy protocols have been updated to reflect appropriate skin preparation prior to venepuncture.
- New stock check and stock rotation processes have been introduced monthly.
- Uniform has been updated and any clinician performing procedures will be in the appropriate uniform.
- All urinalysis has been moved to an appropriate and dedicated sluice room within the surgery.
In the coming 12 months Oaks Healthcare intends to:
- Improve general condition of the building including flooring repairs in clinical areas
An audit on minor surgery was undertaken by Chloe Johnson in February 2025.
The title of minor surgery pertains to the introduction, replacement or removal of intrauterine contraceptive devices.
Oaks Healthcare has re-introduced minor surgery of intrauterine contraceptive devices in the last 12 months. These clinics are in a dedicated treatment room using aseptic technique and single use equipment by appropriately trained clinicians.
No infections were reported for patients who had had minor surgery at Oaks Healthcare
As a result of the audit, the practice has changed the uniform requirements for these clinics and the clinicians working within; these clinics will adhere to Oaks Healthcare uniform policy.
A handwashing audit has been undertaken across the space of 3 months in which all clinicians audited performed an excellent knowledge of the importance, frequency and method of handwashing. Handwashing audits are conducted throughout the year at different intervals which will continue for the foreseeable future.
Oaks Healthcare plans to undertake the following audits in 2025/26:
- Minor Surgery outcomes audit
- Monthly domestic audit in connection with cleaning contractors
- Hand hygiene audit
- Annual IPC audit
- Clinical waste audit
Oaks Healthcare plan to undertake the following weekly audits:
- Sharp waste disposal
- Stock monitoring and rotation
- Emergency equipment, including oxygen cylinder visual checks
Risk Assessments
Risk assessments are carried out so that best practice can be established and then followed. In the last year the following risk assessments were carried out/reviewed:
Legionella (Water) risk assessment: The practice has conducted/reviewed its water safety risk assessment to ensure that the water supply does not pose a risk to patients, visitors or staff.
Immunisation: As a practice we ensure that all our staff are up to date with their Hepatitis B immunisations and offer any occupational health vaccinations applicable to their role (i.e. MMR, Seasonal Flu). We take part in the National Immunisation campaigns for patients and offer vaccinations in house and via home visits to our patient population.
Curtains: The NHS Cleaning Specifications state the curtains should be cleaned, or if using disposable curtains, replaced every 6 months. To this effect we use disposable curtains and ensure they are changed every 6 months.
The window blinds are very low risk and therefore do not require a particular cleaning regime other than regular vacuuming to prevent build-up of dust. The modesty curtains, although handled by clinicians, are never handled by patients and clinicians have been reminded to always remove gloves and clean hands after an examination before touching the curtains. All curtains are regularly reviewed and changed if visibly soiled. All window blinds were replaced in 2024.
Toys: Please refer to cleaning protocol for toys kept in practice.
Training
All our staff receive annual training in IPC.
This may be via electronic learning platforms for example: eLearning for Health or Clarity TeamNet.
Handwashing observation has been changed to face-to-face supervision for all clinical staff performed by Chloe Johnson, Oaks Healthcare IPC lead.
Handwashing supervision for the IPC lead will be undertaken by another appropriately trained clinician.
Policies
All IPC related policies are in date for this year.
Policies relating to IPC are available to all staff and are reviewed and updated annually and all are amended on an on-going basis as current advice, guidance and legislation changes. IPC policies are circulated amongst staff for reading and discussed at meetings on an annual basis.
Responsibility
It is the responsibility of each individual to be familiar with this statement and their roles and responsibilities under this. IPC is the responsibility of all staff employed by, or working with Oaks Healthcare, including visitors to the building i.e. meeting attendants, visiting locum clinicians and medical/nursing students.
Review date
25/04/2026
Responsibility for Review
The IPC Lead, the management team and the GP Partners are responsible for reviewing and producing the Annual Statement.
Chloe Johnson
For and on behalf of the Oaks Healthcare