We asked our HCPA Impartial Assessor, Heather McAndrew RGN to give advice to Care Homes on managing winter Bugs. Please read her comments below and don’t hesitate to get in touch if you think Heather can help you.
It’s that time of year where anyone and everyone is at risk of those nasty ‘winter-bugs’. Especially those who are: Immunocompromised, aged 65+ and anyone with an underlying health condition.
Sometimes, no matter how hard we maintain Infection Control Precautions, these winter-bugs are unavoidable.
The most common forms of ‘winter-bugs’ that start from mid-September to the end of February include:
- Norovirus
- Influenza (Flu)
None of the above directly requires antibiotic treatment.
Admitting your resident to hospital with either Norovirus or the Flu is putting other vulnerable service users at risk.
As I work alongside the Care Homes in East and North Hertfordshire, I see the phenomenal care that the Care Practitioners provide to their residents and how they always have their residents’ best interests at heart. Many feel that admitting their service users to hospital is the safest option; however, in some cases it is most appropriate to care for them in the Care Home.
Of course, there are circumstances whereby you know your resident best and it is okay to call for assistance. I can only provide guidance; you are at the core of your service user’s care. If they are admitted, then please contact me for support:
Heather McAndrew, Registered Nurse and Care Home Impartial Assessor
07833 097195 | heathermcandrew@hcpa.info
I am able to follow your service user through their hospital experience and identify when they are due to be discharged.
When to get medical advice?
If you suspect that your resident may have Noro-virus or Influenza, normally, there is no need to arrange a GP appointment or admit your resident to hospital, as there is no specific treatment for these viruses, only close observation and management of symptoms.
As stated above, there are of course exceptional circumstances whereby medical treatment may be required.
Antibiotics will not assist in the direct management of these viruses. Antibiotics are only beneficial where there is a bacterial infection. Occasionally, a resident with flu can develop a secondary bacterial infection.
If you have provided the following to your resident but continue to remain concerned about their overall health, phone the NHS 111 service for further advice:
- Encourage plenty of oral fluids and monitor your resident’s fluid
input and output, with a fluid balance chart. AKI (Acute Kidney Injury- caused by dehydration is very common with these viruses). If their urine output falls significantly then always seek further medical advice
- Provide your resident with paracetamol to help assist in the control of their temperature- Keep their temperature below 38oc
- Encourage plain foods if your resident can tolerate eating. For example: soups or build up shakes
- If the resident can tolerate rehydration drinks or sachets are a great way to quickly rehydrate your service user- this is very similar to the IVF hydration that service users receive in hospital
- Allow plenty of bed rest. Remember your resident is older and it will often take them a lot more time to recover in comparison to a younger, healthier person
- A resident with Norovirus is most infectious from when their symptoms start until 48 hours after their symptoms have passed
- A resident with Influenza is most infectious from the onset of their symptoms, up until 7days after
During this period of time ensure that the resident is:
- Cared for in their own room, if safe to do so
- Minimise the number of items of equipment shared between this resident and other residents. If unavoidable, make sure any items are cleaned and then disinfected thoroughly before leaving the affected resident’s room. It is important that wherever possible, no other residents share the same commode as a resident with possible Norovirus
- Care Practitioners apply appropriate PPE and remove it before leaving the resident’s room
- Maintain high standards of hand hygiene by washing your hands with soap and water- hand gel will not kill either of these viruses
- Where possible, locate a key worker to care for the resident- this may assist in the reduction of the viruses spreading, by limiting contact. This member of staff should not work on other units within the home
- Disinfect all surfaces and objects that could be contaminated
- Don’t share towels or flannels
- Immediately flush away infected fecal matter or vomit in the toilet (with the toilet lid closed)
- Wash the residents bedding and clothes separately at 60oc
- Discard any waste from this resident’s room into the infectious waste stream
The care of residents with these viruses in a care home would be similar to the care received in the hospital.
Visitors:
It is recommended that visitors who have either had the viral infection themselves, or have visited someone who has either of the infections, should not visit one of your residents for up to 48 hours after their symptoms have resolved or 48 hours post contact with the infected person. You have a duty of care to protect your staff and those residents who are at risk.
Staff:
If staff develop vomiting and / or diarrhoea, then must stay away from work until 48 hours after their last symptoms. If they are diagnosed with flu (not the common cold), then they should stay away from work for at least 7 days
All staff must be actively encouraged to receive their flu vaccination and records kept of who has been vaccinated and who has refused vaccination. This way you will know who can be safely allocated to look after any potentially infected residents
As the Care Home Impartial Assessor I know only too well of the pressures that you and your Care Home receives when a resident needs to be discharged from hospital. With these ‘winter-bugs’ circulating their way around the care homes and hospitals, it’s imperative that you are aware and are supported in an appropriate discharge.
Below is clarification from the Public Health Agency as to when a new or returning resident can be admitted, following an outbreak in your Care Home.
Admissions and transfers of residents:
Admissions and transfers of new residents to the Care Home should be stopped until 48 hours after the last symptoms among residents.
*Note: a new resident is a new admission who has not previously been resident in your Care Home.
If an existing resident is discharged from acute services (i.e. transferred back from hospital care), they can be received into their own single room in the home after it has been terminally cleaned (if required).
Residents received from acute services should be nursed in isolation in their own room until 48 hours after the last symptoms among residents in the facility (i.e. when the outbreak is concluded).
**Note: an existing resident is someone who is usually resident in your care home and who has been transferred to another service (e.g. acute hospital services) for a period of care.
Heather McAndrew, Registered Nurse and Care Home Impartial Assessor
07833 097195 | heathermcandrew@hcpa.info