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Infection Prevention & Control

Introduction

This page has all local and national guidance for Infection Control. It will support you are your staff to:

  • Updated understanding of infection control principles and guidance- Importance of Hand Hygiene, PPE and Cleaning
  • Understanding how to reduce the risks of COVID 19
  • Refreshed competence on PPE donning and doffing
  • Understand the process of IPC Auditing and why its important
  • Understand requirements around contact tracing
  • An awareness of some of the resources available to help

For PPE Supplies Click here

Guidance

Infection Control Checklist

The purpose of this supportive development tool is to help identify if the home is well prepared for dealing with a resident suspected or confirmed as being infected with COVID-19 and minimise the spread of infection.

It is vital that staff are confident in:

  • Effective hand hygiene
  • Putting on and taking off PPE correctly including being clear what PPE is required when working within the care environment
  • Practising social distancing
  • Effective isolation of suspected or confirmed cases of COVID-19 14 days including identifying those who have been in contact with said case
  • Equipment decontamination
  • Environmental cleaning and disinfection
  • Safe handling of laundry and waste management
  • How to escalate if they suspect residents may be COVID-19 positive
  • The resident and staff testing pathway
  • Safe practices for staff uniforms

Click here to download

Signs and Symptoms of COVID19

The following symptoms may develop within the 14 days after exposure to someone who has COVID-19 infection:

  • a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • a loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal

Click here to download the Symptom Checker

Remember individuals may be asymptomatic. Even if someone is not showing symptoms, they can transmit the virus.

Key principles of Infection Prevention and Control

  1. Good hand hygiene is a must and singularly the most effective way to prevent the spread of Covid 19
  2. Keeping the environment and equipment clean – Cleaning of communal areas regularly to avoid the spread of any infection
  3. Managing symptomatic patients through self isolation and care routines to reduce risks of cross infection
  4. It is recommended you attend work and 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.
  5. Good personal hygiene in important to ensure good resistance to the virus
  6. Using correct and appropriate PPE through the care settings
  7. Distance: Care home providers should follow social distancing measures for everyone in the care home – keep at least  2m apart

Hand Hygiene

Hand Hygiene Technique

  • Hand hygiene is vital in stopping the transmission of Covid19 and other micro-organisms
  • YOU should be ‘bare below the elbows’ to ensure effective hand hygiene
  • Remove watches, stoned rings, fit-bits/ bracelets
  • Short sleeves or long sleeves rolled up
  • No long nails, no false nails
  • No nail varnish/gels

Click here to video

Click here for poster

NOTES:

  • The entire set of actions should not take less than 20 seconds
  • Staff should be ‘Bare Below the Elbows’ (BBE) when delivering direct care to residents. BBE is being free from long-sleeved clothing, wrist and hand jewellery (other than one plain band ring which must be able to move up and down).
  • Long sleeves, if worn, should be rolled or pushed up to the elbows.
  • Fingernails should be short and clean, no nail varnish, false or acrylic nails, nail extensions or nail jewellery.

 

Using Alcohol Hand Gel

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

 

 

 

PPE

  • Gloves
  • Aprons
  • Fluid resistance Surgical Mask (Type IIR)
  • Eye protection

Wear even if you have had a negative test

Gloves and aprons are subject to single use as per SICPs with disposal after each patient or Service User contact

Fluid repellent surgical mask and eye protection can be used for a session of work rather than a single patient or Service User contact. Cloth Masks should not be used within the care home as they are not fluid repellent.

Hand hygiene should be practiced and extended to exposed forearms, after removing any element of PPE

For PPE Supplies click here

Masks

Remember masks MUST be worn at all times in Care Settings

Always wear masks In STAFF ROOMS, OFFICES & CORRIDORS

  • Delivering care, being within 2 metres and all other work = Fluid repellent surgical mask (Type IIR)
  • Masks should only be removed when eating / drinking (where others are not present, or you are ensuring 2 meters distance)
  • When eating and drinking in a break area always clean surfaces before and after with disinfectant wipe- Make sure you discard an old mask after and replace with a new one
  • Clean your hands before removing PPE and after
  • If PPE breaks or falls off, replace immediately

Download poster here

No Mask Exemptions in Care Services

“During a period of sustained transmission of COVID-19 across the UK, an additional level of PPE is required for normal care. See guidance on specific PPE for use in the care home sector and guidance on specific use of PPE on Domiciliary Care.

Therefore, it is counter to that guidance to think that staff with a mask exemption letter can continue to provide care.

