adult care infection prevention and control policy

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Infection Prevention and Control Policy Issued: November 2020

Review Due: November

2021

Derbyshire County Council Adult Care Infection Prevention and Control Policy

Approval and Authorisation

Name Job Title Date

Authored by: Jane Parke Trevor Thacker Bob Thompson

Development and Compliance Service Manager Principal Health and Safety Officer Bob Thompson – Health and safety Officer

July 2013

Authorised by: Policy and Procedures Group February 2015

Change History

Version Date Name Reason

V 1 July 2010

V 2 July 2013 J Parke, Trevor Thacker & Bob Thompson

Review and update

V 2.1 October 2013 Trevor Thacker Update to include Actichlor instructions and General Infection control in care homes guidance note

V2.2 February 2015 Jane Parke, Trevor Thacker

Review and Update to include changes to Reportable Diseases

V3 July 2018 Emma Benton Review and update.

V4 November 2020 Jenny Harper Review in response to COVID 19 requirements.

This document will be reviewed on a regular basis – if you would like to make any comments, amendments, additions etc. please email Phil Robson. [email protected]

mailto:[email protected]

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Once printed, this is a controlled document 2

Ref: Title Page No:

1.0 Introduction 4

2.0 Policy Statement 4

3.0 Code of Practice 5

4.0 Roles and Responsibilities 6

5.0 Infection, Prevention and Control Duties Delegated to Staff 10

6.0 Infection 11

6.1 The Chain of Infection 11

6.2 Infections 11

6.3 Notifiable Diseases 12

6.4 Diseases Contracted by Staff Due to an Occupational Exposure 12

6.5 Visitors 12

7.0 Risk Assessments 13

8.0 Standard Infection Prevention and Control Precautions 14

8.1 Hand Hygiene 14

8.2 Personal protective equipment(PPE) 14

8.3 Aseptic Technique 17

8.4 Use and Care of Invasive Devices 17

8.4.1 Catheter Care 17

8.4.2 Enteral Feeding 18

9.0 Laundry 19

9.1 Residential and Day Services 19

9.2 Workwear 19

10.0 Preventing Infection 20

10.1 Immunisation 22

10.2 Antimicrobial Resistance 21

11.0 Cleaning 23


11.2 Home Care 24

11.3 Small Group Living 25

12.0 Pets 26

Contents

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13.0 Building Maintenance 27

14.0 Pest Control 27

15.0 Collection and Disposal of Waste 28


15.2 Home Care 29

16.0 Disposal of Sharps 30

17.0 Recognising Infections 31

17.1 First Signs 31

17.2 Isolation 31

18.0 Infection Outbreak 32

18.1 Managing the Outbreak 32

18.2 Monitoring and Reporting of Infections 33

19.0 Care of the Deceased 35

20.0 Occupational Health 36

21.0 Training 36

22.0 Audits 37

23.0 Monitoring and Reviews 37

23.1 Monitoring 37

24.0 Annual Statement 38

25.0 Appendix List 39

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This policy sets the standards by which the management and staff of Derbyshire County Council (DCC), Adult Care and Health will control the risk of the spread of infectious diseases when providing care and support. The general principles contained within this policy should be applied by all employees working within Adult Care and Health. Good infection prevention (including cleanliness) is essential to ensure that people who use health and social care services receive safe and effective care.

Derbyshire Adult Care will comply with the following legislation:

• The Health and Social Care Act 2008: Code of Practice on the Prevention and Control of Infections and Related Guidance (Department of Health, July 2015) (The Code).

• The Health and Safety at Work etc. Act 1974

• Management of Health and Safety at Work Regulations (as amended) 1999

• Control Of Substances Hazardous to Health 2002

• Medicines Act 1968

This policy sets out how DCC Adult Care will comply with the above Code of Practice. It applies to registered providers of all healthcare and adult social care in England. The Code of Practice sets out the 10 criteria against which the Care Quality Commission (CQC) will judge a registered provider on how it complies with the infection prevention (including cleanliness) requirements. The general principals contained within this policy should be applied by all staff working within Adult Social Care and Health.

It is a requirement that all Direct Care Services including contracted providers will produce and maintain a policy which sets out how these standards are to be met. Employee’s working for, or on behalf of DCC, Adult Care will comply and maintain high standards of personal hygiene when caring for all clients, whether it is known that they suffer from, or carry an infectious disease or not.

1.0 Introduction

2.0 Policy Statement

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The ‘Code of Practice’ is for all providers of healthcare and adult social care on the

prevention of infections under The Health and Social Care Act 2008. This sets out the 10

criteria against which a registered provider will be judged on how it complies with the

registration requirements related to infection prevention. Not all criteria will apply to every

regulated activity.

The Health and Social Care Act 2008: code of practice on the prevention and control of

infections and related guidance

Part 2: The Code of Practice

Compliance criterion

What the registered provider will need to demonstrate

1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider the susceptibility of service users and any risks that their environment and other users may pose to them.

2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.

3 Ensure appropriate antimicrobial use to optimise patient outcomes and to reduce the risk of adverse events and antimicrobial resistance.

