Infection control is the name given to a wide range of policies, procedures and techniques intended to prevent the spread of infectious diseases amongst staff and service users. All of the staff working in the organisation are at risk of infection or of spreading infection, especially if their role brings them into contact with blood or bodily fluids like urine, faeces, vomit or sputum. Such substances may well contain pathogens that can be spread if staff do not take adequate precautions.

In addition to normal standards of infection control, there are occasions where more is required, dependent upon the type of situation which from time to time may arise. They are generally classed as:

Outbreaks: these can occur at any time, are usually brought into the service users’ home and are often communicable diseases, such as scabies, norovirus etc. They are localised in nature.

Epidemic: this is an outbreak of a disease that occurs over a set geographical area and affects an exceptionally high proportion of the population, such as yellow fever, cholera, and smallpox.

Pandemic: this relates to a geographical spread from country to country and continent to continent, infection and spread is quick and fatalities can be high within recognised “at-risk” groups of people.

As an organisation, we follow the advice and guidance for the mitigation and management of these types of situations issued by the government, available from public health authorities and the .Gov website.
This organisation believes that adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of both service users and staff. It also believes that good, basic hygiene is the most powerful weapon against infection, particularly concerning hand washing.

Note: Under the Health and Social Care Act 2008, [Regulations 2014], Reg.12 Safe Care and Treatment, all managers are required to comply with the Code of Practice for Health and Adult Social Care on the Prevention and Control of Infections and Related Guidance, which was updated in July 2015.
The Code of Practice on the Prevention and Control of Infections applies to registered providers of all health and social care in England. The code sets out ten criteria against which the Care Quality Commission (CQC) will judge a registered provider on how it complies with the infection prevention requirement which is set out in the regulations.

As an organisation, we have read and considered this document and its application throughout our service. Due to the Covid-19 pandemic, we also follow the latest guidance from the government. See our separate Covid-19 risk assessments.
Although the code is not mandatory, as an organisation we will use the code for guidance in meeting our regulatory requirements

The goals of the organisation are to ensure that:

Staff are trained and regularly updated to recognise the signs of an infection. Prompt recognition enables the GP to diagnose and treat quickly and any isolation procedures being put in place to reduce cross-infection. The GP and our staff will draw on professional expertise in infection prevention and health protection.

UK Health Security Agency
World Health Organisation

When staff are working with a service user in their own home all basic infection control precautions are taken to prevent any infection from being transferred to other service users. If the service user requires specialised support concerning infection control then the advice would be taken from the local Health Protection Agency and any further precautions would be put in place with the involvement of the service user.

This criterion does not apply to Adult Social Care.

Risk assessments and the guidance given in the Code of Practice will assist registered providers to decide which policy areas might apply to them.

Our Registered Nurses will discuss any health related matters and advise to seek advice from appropriate professionals eg. GP.

Hand washing aims to prevent transient micro-organisms from being transmitted from care workers’ hands to the service user or the environment through poor practice. By reducing the transmission of these organisms, the risk of cross-infection can be greatly reduced.
The association between effective hand washing and the prevention of cross-infection is well established; hand washing is known to be the single most effective way to reduce cross-infection.
Effective social hand washing removes most transient micro-organisms and takes from 20-30 seconds.

Liquid soap is suitable for all social hand washing. Cakes or bars of soap are not recommended due to the opportunity of contamination, and therefore should not be used.

The use of 70% alcohol gel for the decontamination of the hands of care workers is recommended for routine hand cleansing when the hands are not visibly dirty and there has not been contact with body fluids or the undertaking of invasive procedures.
The use of alcoholic products for hand decontamination is not intended to replace washing hands with soap and water but rather to.

Emollient hand cream should be applied regularly to protect skin from the drying effects of regular hand decontamination. If a soap, antimicrobial hand wash or alcohol product causes skin irritation an occupational health services or local infection control team should be consulted.

