April 2020: Changes in relation to Coronavirus
During the COVID-19 outbreak, additional measures to reduce risk need to be taken to further prevent the spread of the virus. This is especially important where face to face contact with adults, their families or other staff is required. Your line manager will give you information about how to keep yourself safe at this time. Click on the link for information from the UK Government: How to protect yourself and others – Coronavirus (COVID-19): what you need to do and Responding to COVID-19: the ethical framework for adult social care (Department of Health and Social Care).
Infection Prevention and Control in Care Homes (Care Quality Commission) – information for inspections
August 2020: This chapter has been amended to include a link to Infection Prevention and Control in Care Homespublished by the Care Quality Commission. The CQC has published the questions to help homes prepare for the risk of a second wave of COVID-19 and the impact of winter pressures.
Good infection prevention and control (IPC) measures are essential to ensure that adults who use the service receive safe and effective care. It must be embedded into everyday practice, with the same high standards applied by all staff.
In order to ensure such working practices, effective management is vital to ensure those standards are maintained by the service.
This chapter outlines the different areas in which action must be taken to keep adults, staff and visitors safe.
2. Service Processes
2.1 Designated lead
The service manager (or the designed responsible person – see Designated Responsible Person) should be the designated lead for IPC.
The IPC lead should report in to the health and safety arrangements in the service. Their role also includes ensuring that this policy and procedures is adhered to by staff, and is monitored accordingly. Any issues with compliance should be addressed through the service’s health and safety arrangements.
The IPC lead should be able to access to specialist expert advice when required, including an infection control doctor.
2.2 Training and information
All relevant staff should complete IPC training as part of their induction (see Staff Training). Periodic update training should also be provided. Additional training for the service may be required in response to an incident.
The service should ensure there is a robust audit process to ensure that all necessary IPC processes are adhered to. This should include a review of daily care and support practices to ensure that principles and guidance covered in training are being fully implemented.
It will be the responsibility of the IPC lead to ensure that any corrective actions identified as a result of an audit are implemented within the agreed timescales. See Quality Assurance and Learning Lessons.
2.4 IPC Risk assessments
The IPC lead should ensure that risk assessments in relation to IPC risks to adults who use the service are carried out:
- during the first contact with the adult; and
- reviewed at agreed intervals or sooner if changes occur.
The risk assessment should be recorded and retained in the service and should identify any steps required to eliminate, reduce or control risks from infection.
Where required, the IPC lead should monitor the risks of infection to determine whether further steps are needed to reduce or control infection.
See also Premises and Equipment.
The service manager is accountable for ensuring there is a safe and clean care environment. All staff, but particularly the service manager, DRP and senior support workers, have direct responsibility for ensuring that cleanliness standards are maintained when they are on duty.
The service manager should ensure that all parts of the premises are fit for purpose, clean and maintained in good physical repair and condition. There should be effective cleaning, disinfection and decontamination of equipment that is used at the point of care, for example hoists, beds and commodes. This includes the supply and provision of linen and laundry.
The cleaning arrangements should detail the standards of cleanliness required in each area and that a schedule of cleaning frequency should be available on request.
The IPC lead should ensure there is adequate and suitable hand washing facilities and anti-microbial hand washes where required.
The IPC lead should ensure a programme of cleaning is in place which will include:
- clear definition of specific roles and responsibilities for cleaning;
- clear, agreed and available cleaning routines;
- sufficient resources dedicated to keeping the environment clean and fit for purpose;
- details of how staff can request additional cleaning, both urgently and routinely.
4.1 Information to adults and their visitors
Information on the general principles of infection prevention and control should be available to all adults who use the service and their relatives, friends and any advocates who visit. These should be in formats that are not overly detailed but outline the main issues, including:
- • general principles on the prevention and control of infection;
- supporting adults’ awareness and involvement in relation to IPC;
- the role of adults (where appropriate), carers, relatives and advocates in IPC when visiting the service;
- the importance of compliance with hand hygiene measures by visitors;
- reporting any concerns about hygiene or cleanliness;
- providing explanations of incidents / outbreak management (see also Duty of Candour).
The service manager may require the support of specialist IPC advice, in relation to more complex issues, information about which may be shared with the adult’s visitors as appropriate.
5. Responding to Infections
5.1 Medical intervention
At the first sign of any transmissible illness, the GP for the service should be contacted and a visit requested.
Where the illness is more urgent the ambulance service should be contacted and visit the adult to conduct an assessment. If it is suspected that hospital or Accident and Emergency admission will be necessary, the hospital should first be contacted for advice, as it may be inadvisable to take an adult with an infectious illness to an area where there are other people.
If the adult is taken to hospital, please see Transfer between Community or Care Home Settings and Inpatient Hospital Settings.
The adult’s GP should arrange any relevant testing required for diagnosis, treatment and management of the illness. The service manager should ensure all necessary arrangements are made if required.
Where the adult is to remain in the service, staff should ensure that they receive any treatment as prescribed by the doctor.
5.2 Obtaining advice
The service manager should obtain advice from relevant practitioners whenever required. If advised by a medical practitioner of a diagnosis / suspected diagnosis, they should inform the local health protection unit of any outbreaks or serious incidents relating to infection. See Public Health England regions, local centres and emergency contacts.
The service manager will seek advice and support from service senior managers in the first instance.
5.3 Reducing the risk of spreading infection
In the event of a suspected or actual outbreak, the service manager should wherever possible isolate any potentially infected adults in order to minimise the spread of infection to other people in the same premises.
Staff who are suspected or have contracted an infectious disease should be placed on sick leave and contact / visit their GP or other medical services as necessary.
The service is not required to have dedicated isolation facilities for adults in such circumstances, but are expected to implement isolation precautions. Specialist health and safety advice may also be required to provide further guidance.
Care workers should wear any additional Personal Protection Equipment as required.