4 Provide suitable accurate information on infections to service users, their visitors and any person concerned with providing further support or nursing/ medical care in a timely fashion.

5 Ensure prompt identification of people who have or are at risk of developing an infection so that they receive timely and appropriate treatment to reduce the risk of transmitting infection to other people.

6 Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection.

7 Provide or secure adequate isolation facilities.

8 Secure adequate access to laboratory support as appropriate.

9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.

10 Providers have a system in place to manage the occupational health needs and obligations of staff in relation to infection.

3.0 The Code of Practice

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

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Director of service will:

Ensure that systems are in place to effectively manage infectious diseases within all areas of Adult Care.

Appoint a lead officer with responsibility for producing and maintaining the Infection Control Management System for the department. This is the Group Manager for the Quality and Compliance Team working in conjunction with Health and Safety and Public Health.

Maintain their knowledge of infection control to a level commensurate with their responsibilities.

Set a good personal example.

Service director – direct care lead will:

Ensure that the departmental procedures for preventing and managing infections or infectious diseases are implemented throughout their area of control.

Monitor the performance of their service and sections within their service, with regards to the control of infectious diseases and compliance with the policy.

Delegate actions to the appropriate managers within their service to ensure compliance with the policy.

Maintain their knowledge of infection control to a level commensurate with their responsibilities.


Lead officer – infection control will:

Produce and maintain the department’s Infection Control Policy.

Monitor the performance of the department as a whole, services within the department and individual establishments as necessary, with regards to the control of infectious diseases and compliance with the policy.

Report directly to the Registered Provider (Service Director, Adult Care).

Act as a source of advice to managers on how to comply with all aspects of the policy and cascade the information.

Maintain their knowledge of infection control to a level commensurate with their responsibilities including the development of a network of professional contacts.

4.0 Roles and Responsibilities

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Service managers – direct care will: Verify the information gathered by the manager on the monthly infection control audits.

Carry out the Infection Control Audit for Service Managers on a six monthly basis on the services they oversee. Appendix 1

Ensure the annual individual observations of practice are carried for Home Care, Day Care and Residential Care. The form for all of these observations can found on Our Derbyshire.

Assist in the development of infection control actions plans and monitor their progress.

To cascade information and give advice to managers with regards to infection control.

Report directly to their Group Manager who will liaise with the lead officer for infection control.

Maintain their infection control knowledge to a level commensurate with their responsibilities. Operational Service Managers and Services Managers must escalate any concerns they have following audits regarding the standard of Infection Prevention Control within an environment in which care is provided.


Establishment managers (including registered managers) will:

Have overall responsibility and be accountable for infection control within their establishment.

Ensure tasks and duties with regards to infection control are carried out as required. Tasks can be delegated to other managers and staff as agreed with regards to their specific service.

Carry out risk assessments as necessary to ensure effective measures to control infection are put in place within the establishment(s) for which they are responsible. Review risk assessments at least annually or more frequently as required.

To ensure that personal service plans include detailed safe systems of work for staff to follow.

Ensure the provision of equipment and facilities to enable staff compliance with standard infection prevention and control precautions e.g. provision of personal protective equipment, hand hygiene facilities, equipment that is easily cleaned.

Monitor the performance of the establishment for which they have responsibility with regards to the control of infection, by carrying out the infection control audit for registered managers on a monthly basis, which addresses different parts of the establishment. Using the Infection Prevention and Control (IP&C) Audit Programme for Adult Care Premises’. Appendix 2 Produce an action plan with the Service Manager from the results of the audit in consultation with clients and staff as appropriate.

https://staff.derbyshire.gov.uk/secure-area/working-here/adult-care/residential-homes-forms/residential-homes-forms.aspx#id_token=eyJ0eXAiOiJKV1QiLCJhbGciOiJSUzI1NiIsIng1dCI6IkdmRW5acmoyMW4yYlYzdTRBaTRaSWs4Vll4WSIsImtpZCI6IkdmRW5acmoyMW4yYlYzdTRBaTRaSWs4Vll4WSJ9.eyJpc3MiOiJodHRwOi8vY29udGVuc2lzLXAuZGVyYnlzaGlyZS5nb3YudWsvYXV0aGVudGljYXRlIiwiYXVkIjoiV2Vic2l0ZUFkZnNDbGllbnQiL

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To provide performance data taken from the audit for the establishment’s service manager and to the Direct Care, Quality and Compliance section and be shared with Public Health.

Produce an annual report and action plan. Appendix 3

Maintain knowledge of prevention and infection control to a level equivalent to their responsibilities by completing training programs and attending update briefings. Provide or arrange refresher training on general and disease specific practice as appropriate. Ensure that all staff including agency staff can demonstrate they have attended up to date training of infection control procedures.

Utilise the Observation of Practice form to monitor staff performance in relation to infection control. Appendix 4a & 4b

The manager must ensure that all parts of the premises from which it provides care are

suitable for the purpose, kept clean and maintained in good physical repair and condition.

Have a clear plan for cleaning which details:

• The roles and responsibilities of managers, care staff and domestic staff.