There are number of major concerns here for a care provider with staff delivering care without correct masks:

  1. Safeguarding – Not wearing a mask could be raised as a safeguarding concern, as the service user is being put at higher risk due to the care delivery
  2. Health and Safety – Staff not wearing PPE while working may go against the act which states the duties employers have towards employees and members of the public and employees have to themselves and to each other
  3. Liability and insurance – The care provider may be opening themselves to breach of insurance or future liability issues if another staff member or service user are infected with Covid-19 and have been in contact with the individual who is not wearing masks

Remember the mask is not only there to protect the service users, but also the whole staff team and the individual themselves. Cloth masks are not a replacement for Fluid Repellent Surgical masks and do not fit PPE requirements for any care delivery.

What can you do?

  • Look at reasonable adjustments for the individual. Can they continue to wear the PPE but be given additional breaks so they can go to a private space or outside to remove the mask for a time period
  • Redeploy the induvial to non-care duties – However please remember masks are meant to be worn throughout care premises including offices so you if there are redeployment tasks these may need to be completed at home
  • If there are no alternatives for the staff member the employer can look at the staff member being put on Furlough as there is not work for them due to COVID-19 – Please find details here

If the person will be working reduced hours due to the above and you need to backfill their role speak to your commissioner at HCC to see if you can claim additional costs through the HCC COVID-19 funding

To support the local NHS in their advocacy role for those requiring exemption letters please email any questions or concerns to assistance@hcpa.info.

Eye Protection

Eye protection is recommended for care of clients where there is risk of droplets or secretions from the client’s mouth, nose, lungs or from body fluids reaching the eyes (e.g. caring for someone who is repeatedly coughing).

Risk Assessment

Do you need to use visors/eye protection? You are advised to carry out a risk assessment, if you think there is a risk of any splashing (even sneezing), then your risk assessment may well suggest that a visor/eye protection is necessary. If you are providing care for a person who is, or you suspect may have, COVID-19 then your risk assessment would say a visor/eye protection is necessary.

» Read the Government guidance

Use of eye protection should be discussed with your manager and you should have access to eye protection (such as goggles or visors). Eye protection can be used continuously while providing care, unless you need to remove the eye protection from your face (e.g. to take a break from duties). We do not recommend continued use of eye protection when driving or cycling.

If you are provided with goggles/a visor that is reusable, then you should be given instructions on how to clean and disinfect following the manufacturer’s instructions or local infection control policy and how to store them between visits.

If eye protection is labelled as for single use then it should be disposed of after removal

Cleaning

Eye Protection (Safety Goggles or face shields) can be used on a sessional basis once risk assessed at a local level. A single session refers to a period of time where a worker is undertaking duties in a specific setting/exposure environment and a session ends when the worker leaves the care setting/exposure environment.

Cleaning protocol to be followed by staff prior to wearing and when returning them to their allocated collection point:

  1. While wearing clean gloves, carefully wipe the inside, followed by the outside of the face shield or goggles using a clean cloth saturated with neutral detergent solution or cleaner wipe
  2. Carefully wipe the outside of the face shield or goggles using a wipe or clean cloth saturated with a disinfectant solution or alcohol wipe
  3. Then wipe the outside of face shield or goggles with clean water/soap or alcohol to remove residue
  4. Fully dry (air dry or use clean absorbent paper towels)
  5. Remove gloves and perform hand hygiene

Please note: At the end of each period of use the staff member should return the eye protection to the allocated collection point in their place of work. Eye protection should be discarded if damaged (e.g., safety glasses can no longer fasten securely, if visibility is obscured).

» See this useful guidance sheet from Peterborough and Cambs CCG
» Homecare PPE Guidance

PPE Training and Competencies

For support with ICP and PPE education visit www.hcpa.info/training or email stopfalls@hcpa.info

Check out of PPE Donning and Doffing demonstration video here which you can share with staff for reminders and updates.

Reminder to complete the Hertfordshire COVID-19 Infection Prevention and Control Checklist

» Click here for the checklist

Check out the new audit tool on Infection Control

» Read more

Hand Hygiene and PPE practice Observation Tool for staff

» Click here to download an observation tool

» Please click here for details on CQC Infection Control review.

Infection prevention and control in Care Homes

» Read the full story from our email on the 5th October 2020

» Key line of enquiry S5

» Use this tool to audit your service

Infection Control Good Practice

» Download the ADASS Care Homes Infection Control – Top Tips Guide

Further IPC Education – Does your team need training in Infection Prevention and Control Including PPE Donning and Doffing Competencies?