As an organisation, we recognise the importance of the sharing of information relating to the prevention of infection with health professionals, care and domestic staff when managing referrals, admissions, discharges and the movement of service users between social care and health care settings. To this end we use Transfer between Services Passport.

As an organisation we recognise the importance of sharing relevant information with other providers, this will include any relevant infection prevention and control issues when a service user.

Staff are trained and aware of the need to send information when a service user is being moved along with the need for confidentiality and data protection responsibilities as laid out in our corresponding policies.

The Use of Personal Protective Equipment – See also separate Personal Protective Equipment Policy for donning and doffing PPE

Risk assessment involves assessing the likelihood of encountering a person with COVID-19, considering the ways that infection might be passed on and how to prevent this, including through the use of PPE.

The PPE used depends upon the risk assessment taken. The risk assessment will be based on the following 2 questions:

1. Are staff likely to be within 2 metres of the individual and carrying out direct personal care or domestic duties?
2. Are staff more than 2 metres from a service user, undertaking domestic duties and not delivering personal care?

These risk assessments will be included in the care plans, however, staff should be involved, as they visit the service user and notice any change in their condition.
A dynamic risk assessment will determine when and for which service user or duties, items such as eye protection and Type IIR masks should be worn.

Staff are encouraged to discuss with their supervisor or manager situations where they are unsure. If, after raising a concern, staff believe they are being asked to work in a way that is not safe, they should initially seek advice from their manager.
Exemptions on wearing face coverings in public are covered by regulations that do not apply to care settings. Where people may have difficulty wearing masks as required by this guidance, this should be discussed between the staff member and their manager or employer. If a mutually agreeable position cannot be reached to comply with the guidance, employees can refer to the Advisory, Conciliation and Arbitration Service (ACAS) for resolution, who can be contacted through their website.

Staff delivering health and care activities must wear face coverings provided for the industry by the employer. It is not recommended to use homemade face coverings or cloth masks.
There will however be circumstances where following this guidance presents challenges in caring for the service users where for example,lip-reading or facial recognition is especially important for their care and support. In these situations, the risk assessments will identify how best to put into practice PPE guidance to minimise any negative impact on the service user, while maintaining staff health and safety. An understanding of the service users needs, discussion with the service user and or family will form part of the risk assessment and should be undertaken in these circumstances.
Within 2 metres of the service user and carrying out direct personal care or domestic duties

Extra precautions need to be taken when undertaking aerosol-generating procedures (AGPs). Please see the section on aerosol-generating procedures.

There may be challenges in following PPE recommendations and providing care particularly for people with learning disabilities, mental health problems, autism and dementia. For example, face masks may cause distress which can result in behaviour that may cause harm to the service user or others.

A comprehensive risk assessment will be undertaken for each service user identifying the specific risks for them.
PPE items must not be altered in any way as this could reduce their effectiveness in protecting staff or the people we are providing care for.

The same PPE recommendations apply for personal care regardless of whether the service user has tested positive or not for COVID-19 or if they have had the vaccine.
The Government vaccination programme aims to protect those who are at most risk from serious illness or death from COVID-19. Everyone will receive a second dose within 12 weeks of their first. The second dose completes the course and is important for long term protection. However, even when fully vaccinated it is vital that we continue to adopt practices that limit infections.

PPE must be put on and taken off at least 2 metres away from the person being visited and anyone in the household with a cough.
A face mask is put on before entering the building or immediately as the staff member enters a service users’ home or their work base.
If there is a need to remove the face mask for whatever reason, it must be done 2 metres away from others (including service users, household members and other staff) and replaced with a new face mask as soon as practical.

Disposable gloves are single-use. When worn correctly, single-use gloves protect from contact with the service users’ body fluids and secretions. Single-use means gloves must be changed between every contact with another person and while working with the same service user (for example after helping with using the bathroom). They should also be changed after using gloves for other activities, for example, cleaning.

