Infection Prevention & Control

Key Principles and Guidance

The key principles of IPC

  • Good hand hygiene – singularly the most effective way to prevent COVID-19.
  • Clean environment and equipment – communal areas should be clean regularly to avoid the spread of any infection.
  • Self-isolation – ensure symptomatic patients are self-isolated and a care routine is in place to reduce risks of cross infection.
  • Changing into uniform – recommended that you change into your work clothes when you arrive and change back at the end of your shift to reduce the risk of the virus being taken out of the home. Place your clothes in a bag and tie the bag, putting in the wash immediately. Ironing or tumble drying will kill the virus.
  • Good personal hygiene – important to ensure good resistance to the virus.
  • PPE – use correct and appropriate PPE through the care settings.
  • Distance – follow social distancing measures as much as possible

 

Guidance

Useful resources relating to guidance:

HCPA IPC Care Manager Responsibilities poster Click here
HCPA COVID-19 True or false myth-busting poster Click here
HCPA ‘Face Masks to be worn’ poster Click here
The Responsibility is in our hands HCPA hand hygiene poster Click here
 #WearItRight HCPA poster for mask-wearing Click here
HCC – movement across care settings Click here
HCC – Advice on car sharing Click here
HCC – Outbreak action checklist Click here

 

Care Home Admissions – updated Sept 2022

Hertfordshire’s latest guidance on admissions to care homes from different locations – Checks, isolation, and testing (updated September 2022)

Click here to view the guidance

Webinars

Infection prevention and control webinar – Monday 11th July 2022

This webinar provides an update on the latest IPC guidance which includes the new IPC Champion course.

Please note this guidance was correct as of the date the webinar was published. 

Click here to view the webinar recording
Click here to download the webinar slides

Upcoming Training

Upcoming training for Residential and Nursing services

Venue Key:

  • HCPA – Face to face at Mundells Campus in Welwyn Garden City
  • Virtual – Delivered via Zoom
  • Mixed – Part delivered at HCPA, the remainder via Zoom
  • Hybrid – Your choice! Either attend at HCPA, or join via Zoom in our new hybrid training room!

Upcoming training for Support at Home services

Venue Key:

  • HCPA – Face to face at Mundells Campus in Welwyn Garden City
  • Virtual – Delivered via Zoom
  • Mixed – Part delivered at HCPA, the remainder via Zoom
  • Hybrid – Your choice! Either attend at HCPA, or join via Zoom in our new hybrid training room!

Upcoming training for Adult Disability and Mental Health services

Venue Key:

  • HCPA – Face to face at Mundells Campus in Welwyn Garden City
  • Virtual – Delivered via Zoom
  • Mixed – Part delivered at HCPA, the remainder via Zoom
  • Hybrid – Your choice! Either attend at HCPA, or join via Zoom in our new hybrid training room!

Manager Responsibilities

Liability

If your service is not following national IPC guidance this could mean that you are potentially breaking your insurance cover terms

Implementing Infection prevention and control (IPC) guidance is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone.

Not following national IPC guidance indicates that your service may not be following the Health and Safety Act;  The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (H&SCA 2008) and therefore potentially breaking your insurance cover terms, as well as opening yourself up to other areas of liability as the H&SCA 2008 and regulations are law and must be complied with.

Here are the areas you will need to prove compliance of following the guidance:

Safeguarding Not wearing a mask could be raised as a safeguarding concern, as the individuals in your care are being put at higher risk due to the care delivery. There are no exemptions for face masks in care settings and fabric/cloth face coverings, eye protection alone or visors are NOT a replacement. When wearing a face mask ensure it is worn correctly covering both the mouth and nose. As a manger you need to make sure you are observing practice and addressing improper practice promptly.
Health and Safety Act Not following correct PPE and IPC guidance will go against the Health and Safety at Work Act (1974) which states the duties employers have towards employees and members of the public as well as those that employees have to themselves and each other. There is no requirement under RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) to report incidents of disease or deaths of members of the public, patients, care home residents or service users from COVID-19.The reporting requirements relating to cases of, or deaths from, COVID-19 under RIDDOR apply only to occupational exposure, that is, as a result of a person’s work.

