Standard Infection Control Precautions: National Hand Hygiene and Personal Protective Equipment Policy V1.0 February 2020

Standard Infection Control Precautions:
National Hand Hygiene and Personal

Protective Equipment Policy
V1.0
February 2020
Summary
Hand Hygiene Personal Protective Equipment

(PPE)
All staff in a clinical area must be bare Risk assess the procedure and select
below the elbow appropriate PPE
Apply the WHO 5 moments of hand Put on and remove PPE correctly
hygiene to practice
Uniforms/clothing must be changed if

Use the Ayliffe technique for hand
contaminated during the shift
decontamination
Staff must report and seek advice if

they develop skin conditions
Standard IPAC Precautions: National Hand Hygiene and Personal Protective Equipment Policy V1.0
Page 2 of 24
Table of Contents
Summary ............................................................................................................................ 2
1. Introduction ................................................................................................................. 4
2. Purpose of this Policy/Procedure ............................................................................. 4
3. Scope ........................................................................................................................... 4
4. Definitions / Glossary ................................................................................................. 4
5. Ownership and Responsibilities ............................................................................... 5
5.1. NHS Improvement in collaboration with Health Protection Scotland ..................... 5
5.2. Organisations must: ............................................................................................... 5
5.3. Leaders of all services must ensure that staff:....................................................... 5
5.4. Staff providing care must: ...................................................................................... 5
5.5. Infection prevention and control teams and health protection teams must: ........... 6
6. Standards and Practice .............................................................................................. 6
7. Dissemination and Implementation ........................................................................ 10
8. Monitoring compliance and effectiveness ............................................................. 11
9. Updating and Review ............................................................................................... 11
10. Equality and Diversity .............................................................................................. 11
Appendix 1. Governance Information ............................................................................ 12
Appendix 2. Initial Equality Impact Assessment Form ................................................. 14
Appendix 3. How to hand wash (clinical areas): step by step images ........................ 17
Appendix 4. How to hand rub: step-by-step images..................................................... 18
Appendix 5. Surgical scrubbing – hand preparation using antimicrobial soap ......... 19
Appendix 6. Surgical Rubbing – hand preparation using alcohol-based handrub .... 20
Appendix 7. Glove use and selection............................................................................. 21
Appendix 8. Putting on and removing PPE ................................................................... 22
Appendix 9. Management of occupational exposure incidents ................................... 23
Appendix 10. How to Hand Wash in Non-Clinical Areas .............................................. 24
Page 3 of 24
1. Introduction
1.1. This standard infection control precautions (SICPs): national hand hygiene
and personal protective equipment (PPE) policy aims to:
 support a common understanding – making the right thing easy to do for every
patient,1 every time
 reduce variation in practice and standardise care processes
 improve how knowledge and skills are applied in infection prevention and
control
 help reduce the risk of healthcare-associated infection (HAI)
 help align practice, education, monitoring, quality improvement and scrutiny.
1.2. This version supersedes any previous versions of this document.
1.3. Data Protection Act 2018 (General Data Protection Regulation –

GDPR) Legislation
The Trust has a duty under the DPA18 to ensure that there is a valid legal basis
to process personal and sensitive data. The legal basis for processing must be
identified and documented before the processing begins. In many cases we may
need consent; this must be explicit, informed and documented. We can’t rely on
Opt out, it must be Opt in.
DPA18 is applicable to all staff; this includes those working as contractors and
providers of services.
For more information about your obligations under the DPA18 please see the
‘information use framework policy’, or contact the Information Governance Team
rch-tr.infogov@nhs.net
2. Purpose of this Policy/Procedure

2.1. To highlight the importance of adhering to hand hygiene and PPE
procedures in order to help reduce incidences of healthcare associated
infections.
2.2. To demonstrate that the Trust has a strong commitment to effective hand
hygiene and PPE.
3. Scope
This policy applies to all employees and contracted staff working at Royal
Cornwall Hospitals NHS Trust.
4. Definitions / Glossary
4.1. Hand hygiene – Removal or destruction of microorganisms on the hands.
Hand hygiene is an overarching term for hand washing with soap and water,
hand disinfection using alcohol hand rub and surgical hand washing using an
antiseptic detergent.
1
‘Person’ can be referred to instead of ‘patient’ when using this document in non-healthcare settings.
Page 4 of 24
4.2. Personal Protective Equipment - any equipment used to reduce the risk
of the wearer or patient from acquiring a health care associated infection.
5. Ownership and Responsibilities