Gloves must be disposed of immediately after completion of a procedure or task and after each person being cared for, and then hands must be washed. Taking care not touch the face, mouth or eyes when wearing gloves.
Disposable gloves may be worn for routine cleaning, however, if chemicals are being used as part of a decontamination schedule a COSHH assessment must be carried out and the correct PPE worn.
The type of glove used should be based on a risk assessment of the task being carried out. There are several different types of gloves: vinyl, nitrile and natural rubber latex.

Vinyl gloves provide sufficient protection for most duties in the care environment, providing the gloves fit.
If there is a risk of gloves tearing, or the task requires a high level of dexterity or requires an extended period of wear, then an alternative better fitting glove (for example, nitrile) should be considered.

If a change of gloves is required during a task because the glove is torn or punctured, then hands must be washed thoroughly for 20 seconds making sure they are completely dry before putting on new gloves.
Consideration must be given to the type of different gloves required for the duties carried out by staff and adequate supplies will be provided. This includes the gloves required in relation to cleaning products; following the manufacturers’ instructions.

Disposable plastic aprons must be worn when providing personal care and when exposure to body fluids is likely. Disposable plastic aprons are single-use and must be disposed of immediately after completion of a procedure or task and after each service user, and then hands must be washed.

A fluid-repellent surgical mask (FRSM) is required. Fluid repellent surgical masks are Type IIR surgical masks and provide additional protection from respiratory droplets produced by service users (for example, when they cough or sneeze). Wearing a Type IIR surgical mask also protects service users by minimising the risk of the staff member infecting them via secretions or droplets from the mouth, nose and lungs.

A fluid-repellent surgical mask must be single-use and disposed of at the end of each homecare visit and a new fluid-repellent surgical mask applied when entering a different service users’ house.
It must also be removed and replaced if damaged, visibly soiled, damp, or uncomfortable to wear.
Staff must ensure that they have enough masks for the duration of their shift.
Face masks must not be touched unless it is to put on or remove it. Make sure the mask fits as snugly to the face as possible, this may include the need to adjust the face straps or ear loops. They should not be crossed over as this increases the gap on the cheeks. Consider trying a different mask if the fit is poor.
The mask is worn to protect the person wearing it and to help to prevent the person from transmitting virus particles to others.

Eye protection can either be a face shield (visor) or goggles. It may be designed for single-use or designed to be used more than once if decontaminated correctly between uses.

Eye protection such as visors provide a barrier to protect the eyes from respiratory droplets (for example, produced by a service user with respiratory symptoms), and from splashing of secretions (for example, of body fluids or respiratory excretions). Eye protection should cover the eye or face completely so prescription spectacles are not sufficient. It should be used in conjunction with a fluid-repellent surgical mask and should not be worn instead of a mask.

Use of eye protection will always be made accessible for staff and they will be instructed on what should be worn for each individual service user. Personal prescription glasses are not a substitute for eye protection, a visor or goggles will be required to be worn as well.

When provided with goggles or a visor that is reusable, instruction will be given on how to clean and disinfect and store them following the manufacturer’s instructions.
As a minimum, between each service user staff, must clean reusable goggles or visors with a neutral detergent wipe, allow to dry, disinfect with a 70% alcohol wipe and leave to dry; or use a single step detergent and disinfectant wipe, allowing the item to dry afterwards. They should be store in a bag or lidded box to avoid possible contamination after cleaning and disinfection are complete. If the staff member wears both prescription glasses and goggles, both will need to be cleaned. For prescription glasses or spectacles, use the cleaning fluid or wipes that are normally used for spectacles as disinfectants may damage the coatings on the lenses.

Eye protection must not be put on until it is completely dry.
Cleaning of reusable PPE items that have been provided is the responsibility of the staff member.
Do not smoke and avoid contact with flames while wearing eye protection.
If eye protection is labelled as for single-use, it should be used for a single task, then it should be disposed of into the service users domestic waste stream.

All care workers who live in the household of the people they are supporting will take part in the weekly testing service for home care workers. All our homecare staff must be tested regularly to reduce the risk of transmission across different settings and to help keep service users and staff safe.