You should only make a report under RIDDOR when one of the following circumstances applies:
– A person at work (a worker) has been diagnosed as having COVID-19 attributed to an occupational exposure to coronavirus. This must be reported as a case of disease.
– A worker dies as a result of occupational exposure to coronavirus. This must be reported as a work-related death due to exposure to a biological agent.

Insurance The care provider will be opening themselves up to breach of insurance or future liability issues if another staff member or service user contracts COVID-19 following a work exposure and having been in contact with the individual who is not wearing the correct PPE at the right time.
Regulation and Monitoring  Many providers will be regulated by CQC and undergo local monitoring by commissioners whereby you are asked to provide evidence of compliance in IPC practices, including staff competencies and auditing. Those providers unable to provide necessary evidence could affect the registration requirements of the service which could potentially impact on performance ratings and lead to improvement notices.

 

What can you do? Ensure your service is following all the correct guidance and that your service following all governance and auditing processes to prove correct practice.

Auditing Practice

Auditing enables your service to understand where there could be gaps and identify additional training and support staff may need. It ensures high quality care that is safe and effective is given as well as showing that your service is responsive and proactive in the management of IPC/PPE. By identifying areas/practices that are found to be not adhering to current guidance your service could prevent a potential outbreak.

Regular audits to monitor adherence to IPC and PPE should include:

  • Appropriate selection
  • Donning
  • Doffing
  • Hand hygiene
  • Environmental contamination
  • Evaluation of appropriate supplies and equipment
  • Proximity of supplies to point of use

Aggregate data can be provided to identify opportunities for improvement.

Click here for the PPE donning and doffing audit tool

Hand Hygiene Audit Tool

This audit tool can be used as a rolling programme of audit of compliance with your Hand hygiene Policy. Please ensure that all staff should are assessed for hand hygiene technique on at least an annual basis, suggest to complete 25% of staff monthly.

» Click here to download

Hand Hygiene

Hand Hygiene Technique

Hand hygiene is vital in stopping the transmission of Covid-19 and other micro-organisms.

Key points with hand hygiene

  • The entire set of actions should not take less than 20 seconds.
  • ‘Bare Below Elbows’.
  • Long sleeves, if worn, should be rolled or pushed up to the elbows.
  • Finger nails should be short and clean, no nail varnish/gels, false acrylic nails, nail extensions or nail jewellery
  • Watches, stoned rings, fit bits/bracelets should be removed

» Click here for a video on how to wash hands

 

Remember your 5 moments for Hand Hygiene

 

1) Before resident contact When? Wash hands before touching a resident when approaching him/her.
Why? To protect resident against harmful germs.
2) Before a clean/Aseptic procedure When? Wash hands immediately before any clean/aseptic procedures.
Why? Protects resident against harmful germs including resident’s own, from entering the body.
3) After bodily fluid exposure risk When? Wash hands immediately after exposure risk to bodily fluids (and after glove removal).
Why? Protects yourself and environment from harmful germs.
4) After resident contact When? Wash hands after touching a resident and their immediate surroundings, when leaving their side.
Why? To protect yourself and environment from harmful germs.
5) After contact with resident surroundings When? Wash hands after touching objects/furniture in residents immediate surroundings on leaving – even without touching the resident.
Why? Protects yourself and the environment from harmful germs.

 

 

Using Alcohol Hand Gel

  • Hand gel is useful when in a hurry.
  • Hand gel should not be used on soiled hands.
  • When using hand gel, the same movements need to be followed as with hand washing.
  • The duration needs to be 20-30 seconds.
  • Handwashing with good technique is just as good as using hand gel – you do not need to do both

PPE

For all the latest guidance on IPC and PPE click here​

 PPE Best Practice

FAQs:
• Face masks should be worn by all care workers and encouraged for visitors in care settings and when providing care in peoples own homes, irrespective of whether the person being cared for is known or suspected to have COVID-19.
• The type of mask recommended depends on the type of activity being undertaken and whether the person is known or suspected to have COVID-19 or not.
• For staff sharing offices (no client contact) masks should still be worn.
• For Day Opportunity services -While indoors please wear a Type I,II or IIR mask. While outdoors no mask is required when supporting someone (who is not suspected , symptomatic or confirmed COVID-19 ).