Responsibilities for the content of this policy
5.1. NHS Improvement in collaboration with Health Protection
Scotland
 ensure the content of this policy remains evidence-based.
Responsibilities for adopting and implementing this policy

All registered providers must demonstrate compliance with the Health and Social Care
Act 2008: Code of practice on the prevention and control of infections and related
guidance. Specific criteria for hand hygiene are 2, 4, 9 and 10.
5.2. Organisations must:

 adopt and implement this policy in accordance with their local governance
processes
 have systems and resources to implement and monitor compliance with
infection prevention and control as specified in this policy in all care areas;
 compliance monitoring includes all staff (permanent, agency and, where
required, external contractors)
 ensure their culture promotes incident reporting, including near misses, while
focusing on improving systemic failures and encouraging safe working
practices.
5.3. Leaders of all services must ensure that staff:

 are aware of and have access to this policy
 have had instruction/education on infection prevention and control by attending
events and/or completing training
 have adequate support and resources to implement, monitor and take
corrective action to comply with this policy; if not, a risk assessment must be
undertaken and approved through local governance procedures
 with health concerns (including pregnancy) or who have had an occupational
exposure are referred promptly to the relevant agency, eg GP, occupational
health or accident and emergency
 have had the required health checks and clearance (including those
undertaking exposure prone procedures (EPPs)
 include infection prevention and control as an objective in their personal
development plans (or equivalent)
 refer to infection prevention and control in all job descriptions.
5.4. Staff providing care must:

 show their understanding by applying the infection prevention and control
principles in this policy
 maintain competence, skills and knowledge in infection prevention and control
by attending education events and/or completing training
Page 5 of 24
 communicate the infection prevention and control practices to be carried out by
colleagues, those being cared for, relatives and visitors, without breaching
confidentiality
 have up-to-date occupational immunisations, health checks and clearance
requirements as appropriate
 report to line managers and document any deficits in knowledge, resources,
equipment and facilities or incidents that may result in transmitting infection
including near misses, e.g. PPE failures
 not provide care while at risk of transmitting infectious agents to others; if in
doubt, they must consult their line manager, occupational health department,
infection prevention and control team (IPCT) or health protection team (HPT)
 contact their HPT/IPCT if there is a suspected or actual HAI incident/outbreak.
5.5. Infection prevention and control teams and health protection

teams must:
 engage with staff to develop systems and processes that lead to sustainable
and reliable improvements in applying infection prevention and control practices
 provide expert advice on applying infection prevention and control in all care
settings and on individual risk assessments, ensuring action is taken as
required
 have epidemiological/surveillance systems capable of distinguishing patient
case(s) requiring investigation and control.
Disclaimer
When an organisation – e.g. an NHS trust – uses products or adopts practices
that differ from those stated in this policy, it is responsible for ensuring safe
systems of work, including the completion of a risk assessment approved
through local governance procedures.
6. Standards and Practice

6.1. Standard infection control precautions
Standard infection control precautions (SICPs) are to be used by all staff, in all
care settings, at all times, for all patients whether infection is known to be
present or not, to ensure the safety of those being cared for, staff and visitors in
the care environment.
SICPs are the basic infection prevention and control measures necessary to
reduce the risk of transmitting infectious agents from both recognised and
unrecognised sources of infection. Sources of (potential) infection include blood
and other body fluids, secretions or excretions (excluding sweat), non-intact skin
or mucous membranes and any equipment or items in the care environment that
could have become contaminated.
The application of SICPs during care delivery is determined by assessing risk to

and from individuals. This includes the task, level of interaction and/or the
anticipated level of exposure to blood and/or other body fluids.
To protect effectively against infection risks, SICPs must be used consistently by

all staff. SICPs implementation monitoring must also be ongoing to ensure
Page 6 of 24
compliance with safe practices and to demonstrate ongoing commitment to
patient, staff and visitor safety.
There are 10 elements of SICPs:

 patient placement/assessment for infection risk
 hand hygiene
 respiratory and cough hygiene
 personal protective equipment (PPE)
 safe management of care equipment
 safe management of the care environment
 safe management of linen
 safe management of blood and body fluids
 safe disposal of waste (including sharps)
 occupational safety/managing prevention of exposure (including sharps).
This SICPs policy focuses on hand hygiene and PPE.
6.2. Hand hygiene