• The frequency that cleaning takes place for each area.

• The level of cleaning required in each area.

• The substances used for each cleaning activity, including where appropriate

assessments carried out in compliance with the Control of Substances Hazardous to

Health (COSHH) Regulations (as amended) 2002.

• Instructions for cleaning equipment that includes the frequency, by whom and with

what be displayed where appropriate, for item such as hoists, beds and commodes.

• Instructions on how to carry out each cleaning activity.

Provide infection control information to their service manager as required.

Set a good personal example. Please see appendix 15 for latest government guidance and additional cleaning requirements links for residential facilities during outbreak of COVID-19 Community managers (Domiciliary Service Organisers) will: Provide information to staff on how to ensure the infection control policy is adhered to within their role.

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Ensure the provision, correct usage and agreed disposal of personal protective equipment.

Record on personal service plans any measures that need to be considered when providing personal care with regard to infection control.

Carry out risk assessments as necessary to ensure effective measures to prevent and control infections are put in place. Review risk assessments at least annually or more frequently as required.

To ensure that personal service plans include detailed safe systems of work for staff to follow.

Maintain knowledge of infection prevention and control to a level equivalent to their responsibilities by completing training programs and attending update briefings.

Ensure that all staff can demonstrate they have attended up to date training of infection control procedures. Provide or arrange refresher training on general and disease specific practice as appropriate.

Utilise the observation of practice form to monitor staff performance in relation to infection control. Appendix 4c

Provide infection control information to their service manager as required. Set a good

personal example.

Staff (e.g. care worker (community), senior care, care, domestic, catering, laundry

staff) as well as social workers and other council employees visiting residential

establishments and carrying out community visits will:

Follow the requirements of the infection control policy in relation to their role.

Maintain knowledge of infection control to a level equivalent to their responsibilities by completing training programs and attending update briefings as directed by their manager.

Adhere to any measures to prevent and control infection as identified in the personal support

plan and risk assessments in place, including the following of standard infection prevention

and control precautions.

Report any infection control concerns to their manager.


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The following form must be completed by the manager and updated.

NAME POSITION ALLOCATED DUTIES

5.0 Infection, Prevention and Control Duties for All Staff

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An infection is a disease, which is caused by a micro-organism (a living thing that cannot be seen by the naked eye, e.g. a virus, bacterium, fungus, etc.). Some can be transferred from one person to another e.g. influenza. These are known as communicable diseases.

6.1 The Chain of Infection

Many micro-organisms are acquired or deposited on the hands from the environments we live and work in, and the people we live and work with. These are known as ‘transient’ and do not live permanently on the skin and are readily removed or destroyed by appropriate hand hygiene.

The environment can also be contaminated by micro-organisms shed by people with an infection which can be spread to others. The greatest risk is from activities which have the potential for contact with blood and body fluids. Hand hygiene and adherence to the standard infection prevention and control precautions, alongside thorough cleaning of equipment such as commodes, is important to prevent cross infection.

Poorly cleaned or maintained equipment can also act as a reservoir of micro- organisms. Therefore regular cleaning and following the agreed cleaning schedules and ongoing maintenance minimises this risk.

Viruses that are responsible for colds and influenza are found in nasal secretion, saliva and sputum. Coughing or sneezing near another person may pass on these viruses in the droplets or aerosol produces (Remember Catch It, Bin It, Kill It). Touching your face will cause secretions to contaminate your hands with these viruses.

6.2 Infections

Examples of infections are:

• Hepatitis A B C

• Tuberculosis

• MRSA

• Food poisoning e.g. salmonella

• AIDS

• E.coli

• Clostridium difficile

• Sickness and diarrhoea outbreaks

• Influenza

• COVID-19

This list is not exhaustive. For guidance on specific diseases see:

• Departmental Health Related Illness Guidance. Appendix 5

• List of Diseases from the Prevention and Control of Infection in Care Homes – an

information resource. Appendix 6

6.0 Infection

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• For more detailed guidance on specific diseases, follow the link below.

Further Guidance from Public Health England

6.3 Notifiable diseases Notification of infectious diseases is the term used to refer to the statutory duties for reporting

notifiable diseases in the Public Health (Control of Disease) Act 1984 and the Health Protection

(Notification) Regulations 2010.

Registered medical practitioners (RMPs) have a statutory duty to notify the ‘proper officer’ at

their local council or local health protection team (HPT), of suspected cases of certain

infectious diseases.

Details of how to do this and a list of notifiable diseases are available here.

In the event of an establishment closure or the service is disrupted, a notification must be

completed by manager immediately to the Care Quality Commission (CQC).

6.4 Diseases Contracted by Staff due to an Occupational Exposure The Reporting of Injuries Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) require any disease contracted by a member of staff that is attributed to an occupational exposure to a biological agent is reported to the Health and Safety Executive (HSE). The disease must be diagnosed by a Registered Medical Professional (MRP).

The manager must inform Adult Care Health and Safety section who will then

report to HSE (see section 20)

6.5 Visitors

It is important that staff engage with visitors in preventing and controlling the spread of

infection by reminding them of handwashing procedures and any other specific precautions

that must be adhered to.