Activity Face Mask? Eye Protection? Gloves? Apron?
Social contact with clients, staff, visitors not known or suspected to have COVID-19 Yes – Type I, II or IIR

Sessional use- mask can be worn maximum of 4 hours

No No No
Care or domestic task involving likely contact with blood or body fluids ( personal care, handling soiled laundry emptying a catheter or commode)

For a person not known or suspected to have COVID-19

Yes – Type I, II or IIR

*Type IIR if splashing likely

Sessional use – can be worn maximum 4 hours

Face mask should be changed if become contaminated or soiled

Risk assess if splashing likely Yes

Yes

Other tasks not involving contact with blood or body fluids such as handling clean linen, tidying, giving medication, writing in care notes

For a person not known or suspected to have COVID-19

Yes – Type I, II or Type IIR

Sessional use – can be worn maximum 4 hours

No No

No

General cleaning with hazardous products (disinfectants or detergents) Yes – Type I, II or IIR

*Type IIR if splashing likely

Sessional use worn maximum 4 hours

Risk assess if splashing likely Risk assess Risk assess
Undertaking an AGP on a person who is not suspected or confirmed to have COVID-19 or another infection spread by the airborne or droplet route Yes – Type IIR Yes Yes Yes (consider a gown if risk of extensive splashing)
Supporting a person outdoors

Who is not symptomatic, suspected or confirmed COVID-19

No No No No
Providing personal care to a person who is symptomatic, suspected or confirmed COVID-19
Personal care includes but not limited to assistance with washing and dressing, toileting, eating and drinking shaving, oral hygiene , catheter care , positioning in bed, applying topical creams/medications
Yes – Type IIR Remove after leaving the area and replace with a new Type I, II or type IIR mask

Yes

Single use or reusable

If reusable clean and disinfect as per manufacturer instructions between use

Yes

Yes

General cleaning duties in the room where a person with suspected / confirmed COVID-19 is being isolated or cohorted (even if more than 2 metres away) Yes – Type IIR

(Remove on leaving the area and replace with a new Type I, II or Type IIR mask

Yes Yes

Yes

Undertaking an AGP on a person who is suspected or confirmed to have COVID-19 or another infection spread by the airborne or droplet route Yes – FFP3

(Remove mask outside the room and replace with a Type I, II or Type IIR depending on what is appropriate for the next task)

Yes – goggles or a visor to be worn

(If FFP3 mask is not fluid repellent a full face visor to be worn)

Yes

Yes (consider a gown if risk of extensive splashing)

 

For tasks other than those above when within 2 metres of a person with suspected or confirmed COVID-19 Yes – Type IIR

(Remove on leaving the area and replace with a new Type I, II or type IIR mask)

Yes Risk assess (if contact with blood or body fluids likely) Risk assess (if contact with blood or body fluids likely)

 

Click here for the letter from HCC regarding IPC including PPE

References

COVID-19 supplement to the infection prevention and control resource for adult social care – GOV.UK (www.gov.uk)
Infection prevention and control in adult social care settings – GOV.UK (www.gov.uk)

Isolation precautions

Closing doors

  • If you have a known Covid 19 positive patient you must consider the risk to other residents and staff members
  • Doors to residents rooms must be shut at all times to reduce the risk of environmental contamination
  • A risk assessment for the closure of the door should be undertaken and steps taken to mitigate the risks
  • Staff need to sure that they decontaminate and take in all items required when they enter the room. Decontamination of items that are not single use only must be undertaken before leaving the resident’s room using the correct cleaning solutions and technique
  • If a resident requires 2 members of staff to undertake care ensure you attend together.

Cleaning

Cleaning Guidance for COVID-19 in care home and supported living

Cleaning is an essential step in protecting staff and residents from infection

COVID-19 infection is transmitted by respiratory droplets that are created by coughing and sneezing.  These droplets can travel in the air for about 2 meters and then fall onto surfaces. Coronavirus can transfer from people to surfaces where it can be passed on to others who may touch them. The virus can survive on surfaces including the skin for many days and be picked up by touching these surfaces and then touching the eyes, mouth or nose.

Regular enhanced cleaning and frequent handwashing limits the potential for coronavirus to spread and is a critical part of making and keeping services safe.

It is important to continually review your products and processes, as guidance may change, and ensure all staff are aware of any changes.