Hand hygiene is considered an important practice in reducing the transmission of
infectious agents that cause HAIs.
Sinks for washing hands must be used solely for that purpose and not for
disposing of liquids.
6.2.1. Before performing hand hygiene:

 expose forearms (bare below the elbow)
 remove all hand and wrist jewellery (a single, plain metal finger ring is
permitted but should be removed (or moved up) during hand hygiene
 ensure fingernails are clean and short, and do not wear artificial nails or nail
products
 cover all cuts or abrasions with a waterproof dressing.
6.2.2. To perform hand hygiene:

Alcohol-based hand rubs (ABHRs) must be available for staff as near to the
point of care as possible. Where this is not practical, personal ABHR dispensers
should be used.
Perform hand hygiene:

1. before touching a patient
2. before clean or aseptic procedures
3. after body fluid exposure risk
4. after touching a patient; and
5. after touching a patient’s immediate surroundings.
NB: perform hand hygiene before putting on and after removing gloves.
Wash hands with non-antimicrobial liquid soap and water if:

 hands are visibly soiled or dirty
 caring for patients with vomiting or diarrhoeal illnesses
Page 7 of 24
 caring for a patient with a suspected or known gastrointestinal infection,
e.g. norovirus or a spore-forming organism such as Clostridium difficile.
In all other circumstances, use ABHRs for routine hand hygiene during care.
Where running water is unavailable, or hand hygiene facilities are lacking, staff
may use hand wipes followed by ABHR and should wash their hands at the first
opportunity.
For how to wash hands, see Appendix 1
For how to hand rub, see Appendix 2
6.2.3. Skin care

 Dry hands thoroughly after hand washing, using disposable paper towels.
 Use an emollient hand cream during work and when off duty.
 Do not use or provide communal tubs of hand cream in the care setting.
 Staff with skin problems should seek advice from occupational health.
6.2.4. Surgical hand antisepsis

Surgical scrubbing/rubbing (this applies to those undertaking surgical and some
invasive procedures):
 Perform surgical scrubbing/rubbing before donning sterile theatre garments
or at other times, e.g. before inserting central vascular access devices.
 Remove all hand and wrist jewellery.
 Single-use nail brushes must only be used for decontaminating nails. Nail
picks can be used if nails are visibly dirty.
 Use an antimicrobial liquid soap licensed for surgical scrubbing or an ABHR
licensed for surgical rubbing (as specified on the product label).
 ABHR can be used between surgical procedures if licensed for this use.
Follow the technique in Appendix 3 for surgical scrubbing.
Follow the technique in Appendix 4 for surgical rubbing.
6.3. Personal protective equipment

Further information can be found in the Personal Protective Equipment Policy
(HSP 16).
Before undertaking any procedure, staff should assess any likely exposure to
blood and/or other body fluids, non-intact skin or mucous membranes and wear
personal protective equipment (PPE) that protects adequately against the risks
associated with the procedure.
6.3.1. All PPE should be:

 located close to the point of use
 stored to prevent contamination in a clean, dry area until required for use
(expiry dates must be kept to)
 single-use only items unless specified by the manufacturer
Page 8 of 24
 changed immediately after each patient and/or after completing a procedure
or task
 disposed of after use into the correct waste stream, ie healthcare waste or
domestic waste.
 Reusable PPE items – e.g. non-disposable goggles, face shields, visors –
must be decontaminated after each use.
6.3.2. Gloves must be:

 worn when exposure to blood and/or other body fluids, non-intact skin or
mucous membranes is anticipated or likely
 changed immediately after each patient and/or after completing a procedure
or task
 changed if a perforation or puncture is suspected
 appropriate for use, fit for purpose and well-fitting.
Double gloving is recommended during some exposure prone procedures, e.g.