Potential visitors who are in any way unwell must contact the manager prior to their visit for

advice. In certain circumstances they may be required to postpone their visit until they have

been clear of symptoms for a period of 48 hours e.g. diarrhoea or vomiting symptoms.

For COVID-19 visiting restrictions please ensure current Derbyshire County Council Policy is

applied.

https://www.gov.uk/government/organisations/public-health-england

https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report

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Infection control Risk Assessments must be carried out by a competent person, to assess the

risk to client, other service users, employees, visiting professionals and all those involved in

performing personal care tasks and others who may be at risk of exposure to infection arising

from the provision of the care.

The Establishment Manager:

• Must ensure that standard infection prevention and control precautions are followed, including for those with a diagnosis of MRSA.

• Will provide guidance on cleaning commodes and equipment, etc.

• Will ensure manufactures guidance is provided for the operating of sluices.

• Must ensure that suitable and sufficient assessments of the risks to the

person receiving care with respect to prevention of infection are in place.

• Must identify the steps that need to be taken to reduce or control those risks.

• Must record its findings.

• Must implement the steps identified.

• Put methods and interventions in place to monitor the risks of infection to

determine whether further steps are needed to reduce or control infection.

• Must ensure that these assessments are completed on a DCC General Risk

Assessment form and stored electronically and in the paper version of the

client’s file.

• The contents of the assessment must be brought to the attention of staff

affected by the assessment. Records of the giving of this information must be

kept.

Below is a list of risk assessments which you may need to complete:

• Providing personal care.

• Cleaning commodes.

• Cleaning equipment, e.g. hoists, wheelchairs, etc.

• Operating sluices.

This list is not exhaustive.

Department Health Illness Guidance (DHIG) are produced for managers and

others to refer to for, enabling them to carry out the correct procedures when dealing

with specific infections and injuries. The guidance is available in Appendix 5

7.0 Risk Assessments

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8.1 Hand Hygiene

Hand hygiene is the single most important measure to reduce the spread of infection.

All employees providing personal/direct care for any client(s) will:

• Wash/clean and dry their hands thoroughly using soap and water, preparing food, before and after delivering personal care/toileting, when caring for someone with diarrhoea symptoms, and prior to tasks requiring aseptic technique.

• In community settings and some areas of an establishment sanitizer will be provided where there are no suitable washing facilities. Staff will be expected to wash their hands with soap and water at the earliest opportunity and should not rely on hand sanitizer unless no other option is available.

• Wear appropriate personal protective equipment (PPE) as identified by risk assessment.

• Dispose of the PPE following guidance in the guidance below:

Hand Hygiene Posters must be displayed in appropriate areas in establishments this includes sluice rooms, staff toilets, laundry areas etc. Appendix 14a & 14b

8.2 Personal Protective Equipment (PPE)

Required for the provision of personal care or other task where there is potential for contact with blood and body fluids e.g. cleaning commodes:

• Disposable gloves.

• Disposable plastic apron.

• Any other item identified as required by a risk assessment e.g. fluid resistant

surgical masks, visors

• A tabard must only be worn for food preparation and handling.

• Staff must wear clean workwear each day.

• Further PPE may be provided on recommendation by infection control advisers or medical professional.

Risk assessments must be undertaken to identify if there is any risk to staff who have contact with clients, but who do not provide personal/direct care. For example, community mental health workers, community care workers, social workers etc. This assessment must identify appropriate infection control measures.

8.0 Standard Infection Prevention and Control Precautions (SIP & CP)

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Applying, removing and disposing of PPE

PPE will only protect you and others if you know how to put it on and take it off correctly and dispose of it safely.

Disposable gloves

Putting on:

• Perform hand hygiene.

• Select correct glove size and type.

• Pull to cover wrists.

Taking off:

• Grasp the outside of the glove with the opposite gloved hand and peel off.

• Hold the removed glove in the gloved hand.

• Slot your finger under the lip of the remaining glove and peel it off, taking care not to touch the contaminated outer surface.

• Dispose of the gloves in the waste bin.

• Perform hand hygiene. Appendix 14a & 14b

Please see link to donning and doffing procedure:

Putting on personal protective equipment (PPE)

Taking off personal protective equipment (PPE)

Disposable aprons

Aprons must always be changed after you finish care activities with each person. Putting on:

• Pull the apron over your head and fasten at the back of your waist. Taking off:

• Unfasten (or break) the ties.

• Pull the apron away from your neck and shoulders, lifting it over your head and taking care to touch the inside only, not the contaminated outer side.

• Fold or roll the apron into a bundle with the inner side outermost.

• Dispose of the apron in the waste bin.

• Perform hand hygiene. Appendix 14a & 14b

The above process must be followed for each episode of personal care provided for each client.

Appropriate PPE and hand washing/cleansing facilities and substances must be made available to all providers of personal care.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881004/Putting_on_PPE_Care_Homes.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881005/Taking_off_PPE_Care_Homes.pdf

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8.3 Aseptic Technique

An aseptic technique is used to carry out a procedure in a way that minimises the

risk of contaminating an invasive device, e.g. urinary catheter, or a susceptible body

site such as the bladder or a wound. This should only be carried out by those that

have been appropriately trained.