» Read more about key points for cleaning for COVID-19 and cleaning laundry

Useful resources relating to COVID-19 and cleaning:

Care home and supported living COVID-19 cleaning guide Click here

 

Portable fans

HCC have provided guidance on the use of portable fans in health and social care settings.

Click here to read the guidance

 

Car sharing

Advice on Car Sharing for Adult Social Care

If you have to car share there are simple actions you are advised to take to help reduce the risk of catching COVID-19 and passing it on to others. These actions will also help to reduce the spread of other respiratory infections such as flu.

  1. Wash your hands with soap and water or use alcohol hand sanitiser before, during and after the journey
  2. Wear a fluid repellent face mask
  3. Ensure maximum ventilation by opening windows during your journey
  4. Keep your distance from other people you are travelling with by sitting as far away as possible from each other
  5. Limit close contact with others you are travelling with
  6. Cover your nose and mouth if you cough or sneeze
  7. Avoid car sharing with multiple people. Try to car share with the same individual / small group
  8. Clean frequently touched car surfaces (e.g. seatbelts, internal / external door handles) after every journey
  9. Do not car share if you have symptoms of COVID-19 or have a positive Covid-19 test result
  10. Do not car share if you feel unwell with symptoms of a respiratory infection or diarrhoea and vomiting
  11. Get vaccinated. Vaccines are the best defence we have against COVID-19 and other respiratory infections such as flu
  12. If the care home/ care setting is experiencing an outbreak of COVID-19, Flu or D&V, avoid car sharing where possible and especially sharing with staff cohorted to affected units/ floors

Care home movement

Click here for the latest HCC guidance on movement of staff/residents between care settings

 

 

HCC Transport and ride sharing

From 06/09/2021 HCC Transport and Dial-A-Ride will move to 1-metre social distancing with:

  • Infection prevention and control measures will remain
  • Face coverings continue to be recommended for service users
  • Testing for drivers, service users is recommended to test regularly

Uniforms & Management of Infectious Laundry

Management of Infectious Laundry

Managing Infectious Laundry

Infectious laundry includes laundry that has been used by someone who is known or suspected to be infectious and/or linen that is contaminated with body fluids

All dirty linen should be handled with care, and attention paid to the potential spread of infection.

Key Principles for safely handing infectious laundry
  • Wash hands between handling different categories of laundry
  • Prevent cross contamination between clean, used or infectious laundry
  • Use a separate laundry receptacle for infectious laundry
  • Place laundry receptacle as close as possible to point of use for immediate deposit
  • Avoid shaking or sorting infectious laundry
  • Do not place infectious laundry on the floor or on surfaces
  • Wear a single use apron to protect worker clothing from infectious laundry
  • Seal infectious laundry in a water -soluble bag immediately on removal from bed then place within an impermeable bag
  • Avoid overfilling receptacle (not more than two third full)

Consider having a dirty to clean flow system in laundry rooms so clean and used laundry are physically separated and ensure hand washing facilities are available where possible

Laundering Infectious linen
  • Do not wash by hand
  • Use appropriate pre- wash cycle
  • Launder separately from other items
  • Launder at the appropriate temperature

If you need further support in this area please email assistance@hcpa.co.uk

 

Best Practice for Uniforms/Workwear

Practice Infection control risk
Workers should wear clean clothes at the start of each shift and change immediately if clothes become visibly soiled or contaminated.

To enable this, workers may wish to consider storing spare, clean clothing at the workplace or in their vehicle

Visible soiling may present an infection risk.
When providing direct, hands – on care, workers should be bare below the elbows.

This means, having short sleeves, or sleeves securely rolled up above the elbow, removing hand and wrist jewellery.

Lanyards and neckties should not be worn during personal care.

-Cuffs at the wrist become heavily contaminated and are likely to come into close contact with people you support.

This ensures effective hand hygiene.

Fingernails should be clean, short and free from nail products including artificial nails. Long nails are harder to keep clean and are a potential hazard for harbouring organisms which can be transferred to the people you support who are vulnerable.
Long hair should be tied up and off the collar. Keeping hair off the collar reduces the incidence of bacterial growth around the collar areas.
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.
If wearing a headscarf, it should be unadorned and tied neatly.