orthopaedic and gynaecological operations or when attending major trauma
incidents.
For appropriate glove use and selection, see flowchart at Appendix 7.
6.3.3. Aprons must be:

 worn to protect uniform or clothes when contamination is anticipated or
likely, e.g. when in direct care contact with a patient
 changed between patients and/or after completing a procedure or task.
6.3.4. Full body gowns and fluid-repellent coveralls must be:

 worn when there is a risk of extensive splashing of blood and/or other body
fluids, e.g. in the operating theatre
 worn when a disposable apron provides inadequate cover for the procedure
or task being performed
 changed between patients and immediately after completing a procedure or
task.
6.3.5. Eye and face protection (including full-face visors) must:

 be worn if blood and/or body fluid contamination to the eyes or face is
anticipated or likely – e.g. by members of the surgical theatre team – and
always during aerosol generating procedures; regular corrective spectacles
are not considered eye protection
 not be impeded by accessories such as piercings or false eyelashes
 not be touched when being worn.
Further information can be found in the eye/face protection literature review.
6.3.6. Fluid-resistant surgical face masks must be:

 worn with eye protection if splashing or spraying of blood, body fluids,
secretions or excretions onto the respiratory mucosa (nose and mouth) is
anticipated or likely
Page 9 of 24
 worn to protect patients from the operator as a source of infection, eg when
performing surgical procedures or epidurals or inserting a central vascular
catheter (CVC)
 well-fitting and fit for purpose, fully covering the mouth and nose
(manufacturers’ instructions must be followed to ensure effective fit and
protection)
 removed or changed:
o at the end of a procedure/task
o if the mask’s integrity is breached, e.g. from moisture build-up after
extended use or from gross contamination with blood or body fluids
o in accordance with manufacturers’ specific instructions.
6.3.7. Footwear must be:

 visibly clean, non-slip and well-maintained, and support and cover the entire
foot to avoid contamination with blood or other body fluids or potential injury
from sharps
 removed before leaving a care area where dedicated footwear is used, e.g.
theatre; these areas must have a decontamination schedule with
responsibility assigned.
6.3.8. Headwear must be:

 worn in theatre settings and clean rooms, eg central decontamination unit
 well-fitting and completely cover the hair
 changed or disposed of between clinical procedures or tasks or if
contaminated with blood and/or body fluids
 removed before leaving the theatre or clean room.
For the recommended method of putting on and removing PPE, see this guide.
7. Dissemination and Implementation

This policy will be implemented via the following routes:
 Information regarding the policy will be included in the Infection Prevention and Control
newsletter.
 The policy will be included in the Trust’s Document Library
 The policy will be circulated to all Link Practitioners, Ward Leaders, Departmental
leads, Matrons, Clinical Directors and Medical Staff.
Page 10 of 24
8. Monitoring compliance and effectiveness
Element to be Compliance with the 5 moments of hand hygiene and PPE
monitored usage
Lead Louise Dickinson, Consultant Nurse/DIPC
Tool Hand Hygiene audit tool

PPE audit tool
Frequency Hand Hygiene -This will be monitored in each ward area monthly.
PPE usage – This will be monitored by the Infection Prevention and
Control team in a spot check of practice six monthly
Reporting Progress on the actions identified in the audits will be monitored via
arrangements the Infection Prevention and Control Committee via the Care Group
Report. This will be recorded in the minutes of the committee
meeting.
Acting on The Infection Prevention and Control Team will make initial
recommendations recommendations at the time of audits. If following the Care Group
and Lead(s) response to the audit at the HICC, it is deemed necessary to make
further recommendations; the Committee will be responsible for
this and will determine the specified time scale.
Change in Required changes to practice will be identified and actioned within

practice and a month. A lead member of the Care Group team will be identified
lessons to be to take each change forward where appropriate. Lessons will be
shared shared with all the relevant stakeholders
9. Updating and Review

This policy will be reviewed within 3 years.
10. Equality and Diversity

10.1.This document complies with the Royal Cornwall Hospitals NHS Trust
service Equality and Diversity statement which can be found in the 'Equality,
Inclusion & Human Rights Policy' or the Equality and Diversity website.
10.2. The Initial Equality Impact Assessment Screening Form is at Appendix 2.
Page 11 of 24
Appendix 1. Governance Information
Standard IPAC Precautions: National Hand Hygiene
Document Title
and Personal Protective Equipment Policy V1.0
Date Issued/Approved: 10 February 2020
Date Valid From: February 2020
Date Valid To: February 2023
Directorate / Department
Jean James, IPAC Lead Nurse
responsible (author/owner):
Contact details: 01872 254969