Examples of when an aseptic technique would be used are:

• Maintaining or dressing an invasive device, e.g. urinary catheter.

• Protecting wounds with a dressing.

• PEG feeds and medication administration.

Use standard precautions:

• Single use items are identified by this symbol on the packaging.

• Store sterile equipment in clean, dry conditions, off the floor and away from potential damage.

• Dispose of waste as per local agreement.

A non-touch technique (clean technique) must be used for the following:

• Dressing open wounds that are healing by secondary intention, e.g., pressure sores, leg ulcers, dry wounds, simple grazes.

• Emptying a urinary catheter drainage bag.

8.4 Use and Care of Invasive Devices

Invasive devices such as a urinary catheter or intravenous line will increase a client’s risk

of acquiring an infection. Where client’s have an invasive device in place, this must be fully

documented in the care plan and the client must be monitored for signs of infection. Staff

must be trained in the care of clients with invasive devices and in how to recognise signs

and symptoms of infection.

8.4.1 Catheter Care

Bacteria can enter the urethra at the point where the catheter enters the body. The date of

catheter insertion and the indication for catheterisation must be recorded in the client’s

notes. The client's clinical need for catheterisation should be reviewed regularly by the GP

or district nurse and the urinary catheter removed as soon as possible. The following advice

will minimise the risk of the client acquiring an infection.

Handling the catheter

Hands must be washed and a clean pair of disposable gloves must be put on before

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handling the catheter or drainage bag. Hands must be cleaned again after removing

gloves.

The point at which the catheter enters the body must be cleaned daily with soap and

water.

Managing the drainage system

The drainage bag or catheter valve must be connected to the catheter at all times, except when changing the bag. This ‘closed system’ reduces the risk of infection. At night, the special night drainage bag must be added without breaking the closed system. The drainage bag must be kept lower than the bladder to allow urine to drain.

The bag must not be allowed to touch the floor because this can increase the infection risk. Catheter bag stands should be used. The drainage bag must be checked and emptied regularly to maintain the flow of urine.

8.4.2 Enteral Feeding

Enteral feeding (sometimes called enteral nutrition or artificial feeding) is prescribed for

those who cannot eat normally. Liquid feed is given through a fine tube that enters the body

by one of three ways:

• Through the nose into the stomach – naso-gastric feeding.

• Directly into the stomach – gastrostomy or PEG feeding.

• Directly into the small bowel – jejunostomy feeding.

Feed must be stored according to the manufacturer’s instructions.

Hands must be washed thoroughly and a clean pair of non-sterile gloves must be put on before preparing the feed or touching the equipment. The insertion site, or stoma (the place where the feeding tube enters the body), must be cleaned with water every day and dried well. To prevent blockage, the enteral feeding tube must be flushed with fresh water before and after feeding or administering medications. Enteral feeding tubes for people whose immune system is not functioning properly (who are ‘immunosuppressed’) must be flushed with either cooled freshly boiled water or bottled sterile water (not bottled mineral or table water) from a freshly opened container. Minimal handling and an aseptic technique must be used to connect the administration system to the feeding tube.

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A pack of pre-packed feed can be used for up to 24 hours in a feeding session. Feeds that have been prepared on site must not be used for longer than 4 hours in a feeding session. After each session the bags and administration sets must be disposed of as household rubbish.

9.1 Residential and Day Services

Each establishment must follow the Laundry Policy and Good Laundry Practice Information Pack.

Use this video on the following web link for staff training purposes.

9.2 Workwear

Workwear must be short sleeved so the forearm is bare from the elbow and does not impede effective hand hygiene and long hair must be tied back.

Staff must change into/out of workwear at the start and end of each shift where there are suitable facilities to do so. In establishments workwear must be laundered on site and washed separately from other items at 60 degrees celsius or the temperature stated on the garment label.

In the community it may not be possible to change into/out of workwear between visits. Where this is not possible staff must wear a clean set of workwear each day. All workwear must be washed separately at 60 degrees Celsius or the temperature stated on the garment label.

The manager must ensure that the DSG for jewellery, clothing, footwear, fingernails, and personal belongings is followed which is listed in Appendix 5.

Off duty staff must not go shopping wearing workwear or undertake similar activities in public. This is because workwear worn after work must be considered ‘dirty’, and workwear must be clean on arrival at work, and not be exposed to other environments.

9.0 Laundry

https://www.youtube.com/watch?v=xIJ-TQaimT4

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10.1 Immunisation

Staff

Vaccinations which create immunity (protection) to certain infections will be provided for

staff, free of charge, where they have been identified as required by a risk assessment.

Whilst some general practitioners will provide these immunisations free of charge, an

increasing number are refusing, as they see it as being an occupational health function. In

these instances specialist clinics may have to be used. Any costs will be met by the

department if it is highlighted by the risk assessment as a need.

