4.1.29 Infection and Communicable Disease Control

A risk assessment should be carried out annually to identify potential sources of infection and the steps which will be taken to control those risks. This should also cover the susceptibility of people in our care to varying kinds of infection (done in an anonymised way), for example whether any people 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 need to 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 infections and how these are monitored. The report should contain a short review of:

• Information on incidents and outbreaks of infection;
• How the incident or outbreak was communicated to staff, people receiving care and visitors;
• Infection prevention and control audits;
• Risk assessments;
• Training and education of staff;
• How this procedure was shared with staff, people receiving care and visitors;
• Action taken to rectify any complaints or incidents in relation to infection prevention and control.

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 Team should be notified and 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:

• Name;
• Age, date of birth;
• GP name and address;
• Date of onset of symptoms and cessation of symptoms;
• Type of symptoms;
• Samples taken and sent;
• Diagnosis;
• Source of infection, if known;
• Contacts- family, friends, visitors, other staff;
• Outcome;
• Whether the case was reported to the Health Protection Team and date of report.

Appropriate and proportionate action must be taken as soon as possible to control an outbreak of infectious disease. This includes:

• Reinforcing hand washing and respiratory hygiene messages for staff, people receiving care and visitors;
• Isolation of people with infections;
• Review of the care to be provided to a person with an infection to ensure their needs, (including psychological support needs) are met while they are unwell;
• Enhanced cleaning schedules;
• Enhanced observation of non-infected people to make sure that any new cases are identified quickly;
• Exclusion of infected staff from work;
• Closure to new admissions;
• Postponement of outside activities;
• Delaying the readmission of people following discharge from hospital;
• Restricting or stopping visiting;
• Postponing visits from outside service providers, e.g. hairdresser, podiatrist etc.

Following an outbreak, it may be helpful to carry out a root cause analysis to identify:

• What happened;
• How it happened;
• Why it happened;
• What we have learned from the outbreak and how that learning can be implemented.

This can then be used with staff to try to prevent a similar outbreak from happening in the future.

People suffering from certain kinds of infection should be isolated in a single room and care taken not to pass the infection to other people. 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 a person has a gastro-enteric infection, they should use a separate toilet or commode which is then 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. 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.

Many infections can be prevented by taking careful steps to do so.

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.  See Catheter Care and PEG Feeding.

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:

• Individual responsibilities for cleaning;
• Frequency of cleaning for each area, item or piece of equipment;
• Advice on how to clean each area, item or piece of equipment;
• Advice on which products to use.

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:

• Red – Bathrooms, washrooms, showers, toilets, basins and bathroom floors;
• Blue – General areas including bedrooms, communal areas, offices and public areas;
• Green – Kitchens and food service areas;
• Yellow – Isolation areas.

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:

• Fouled items and those from someone with a known infection must be collected and laundered separately from other items;
• There must be workflow system in place which keeps clean and dirty items separate;
• Personal protective equipment such as disposable aprons and gloves should be used together with good hand hygiene practice to avoid infection being transferred by staff;
• Fouled items should never be sluiced within the laundry room;
• Bed linen should be removed with care as some infection is spread through airborne particles. It should be care fully placed in a bag and then straight into the washing machine. It should not be tipped onto the floor first for sorting;
• Wherever possible, laundry should be disinfected during washing by being washed on a cycle which maintains a temperature of 65c for a minimum of 10 minutes or 71c for a minimum of 3 minutes.

Under 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, COVID 19 and a one off vaccination against pneumococcal infection.