Headwear worn for religious reasons such as turban, kippot veil, headscarf are permitted providing patient care and safety is not compromised.

These must be washed and/or changed daily or immediately if contaminated.

 

Uniforms and workwear should be laundered as follows: 

  • At the hottest temperature, the fabric can tolerate.
  • Heavily soiled items should be washed separately to eliminate the risk of cross contamination.

 

We recommend that all organisations/providers:

  • Have a local uniform policy in place and monitor compliance.
  • Provide enough uniforms/workwear for staff to have clean clothes for each shift.
  • Provide changing and storage facilities for staff and ensure these are cleaned regularly.

 

Click here for further guidance
Click here for the National infection prevention and control manual for England

If you cannot wear a uniform, we would recommend that all staff change clothes upon arrival to the site and at the end of the day as this will reduce risk of transmission in the home setting. The clothing should be transported home in a disposable plastic bag and washed separately as above, if unable to wash on site.

This does not need to apply to underclothes unless contamination from the resident’s body fluid (e.g. vomit, or fluids soaked through external items).

 

Norovirus

Norovirus outbreaks are increasing in England, particularly in early year educational settings and some cases have been reported in care home settings.

»  Click here to the HCC Norovirus poster which can be displayed within the care home

Common Symptoms include: 

  • Sudden onset of nausea
  • Projectile vomiting
  • Diarrhoea

Other possible symptoms include:

  • High temperature
  • Abdominal pains
  • Aching limbs

How to reduce the spread of Norovirus in Care Homes or Supported Living/Flexicare settings:

  • Promptly isolate anyone that you support to their own room if they have diarrhoea and/or vomiting. Asking resident to confide themselves to their room until recovered and 48 hours symptom free.
  • Deal with any body fluid spillage promptly (wearing correct PPE and washing hands after) using disposable cleaning materials including mops and cloths. After cleaning with a detergent, disinfect with 0.1% sodium hypochlorite (1000ppm available chlorine – Chlorclean or Actichlor tablets made up daily with cold water). Be safe remember COSHH, refer to safety data sheets and make up in well ventilated areas.
  • Monitor unwell residents closely and encourage fluid intake to prevent dehydration.
  • Staff who become ill at work should be excluded immediately. Symptomatic staff should be excluded until recovered and they have been symptom-free for 48 hours.
  • If there are two cases in a residential setting (either amongst staff or residents) please notify PHE HPT so a risk assessment can be undertaken to confirm if the situation is an outbreak and additional action will need to be taken.

Phone: 0300 303 8537  or email EastofEnglandHPT@phe.gov.uk

» More information can be found here from GOV.UK
» Click here for the Norovirus checklist

Walking with purpose

Due to the COVID-19 pandemic, care homes have been required to implement new IPC measures along with social distancing and isolation measures to reduce the risk of the spread of the virus.

These measures result in the restriction of movement for residents living in care homes which means there will be a change to their daily care routines and practices. This is likely to be particularly stressful and unsettling for people living with dementia who ‘walk with purpose’.

What is walking with purpose?

Walking with purpose is likely to be an expression of an unmet need and the persons efforts to communicate, meet or respond to that needs. People living with dementia is care homes who walk with purpose may struggle to follow IPC measures and may find it difficulty to understand why they are required to remain in their room.

Common reasons for walking with purpose are:

  • Looking for someone or something
  • Attempting to relieve pain or discomfort
  • Feeling lost and trying to find the way
  • Fulfilling a previous occupational role or family commitment
  • Getting hungry, thirsty, or needing to go to the toilet
  • Feeling lonely or stressed
  • Feeling bored
  • Walking is part of their everyday routine
  • They enjoy being physically active

» Click here for more information on COVID-19 and living with dementia in care homes

Useful Resources

GOV UK  – Videos and instructions for how to take swab samples for COVID-19 testing Click here
UK Health Security Agency  – How to use the self-swabbing kit for a combined throat and nose swab (video) Click here
UK Health Security Agency – How to use a nose swab kit to test for COVID-19: a guide for social care staff (video) Click here
DHSC – Video on how to take a self-test swab Click here
NHS – How to wash your hands Click here
NHS – Catch it, kill it, bin it poster Click here
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