It may also be advised by an appropriate medical professional e.g. GP, infection control

specialist or occupational health physician, that individual members or groups of staff, as

part of their work, are at risk from contracting or carrying an infectious disease and could

spread this disease to people in their care or to the wider community. Where this is the case

it must recorded on the risk assessment.

The list of diseases is not exhaustive and will be guided by the risk assessment of staff

groups, taking into account the nature and level of contact with clients.

The most common diseases which some staff may need vaccination for in social care work

are:

• Hepatitis B.

• Tuberculosis.

• Influenza (Seasonal)

• COVID-19(when available)

please see appendix 15 for latest government guidance and additional cleaning

requirements for residential during outbreak of COVID-19

Guidance for time off for work related vaccinations can be found in Employee

Leave Schemes and Flexible Working.

Client

Managers and staff must ensure that clients have information about vaccinations in a way

that they understand so that they are able to make informed decisions about immunisation

e.g. flu. Where necessary they must assist the client in accessing this service.

10.0 Preventing Infection

https://staff.derbyshire.gov.uk/pay-and-benefits/holidays-and-leave/employee-leave-schemes-and-flexible-working/employee-leave-schemes-and-flexible-working.aspx

https://staff.derbyshire.gov.uk/pay-and-benefits/holidays-and-leave/employee-leave-schemes-and-flexible-working/employee-leave-schemes-and-flexible-working.aspx

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10.2 Antimicrobial Resistance

Antimicrobial resistance happens when a micro-organism (bug) has adapted and learnt to

fight an antimicrobial drug that was originally able to kill it and therefore, stop infections caused

by it.

Resistant bugs (including bacteria, fungi, viruses and parasites) are able to withstand attack

by drugs, such as antibiotics, antifungals, antivirals, and antimalarial.

Eventually standard treatments become ineffective and infections persist, increasing the risk

of spread to others. This means it is now more difficult to treat common infections, such as

urinary tract infections.

Poor infection control practices, unhygienic living conditions and inappropriate food-

handling encourage the further spread of resistant bugs.

Staff must:

• Be aware of the importance of ensuring drugs that treat infections are given. as prescribed and that no doses are missed.

• Keep accurate records of antimicrobial prescriptions.

• Document any known allergies.

• Record dose, duration and reason for treatment. Therefore it is important the Medication Administration Record (MAR) is up to date and

followed as prescribed. Please refer to your specific services medication policy for more

information.

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Cleaning is one of the most import factors in preventing the spread of infection and cross contamination. All premises where personal care is provided must maintain appropriate standards of décor, cleanliness and hygiene. Residential establishments generally employ their own domestic staff but day services are cleaned either by Property Services or staff employed by the owner/manager of non-Derbyshire County Council owned premises. For staff carrying out cleaning activities, appropriate training in infection control techniques must be provided. Specific cleaning regimes will have to be followed for certain specified illnesses. More information on this can be found in Departmental Safety Guidance List at Appendix 5 and in the Infection Outbreak in Section 18 of this policy. Each establishment must have a cleaning schedule that covers all parts of the unit and must be readily available for inspection by interested parties. Where the premises are cleaned by others this information should still be made available. Service Managers should be assured that relevant standards are being met. Please refer to the Domestic Policy. For copies of the Adult Care Domestic Cleaning System - cards and wall chart please contact the Catering and Domestic Services Manager. 11.1 Residential and Day Services

Where staff are employed by Adult Care, Unit Managers must refer to the Domestic Policy. To ensure premises under the control of Derbyshire County Council, Adult Care Department have a clear plan for cleaning which details:

• The roles and responsibilities of managers, care staff and domestic staff.

• The frequency that cleaning takes place for each area.

• The level of cleaning required in each area.

• The substances used for each cleaning activity, including where appropriate assessments carried out in compliance with the Control of Substances Hazardous to Health (COSHH) Regulations (as amended) 2002.

• Instructions for cleaning equipment, including hoists, beds and commodes, and displayed where appropriate.

• Instructions on how to carry out each cleaning activity.

The domestic cleaning system provides the following information about each cleaning task

including how to deal with body spillages:

11.0 Cleaning

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• The contamination risk category of the task, red - high, blue - medium or yellow – low.

• The colour coded equipment required to carry out the task to prevent cross contamination.

• All relevant safety information including first aid advice.

• Product dilution rates.

• Instructions on how to carry out the cleaning tasks.

• The standard to be achieved on completion of the cleaning task.

The system includes wallcharts to be displayed in appropriate areas of the unit such as

sluices.

Laminated cleaning plans must also detail actions to be taken in an emergency e.g. spillages

of body fluids, etc. This plan must specify the equipment to be used for dealing with body

fluids, e.g. colour coded buckets, mops, bags, etc. These must be on display in appropriate

areas of the unit such as sluices.

Any defects including tears to mattresses, commodes, soft furnishings, etc. must be reported

to the manager on duty immediately to record and take any action.

The building maintenance must be kept to an acceptable standard and any broken floor/wall

tiles, toilets, sinks, etc., must be reported to the manager on duty who must record and take

any action immediately.

Day Services (cleaned by Property Services)

Unit managers must liaise with the cleaning supervisor responsible for supervising their site

for information regarding hours employed and cleaning frequencies.