A risk assessment carried out by the employer and staff member will determine which PPE to use and where possible this should include the service user or family member. This risk assessment may include wearing Type I or II masks for source control (that is, the mask is worn to protect others from the staff member).

If the care worker is living with the supported individual for a long period, they will be considered part of the household and will not need to wear PPE when doing domestic duties, unless the person supported, or a member of their household tests positive for COVID-19, or develops respiratory symptoms such as coughing or sneezing. It remains important, however, that PPE continues to be used for the care provided, following standard infection control procedures. For example, gloves and an apron should be worn if handling soiled linen or may come into contact with body fluids such as urine, faeces or blood.

If the individual supported develops respiratory symptoms, tests positive for COVID-19, or is self-isolating, current government recommendations will be followed, as in the table above “within 2 metres and carrying out direct personal care or domestic duties”
If someone in the household develops symptoms of COVID-19 or has tested positive, the Stay at home government guidance will be followed.
If a member of staff arrives in England to deliver ‘live-in’ homecare from outside the UK, we will refer to the current guidance on travel and quarantine arrangements.

Most home care workers are not expected to undertake aerosol-generating procedures (AGPs), although some who are working in complex care may do so. Staff will be informed if AGPs are relevant to be used and will instruct staff if FFP3 or N95 respirators and/or additional precautions are required.

Procedures which are currently considered to create an increased risk of respiratory infection transmission and therefore require airborne precautions are published by the government and updated regularly: https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-infection-prevention-and-control-guidance-aerosol-generating-procedures

The government has also produced guidance that covers the donning and doffing of personal protective equipment for aerosol-generating procedures – for airborne procedures. All staff must be trained and competent in this and be able to perform a fit check on their respirator before carrying out an aerosol-generating procedure: https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-aerosol-generating-procedures
Certain other procedures or equipment may generate an aerosol from material other than personal secretions but are not considered to represent a significant infectious risk for COVID-19. Procedures in this category include

Staff should use appropriate hand hygiene when helping patients to remove nebulisers and oxygen masks.
In addition, the current expert consensus from the New and Emerging Respiratory Viral Threat Assessment Group (NERVTAG) is that chest compressions are not considered to be procedures that pose a higher risk for respiratory infections including COVID-19.

If the staff member has been giving personal care to service users and they are changing their work duties, for example, going to visit or work in the organisation’s office, then they must remove and dispose of their face mask, wash their hands and put on a new Type l or Type ll face mask.

Type 1 surgical masks do not protect the person wearing them but they may reduce the spread of COVID-19 by preventing passing on the virus to other people (for example, through respiratory droplets or via their hands after touching their mouth or nose and then touching surfaces). A Type IIR mask could also be used if lower specification masks are not available.
A social or physical distance of 2 metres should be maintained where possible.
If eating or drinking, the mask should be removed, disposed of and hands washed. Once finished eating or drinking, a new mask must be put on.
To enable homecare staff to remain at least 2 metres apart from the office staff, we have a designated area for collection and drop-off points for PPE and other equipment.
Car sharing.
If staff have to share a car, they must wear a face mask, clean the vehicle before and after use and open windows or car vents for ventilation.

If staff are required to have these skills for an individual service user then they are trained by a health professional.

Staff are trained to recognise the signs of infections and to understand what actions they are required to take.
In the event of the suspected outbreak of infectious disease at the organisation, advice on outbreaks can be sought from health protection nurses at Public Health England (PHE). If there is an outbreak or suspected outbreak of infection, it should be reported to PHE)for collation. PHE is responsible for advising on outbreak control and monitoring the outbreak.
If it is a suspected food-related outbreak, advice can be sought from environmental health departments

UK Health Security Agency

North East HPT. Floor 1 Barrass Bridge. Newcastle. NE1 8QH. Tel: 0300 303 8596

Environemtnal Health

Cicic Centre. Newcastle. NE1 8QH. Tel: 0191 78 7878

Waste should be placed in a refuse bag and can be disposed of as normal domestic waste unless the service user has confirmed COVID-19 or symptoms of COVID-19, that is, a new continuous cough, a high temperature, a loss of, or change in, your normal sense of taste or smell.
Waste from people with symptoms or confirmed COVID-19, waste from cleaning of areas where they have been (including disposable cloths and used tissues) and PPE waste from their care:

1. Should be put in a plastic rubbish bag and tied when three-quarters full.
2. The waste can be disposed of in the domestic waste stream 72 hours later.
3. Storage arrangements for these bags will be arranged with the service user and fully documented in the care plan for staff to follow.