» Click here to book your place

Gloves

Gloves are not a substitute for hand Hygiene and Hand contamination is possible during glove removal
  • DO: use when in contact with body fluids
  • DO: Make sure the gloves are the right size
  • DO: Limit opportunities for ‘touch contamination’ – Protect yourselves, others and environment
  • DO: store PPE in key places / appropriate access to PPE – Area must be kept clean and uncluttered
  • DON’T: touch your face or adjust PPE with contaminated gloves
  • DON’T: touch environmental surfaces except as necessary
  • DON’T: keep gloves in your pockets

 

Cleaning

There is detailed information in the document Admission and care of Service Users in a Care Home during Covid19  on cleaning and the suitable products that you should use as well as managing healthcare waste.

  • Pay greater attention to frequently touched surfaces.
  • Clean communal areas as soon as possible if a Service User with suspected symptoms has been there
  • The frequency of cleaning should be increased
  • Ensure that the correct cleaning and disinfectant products are used
  1. Disinfectant wipes that conform to EN standards 14476
  2. Use either a combined detergent disinfectant solution at a dilution of 1000 parts per million (ppm) available chlorine (av. cl.) or
  3. A neutral purpose detergent followed by disinfection (1000 ppm av. cl.)
  4. Follow manufacturer’s instructions for dilution, application and contact times for all detergents and disinfectants

After an outbreak carry out a Deep clean- Click here to download checklist

Linen and Laundry

  • All linen used by Service Users with suspected or confirmed COVID-19 should be managed as ‘infectious’ linen
  • It must be handled, transported and processed in a manner that prevents exposure of staff, contamination of their clothing and the environment
  • Do not rinse, shake or sort linen
  • A laundry receptacle (skip) should be available as close as possible to the point of use for immediate linen deposit
  • All linen should be handled inside the patient room/cohort area
  • Utensils –Use a dishwasher as much as possible. Use the highest temperature the dishes can tolerate

 

Waste Management

Disposal waste that has been used in the care of the Service User suspected or confirmed to have Covid19

  • Place in the usual ‘tiger bag’ – a yellow bag with a black stripe. Secure with swan neck and zip tie or tape and store safely.
  • This should be securely stored for at least 72 hours before being put in your usual collected waste bin and disposed of as per usual arrangements.
  • If this is not possible then place in an orange bag. Secure with swan neck and zip tie or tape and store safely. Dispose of as infectious clinical waste (Cat B).

 

Staff Uniforms

Staff should  change into uniform when they arrive at work and change out of it before they leave as this will keep contamination down to a minimum.

Uniforms should be transported home in a disposable plastic bag

Cleaning work clothes/uniform at home:

  • Separately from other clothes after every shift
  • Coats should not be left out and should be left in the car or in a bag in your locker. (staff should not share lockers)
  • Do not overload machine
  • Use  the maximum temperature the fabric can tolerate. Clothes should be ironed or tumble dried after wash

Do not wear your uniform when going home

Auditing Practice

  • Auditing enables your service to understand where there could be gaps and to identify additional training and support staff may need
  • Ensures high quality care that is safe and effective is given
  • To show that your service is responsive and proactive in the management of IPC/PPE
  • It may stop an outbreak by identifying any areas/practices that are found to be not adhering to current guidance
  • To ensure that staff are adhering to guidance to keep themselves and the Service Users as safe as possible – it’s also a chance to refresh knowledge in a supportive way

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.

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 be assessed for hand hygiene technique on at least an annual basis, suggest to complete 25% of staff monthly
  • Please use additional copies of this form as necessary.
  • All columns should be completed.
  • During clinical situations, where possible, staff should be observed undertaking ‘Key Moments’ – see overleaf.
  • During non-clinical situations, e.g. assessing hand hygiene technique after a team meeting, tick N/A in the ‘Key Moment’ column.
  • In the event of non-compliance, action plans should be produced and reviewed regularly.
  • Completed audit tools should be kept locally for good practice assurance and as evidence for CQC inspections and local monitoring.

Click here to download

PPE Audit Tool

  • This audit tool can be used as a rolling programme of audit of compliance with your PPE practice.
  • Please ensure that all staff should be assessed on PPE regularly, suggest 25% of staff monthly.
  • Please use additional copies of this form as necessary.
  • All columns should be completed.
  • In the event of non-compliance, action plans should be produced and reviewed regularly.
  • Completed audit tools should be kept locally for good practice assurance and as evidence for CQC inspections.
  • Prior to auditing all staff should have had undertaken training and had completed Donning and doffing competency for PPE.

Click here to download Audit Tool

Click here to download competency checklist