Day Services (cleaned by non DCC staff)

Unit Managers must liaise with the owner/manager of the premises in relation to the time any

cleaning hours are worked, the products used and the frequency of cleaning. It may be

necessary for day services staff to undertake some cleaning duties if others use the building

before our day services and no planned cleaning has taken place. This would involve using a

sanitiser to disinfect any hand contact surfaces such as door handles, tables, chair arms, etc.

11.2 Home Care

For Home care services any cleaning activities required must be set out in the personal

service plan (PSP).

In most circumstances staff will be expected to use, and clean equipment used, at the point of

care e.g. hoists, beds and commodes. They will use clearly labelled

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substances provided by the client/carer which are in their original containers and follow the

instructions on the label.

In extreme circumstances, equipment/substances may be provided by the department e.g.

intensive clean. Where this is the case, appropriate assessments carried out in compliance

with the Control of Substances Hazardous to Health (COSHH) Regulations (as amended)

2002 will be required.

11.3 Small Group Living

In some small care homes the specific aim will be to support people to be independent and

to have choice and control over their daily life, including decisions about the environment in

which they live.

In a service where people are generally well and supported to develop independent living

skills:

• Detailed cleaning schedules would not be necessary. Cleaning responsibilities

and routines must form part of the individual plan of care.

• There must be a plan for cleaning communal areas which describes individual

responsibilities for cleaning.

• Staff must carry out ongoing monitoring of the standard of cleanliness and

support clients if cleanliness falls short of an acceptable minimum.

• Risk assessments must be in place.

• Recorded in the clients individual Personal Support Plan.

For all of these above services please see appendix 15 for latest government guidance and

additional cleaning requirements for residential during outbreak of COVID-19

http://www.hse.gov.uk/nanotechnology/coshh.htm



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The registered manager must ensure that all animals brought into the home are within the following recommended guidelines and also for the relevant Departmental Health and Illness Guidance (DHIG) list in Appendix 5.

• All animals must be regularly groomed and checked for signs of infection or

other illness.

• If pets become ill, diagnosis and treatment by a vet must always be sought and the animal should not be returned to the home until restored to health.

• All animals must have received relevant inoculations.

• All animals must be wormed regularly.

• Claws must be kept trimmed to reduce the risk of scratches. Any scratches on residents must be promptly and thoroughly cleaned and observed for signs of infection.

• Pets must have been exercised before being allowed to meet with residents.

• All pets, but especially cats and dogs, must have their coats cleaned regularly.

• Bedding must also be cleaned regularly and appropriate insecticides used, as necessary, on the environment and the pet to control fleas.

• Specialist advice must be sought if problems occur.

Care home staff should be familiar with good hygiene practice in relation to pets. These include:

• Pets should not be permitted to lick residents.

• After residents and guests have touched animals, they must wash their hands thoroughly.

• Pet feeding areas must be kept clean.

• Pets must have their own feeding dishes, be washed separately from dishes and utensils used for residents and staff.

• Pets must not be fed in the kitchen or other food preparation areas.

• Pet food containers, once opened, must be kept separate from food for human consumption.

Litter boxes must be dealt with as follows:

• Cleaned by someone who is healthy and not pregnant.

• A protective apron and gloves must be worn when litter boxes are being cleaned.

• A disposable liner must be fitted to the box for easy cleaning.

• Litter must be changed daily.

• Litter must be sealed in a plastic bag and disposed of in the general waste situated outside the establishment.

• The box must not be situated near food preparation, storage or eating areas.

• The box must be disinfected weekly by filling with boiling water which is allowed to stand for at least five minutes, in order to reduce the risk of toxoplasma infection.

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The manager must ensure that the premises is kept clean, suitable for its intended purpose

and maintained. Equipment that is used to deliver care and treatment is clean, suitable for

the intended purpose, maintained, stored securely, in the appropriate location and used

properly.

Any defects including tears to mattresses, commodes, soft furnishings, etc. must be

reported to the manager on duty immediately to record and take any action.

Should any issues be identified this must be risk assessed to establish its potential severity

and therefore prioritised accordingly where an action plan is put into place

e.g chipped plaster in a lounge is a lower priority to the chipped plaster in a toilet. The service

manager must be informed of the identified areas of concern and the action required in

rectifying the problem.

Pests contaminate and spoil food and rodents damage the fabric of buildings from the woodwork to electric cables. Control measures should include the following:

• A manager must take on the role of pest monitoring officer and liaise with an

environmental health officer from the local authority or a reputable commercial pest control company.

• Stop pests entering with well-fitting doors, covered drains, fly screens or bird- netting. Sealing of potential entry points such as small holes in brick work or pointing.

• Look out for evidence of the presence of pests – droppings, nests, chew-marks on wood or cables (in the case of rodents) or, for insects, droppings, egg cases, vomit marks, damaged food containers, webbing caused by moths or the presence of the live insects themselves.

• Discard any foodstuffs or other articles affected by pests, including milk from bottle tops that have been pecked by birds.