Do not put any items of PPE (or face coverings of any kind) in the recycling bin

Symptoms develop two to ten days after the aspiration of the droplets with pneumonia type signs, such as a cough, shortness of breath, chest pain, confusion in their mental state, as well as gastrointestinal nausea, vomiting or diarrhoea and the individual should be seen by a GP.
Legionnaires is not contagious but can be fatal within certain age groups.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) oblige the organisation to report the outbreak of notifiable diseases to the Local Environmental Health Officer, who will inform the Health and Safety Executive (HSE). Notifiable diseases include cholera, food poisoning, smallpox, typhus, dysentery, measles, meningitis, mumps, rabies, rubella, tetanus, typhoid fever, viral haemorrhagic fever, hepatitis, whooping cough, leptospirosis, tuberculosis and yellow fever.
Records of any such outbreak, specifying dates and times, must be retained, and a completed disease report form sent to the HSE.
In the event of an incident, the Registered Manager is responsible for informing the HSE.
RIDDOR information is found on the HSE website and reports should be made using an online form.
Notifications must be sent to CQC as required in Regulation 20 “Duty of Candour”

This organisation has a dress code policy in place which ensures clothing worn by staff when carrying out their duties is clean and fit for purpose.

Regardless of wearing PPE, uniforms should be laundered:

If staff do not wear a uniform, they should change their clothing immediately when they get home and launder clothing used for work as described for uniforms above. This does not need to apply to underclothes unless there was contamination from the service users’ body fluid (for example, vomit, or fluids have soaked through external clothing). If prescription glasses or spectacles are worn, they should be cleaned using the cleaning fluid or wipes that are normally used for spectacles.

This organisation has a Vaccination Policy in place.

Accidents Incidents and Emergencies Reporting (RIDDOR)
Business Contingency and Emergency Planning
Co-operating with Other Providers
Confidentiality
Data Protection Legislative Framework (GDPR)
Dress Code
End of Life
Good Governance
MRSA
Notifications
Nutrition, Hydration and Food Safety
Prevention of Pressure Ulcers
Personal Protective Equipment
Vaccinations

Covid-19: infection prevention and control ( IPC)
https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

Covid-19:how to work safely in domiciliary care in England
https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-domiciliary-care

Stay at home guidance
https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection

Travel and quarantine guidance
https://www.gov.uk/guidance/how-to-quarantine-when-you-arrive-in-england
https://www.gov.uk/guidance/red-amber-and-green-list-rules-for-entering-england

Coronavirus:how to stay safe and help prevent the spread
https://www.gov.uk/guidance/covid-19-coronavirus-restrictions-what-you-can-and-cannot-do

CQCRegulation 12: Safe Care and Treatment:
https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulation-12-safe-care-treatment

NICE Guideline (CG139), March 2012, updated February 2017, Infection: Prevention and Control of Healthcare-Associated Infections in Primary and Community Care:

www.nice.org.uk/guidance/cg139

NICE Quality Standard QS61, published April 2014, Infection Prevention and Control:
https://www.nice.org.uk/guidance/qs61

Health and Social Care Act 2008 Code of practice for the Prevention and Control of Infections:

https://www.gov.uk/government/publications/the-health-and-social-care-act-2008-code-of-practice-on-the-prevention-and-control-of-infections-and-related-guidance

Royal College of Nursing Essential Practice for Infection Prevention and Control:
www.rcn.org.uk/

HSE Legionnaires:
https://www.hse.gov.uk/