Policy procedures and guidance for standard
infection control precautions (SICPs): hand hygiene
Brief summary of contents
and assessment, provision use and management of
personal protective equipment.
Hand Hygiene
Suggested Keywords: Personal Protective Equipment
Gloves
RCHT CFT KCCG
Target Audience

Executive Director responsible
Director of Nursing
for Policy:
Date revised: January 2020
This document replaces (exact
New Document
title of previous version):
Approval route (names of
Hospital Infection Control Committee
committees)/consultation:
Care Group General Manager Louise Dickinson, Consultant Nurse/Joint DIPC

confirming approval processes
Name and Post Title of additional
Not Required
signatories
Name and Signature of Care
Group/Directorate Governance {Original Copy Signed}
Lead confirming approval by
specialty and care group Name: Claire Martin
management meetings
Signature of Executive Director
{Original Copy Signed}
giving approval
Publication Location (refer to
Policy on Policies – Approvals Internet & Intranet  Intranet Only
and Ratification):
Document Library Folder/Sub
Clinical / Infection Prevention & Control
Folder
Page 12 of 24
Regulation 12
Health and Safety at Work etc. Act 1974
Links to key external standards Personal Protective Equipment Regulations 1992
Control of Substances Hazardous to Health
Regulations 2002
Personal Protective Equipment Policy

(HSP 16).
H&S Policy
Risk Assessment Policy
Royal Cornwall Hospital NHS Trust ( 2016)Glove Use
Policy
Department of Health (2015) The Health and
Social Care Act 2008. Code of Practice on the
Prevention and Control of Infections and related
Related Documents: guidance
Epic 3 (2014) National Evidenced based

guidelines for preventing healthcare associated
infections in NHS hospitals in England.
NICE (2014) Prevention and Control of

Healthcare Associated Infections – quality
improvement guide.
Training Need Identified? No
Version Control Table
Version Changes Made by

Date Summary of Changes
No (Name and Job Title)
Jean James, IPAC

01.10.19 V1.0 Initial version
Lead Nurse
All or part of this document can be released under the Freedom of Information
Act 2000
This document is to be retained for 10 years from the date of expiry.

This document is only valid on the day of printing
Controlled Document
This document has been created following the Royal Cornwall Hospitals NHS Trust
Policy for the Development and Management of Knowledge, Procedural and Web
Documents (The Policy on Policies). It should not be altered in any way without the
express permission of the author or their Line Manager.
Page 13 of 24
Appendix 2. Initial Equality Impact Assessment Form
Name of the strategy / policy /proposal / service function to be assessed
Standard IPAC Precautions: National Hand Hygiene and Personal Protective Equipment Policy
V1.0
Directorate and service area: New or existing document:
Corporate New
Name of individual completing assessment: Telephone:
Jean James 01872 254969
1. Policy Aim*
Who is the strategy / To protect staff and patients from cross infection.
policy / proposal /
service function aimed
at?
This policy provides guidance to ensure that staff
a) are aware of when and how to decontaminate their hands effectively
and how to use PPE correctly
2. Policy Objectives*
b) can assess any likely exposure to blood and/or other body fluids,
non-intact skin or mucous membranes and wear personal protective
equipment (PPE) that protects adequately against the risks
associated with the procedure.
3. Policy – intended
Outcomes* Prevention of Cross infection
4. *How will you Hand Hygiene -This will be monitored in each ward area monthly.
PPE usage – This will be monitored by the Infection Prevention and Control
measure the team in a spot check of practice six monthly
outcome?
5. Who is intended to
benefit from the Patients and Staff
policy?
Local External
6a Who did you Workforce Patients Other
groups organisations
consult with
√
b). Please identify the Please record specific names of groups

