SCOPE OF THIS CHAPTER
This should be followed in all establishments where direct care of customers is undertaken. It provides guidance to help staff take reasonable precautions to protect customers and staff from acquiring infections and also to assist managers when carrying out risk assessments and responding to outbreaks of infection.
Infections may be serious and in some cases, life threatening. They may worsen underlying medical conditions and adversely affect recovery. The steps taken to protect people from infection are an important element in the quality of care, particularly where a number of vulnerable people share eating and living space.
Effective prevention and control of infection must be part of everyday practice and must be applied consistently by everyone.
2. Procedural Steps
A risk assessment should be carried out annually to identify potential sources of infection and the steps taken to control those risks. This should also cover the susceptibility of current customers to varying kinds of infection in an anonymised way, for example whether any customers have a catheter or PEG feeding tube fitted or whether someone has an underlying respiratory condition. If a potential source of infection is identified, the frequency of risk assessments may be increased, depending on how well the risk is or can be controlled. (See also Catheter Care Procedure.)
The Code of Practice on the prevention and control of infections requires that the Registered Manager of a care home will prepare an annual report on the systems in place for the prevention and control of infection and how these are monitored. The report should contain a short review of:
An outbreak is defined as two or more cases occurring around the same time in residents or staff. If an outbreak occurs, it must be carefully managed to minimise harm. The Table of Action to be Taken should be referred to in order to inform whether the Health Protection Unit should be notified, whether isolation of infected people or exclusion of staff from work are necessary.
It is important that staff are able to recognise the signs and symptoms of infection, for example fever, diarrhoea or vomiting, skin rashes, respiratory problems, unexpected falls and confusion and know that they must report these to the senior staff member on duty immediately.
If an outbreak of infectious disease does occur, good record keeping will help to monitor the management of the outbreak and ensure that any learning to be had from the outbreak can be incorporated into the revised risk assessment. As a minimum the following information should be recorded for each infected person, including staff:
Appropriate and proportionate action must be taken as soon as possible to control an outbreak of infectious disease. This includes:
|4.||Root Cause Analysis:
Following an outbreak, it may be helpful to carry out a root cause analysis to identify:
This can then be used with staff to try to prevent a similar outbreak from happening in the future.
|5.||Care of Infected Person:
People suffering from certain kinds of infection should be isolated in a single room and care taken not to carry infection out to other people. A table showing the kinds of infection requiring isolation is available in the forms library. Staff providing care to someone carrying an infection should wear a disposable apron and gloves which should be disposed of as hazardous waste (see Section 9, Cleaning). If someone has a gastro-enteric infection, they should use a separate toilet or commode which is disinfected after each use. Staff should wash and dry their hands thoroughly after providing care. Laundry should be washed separately and food and drink should be taken in the person’s room where possible. Consideration should be given to regulating visitors – either making sure visitors do not enter communal areas or delaying visits until the person is no longer infectious.
Anyone attending day services who is suffering from an infectious disease should be asked not to attend until they are no longer infectious. A table showing how long a range of illnesses are infectious for is available in the forms library. This should be used as a guide to the length of time someone should be asked not to attend. If non-attendance at the day service puts the person at risk, the relevant long term support team should be contacted and asked to explore interim services.
|Day Service Manager|
|7.||Prevention of Infection:
Many infections can be prevented by taking careful steps to do so. The following steps identify some of the things which can be done to prevent infection.
|8.||Use and Care of Invasive Devices:
Invasive devices such as urinary catheters and gastronomy (PEG) tubes increase a person’s risk of acquiring an infection and separate, detailed procedures are available for each.
Establishments which provide care should be kept clean to the highest standards possible while maintaining a homely environment. A cleaning schedule should be developed which identifies:
Compliance with this schedule should be monitored and action taken to address any issues.
Cross contamination of bacteria and other infective agents is best avoided by having separate cleaning equipment for different areas. The national colour coding scheme states that cloths, mops and any other equipment should be colour coded as follows:
Infection can be transferred between contaminated and uncontaminated items of clothing, towels, bedding and other laundry items and the areas in which they are stored. Specific hygiene measures must be taken to avoid this as follows:
As a consequence of the Hazardous Waste Regulations 2005, any waste that contains infectious material is deemed to be hazardous waste and should be disposed of by a suitably licensed waste contractor. Other forms of hazardous waste include waste contaminated with blood or body fluids, dressings and sharps. Any area which may generate hazardous waste must have a foot operated pedal bin containing a yellow plastic bag marked as hazardous waste. The bags must be removed when they are no more than three quarters full and sealed with a ‘swan neck’ tie – twisting the top which is then turned over on itself and sealed with tape and tie.
Non-hazardous waste must not be mixed with hazardous waste but collected separately in black plastic bags.
All waste must be stored in a well drained area with impervious hard standing and kept secure from unauthorised persons or animals. Hazardous waste should be segregated from other forms of waste.
Sharps must be place in a sharps bin which is sealed when no more than three quarters full. Sharps should not be broken or otherwise handled and should not be transported to the sharps bin. The sharps bin should be carried to the place where the sharps will be used.
The choice about whether to be vaccinated or not must always rest with the individual, but people living in residential homes should be offered vaccination against seasonal flu and a one off vaccination against pneumococcal infection.
|Registered Manager to offer|