groups who have Hospital Infection Control Committee
been consulted about Infection Prevention and Control Steering Group
this procedure.
Page 14 of 24
What was the
outcome of the Policy approval
consultation?
7. The Impact
Please complete the following table. If you are unsure/don’t know if there is a negative
impact you need to repeat the consultation step.
Are there concerns that the policy could have differential impact on:
Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence
Age √
Sex (male, √
female, trans-gender /
gender reassignment)
Race / Ethnic √
communities
/groups
Disability - √
Learning disability,
physical
impairment, sensory
impairment, mental
health conditions and
some long term health
conditions.
Religion / √
other beliefs
Marriage and √
Civil partnership
Pregnancy and √
maternity
Sexual √
Orientation,
Bisexual, Gay,
heterosexual, Lesbian
You will need to continue to a full Equality Impact Assessment if the following have
been highlighted:
 You have ticked “Yes” in any column above and
 No consultation or evidence of there being consultation- this excludes any policies which have
been identified as not requiring consultation. or
 Major this relates to service redesign or development
Page 15 of 24
8. Please indicate if a full equality analysis is recommended. Yes No √
9. If you are not recommending a Full Impact assessment please explain why.
Not indicated
Members approving
Date of completion Policy Review Group (PRG)
screening assessment
and submission 03.12.19
‘APPROVED’
This EIA will not be uploaded to the Trust website without the approval of the Policy
Review Group.
A summary of the results will be published on the Trust’s web site.
The following Appendices from 3 – 10 have received copyright permission from Linda
Dempster, Head of Infection Control NHS England and NHS Improvement on 16.01.20
Page 16 of 24
Appendix 3. How to hand wash (clinical areas): step by step
images
Page 17 of 24
Appendix 4. How to hand rub: step-by-step images
Page 18 of 24
Appendix 5. Surgical scrubbing – hand preparation using
antimicrobial soap
Page 19 of 24
Appendix 6. Surgical Rubbing – hand preparation using
alcohol-based handrub
Page 20 of 24
Appendix 7. Glove use and selection
Page 21 of 24
Appendix 8. Putting on and removing PPE
Page 22 of 24
Appendix 9. Management of occupational exposure incidents
Page 23 of 24
Appendix 10. How to Hand Wash in Non-Clinical Areas
Page 24 of 24

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Standard Infection Control Precautions:

National Hand Hygiene and Personal

Hand Hygiene Personal Protective Equipment

Uniforms/clothing must be changed if

Staff must report and seek advice if

1.2. This version supersedes any previous versions of this document.

1.3. Data Protection Act 2018 (General Data Protection Regulation –

2. Purpose of this Policy/Procedure

5. Ownership and Responsibilities

Responsibilities for adopting and implementing this policy

5.2. Organisations must:

5.3. Leaders of all services must ensure that staff:

5.4. Staff providing care must:

5.5. Infection prevention and control teams and health protection

6. Standards and Practice

The application of SICPs during care delivery is determined by assessing risk to

To protect effectively against infection risks, SICPs must be used consistently by

There are 10 elements of SICPs:

This SICPs policy focuses on hand hygiene and PPE.

6.2. Hand hygiene

6.2.1. Before performing hand hygiene:

6.2.2. To perform hand hygiene:

Perform hand hygiene:

Wash hands with non-antimicrobial liquid soap and water if:

For how to wash hands, see Appendix 1

For how to hand rub, see Appendix 2

6.2.3. Skin care

6.2.4. Surgical hand antisepsis

Follow the technique in Appendix 3 for surgical scrubbing.

Follow the technique in Appendix 4 for surgical rubbing.

6.3. Personal protective equipment

6.3.1. All PPE should be:

6.3.2. Gloves must be:

Double gloving is recommended during some exposure prone procedures, e.g.

For appropriate glove use and selection, see flowchart at Appendix 7.

6.3.3. Aprons must be:

6.3.4. Full body gowns and fluid-repellent coveralls must be:

6.3.5. Eye and face protection (including full-face visors) must:

Further information can be found in the eye/face protection literature review.

6.3.6. Fluid-resistant surgical face masks must be:

6.3.7. Footwear must be:

6.3.8. Headwear must be:

7. Dissemination and Implementation

Tool Hand Hygiene audit tool

Change in Required changes to practice will be identified and actioned within

9. Updating and Review

10. Equality and Diversity

10.2. The Initial Equality Impact Assessment Screening Form is at Appendix 2.

Date Issued/Approved: 10 February 2020

Date Valid From: February 2020

Date Valid To: February 2023

Contact details: 01872 254969

Care Group General Manager Louise Dickinson, Consultant Nurse/Joint DIPC

Personal Protective Equipment Policy

Epic 3 (2014) National Evidenced based

NICE (2014) Prevention and Control of

Training Need Identified? No

Version Control Table

Version Changes Made by

Jean James, IPAC

This document is to be retained for 10 years from the date of expiry.

b). Please identify the Please record specific names of groups

 Major this relates to service redesign or development