• Clean up any spillages and decaying food immediately, carry out regular inspection and rotate any stock, use rodent-proof containers with well-fitting lids and store food off the ground.

• Use and maintain properly installed electric, flying-insect killer.

• Use plastic wheelie bins for all waste as these can be easily cleaned. A risk assessment and safe system of work must be produced on how this will be achieved.

13.0 Building Maintenance

14.0 Pest Control

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Health care waste could include the following:

Infectious – orange bag

• Contaminated dressings from infected wounds

• PPE e.g. gloves and aprons after care of infectious clients

• human waste from infected clients/isolated clients

• all waste produced from clients under barrier precautions

Offensive – tiger bag

Offensive hygiene or recognisable healthcare waste not known to be infected;

• incontinence pads

• wound dressings

• Colostomy/catheter bags etc.

• Disposable personal protective equipment (PPE) used for providing personal care and cleaning up body fluids.

• nappies

Non-infectious/ general waste could include the following: - black bag

• Paper hand towels.

• .

• Everything not listed above, for example bubble wrap and plastic wrappers

Sharps may include the following:

• Needles.

• Broken glass.

15.1 Residential and Day Service

It is important that clinical/infectious waste and non/infectious/offensive waste is separated before being disposed of.

Waste must only be disposed of as clinical/infectious if it is known to be such. This will require managers and staff to be aware of residents/clients and staff who are infectious as diagnosed by a registered medical practitioner (RMP).

In residential or day care, it is the responsibility of the unit manager to arrange a contract with a licensed waste disposal operator to dispose of the infectious, clinical waste and offensive waste. All other waste will be disposed of by the contracted service.

15.0 Collection and Disposal of Waste

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Procedure for disposal of health care waste in residential/day care settings

See the Waste Segregation poster at Appendix 7

• All internal bins must be foot operated

• Waste must be segregated in accordance appendix 7. There must be no transport of loose waste around the establishment

• All bags to be no more than two thirds full.

• Bags to be sealed using strong tape e.g. parcel tape or similar or knotted.

• Sealed bags to be stored in a suitable receptacle provided for this purpose to prevent access by unauthorised persons or animals.

• Sealed bags to be collected by a licensed waste disposal contractor and taken for incineration.

15.2 Home Care

A medical practitioner/nurse will make an assessment of the health care waste being produced in a person’s home and they will classify this accordingly. If the waste is classified as clinical infectious they will make separate arrangements for this to be collected.

Procedure for disposal of waste in home care settings

This section is dependent on waste collection services available for the different local councils, therefore the following is best practice guidance.

Clinical infectious waste should be placed in a yellow or orange bag and sealed. This should be collected separately but each area has specific arrangements for the collection of clinical waste which must be included in local infection control procedures. For COVID specific waste disposal please follow national guidance in appendix 15

Non-infectious/offensive waste produced in a client’s home.

Provided the quantity of waste produced does not exceed ½ a bag per collection it can be double black bagged, tied and put into the refuse bin. If the quantity is more than ½ a bag and likely to be produced on a regular basis the assessing medical practitioner should be informed so that a suitable mode of collection can be identified.

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Procedure for the disposal of sharps in home care and residential settings

All sharps e.g. syringes, diabetes testers, etc. must be placed in a ‘sharps’ bin provided by health.

The bin must be brought to the client for them to place the sharps into the bin. Staff must never touch a needle.

When a sharps bin is full the manager of the establishment or service will arrange for the collection and disposal of the bin.

All sharps injuries must be reported to health and safety section on the DCC online incident

reporting system. For relevant DSG see Appendix 5.

Where it is known that the sharp is infected with a blood borne virus or where the staff

member develops a blood borne virus at a later date as a result of the needle stick injury, the

health and safety section will report to the HSE and the registered manager must notify CQC.

For further information regarding the reporting of any occupational exposure to an infectious

disease please see the Adult Care Accident Reporting and Investigation Guidance and Section

20 of this document.

16.0 Disposal of Sharps

https://staff.derbyshire.gov.uk/secure-area/secure-site-elements/secure-documents/your-wellbeing/health-and-safety/adult-care/adult-care-accident-and-assault-reporting-and-investigation-guidance.pdf

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17.1 First Signs

Where a staff member is concerned that a client may have contracted an infection. It is their

responsibility to inform the senior person on duty and record their findings in the clients daily

log sheets. The senior person must then contact the relevant heath care professional to

request a health care review ensuring prompt treatment.

The manager must ensure that all staff are made aware of any clients who have contracted

an infection or infectious disease and how this is being managed. The giving of this

information must be recorded.

In an adult care service, general practitioners will provide advice and report where necessary

to the appropriate authority when a client develops an infection. The GP may then wish to

draw on local professional expertise in infection prevention and health protection.

When specimens have been requested these must be safely contained in an approved leak

proof container. This must be enclosed in another container, commonly a sealable polythene

bag. The request form must be placed in the side pocket of the polythene bag and must not

be secured with clips or staples, as these may puncture the bag. Care must be taken to

ensure the outside of the container and the bag remains free from contamination with blood

and other body fluids. The request form must be completed fully. This includes the client

identifier, the test required and relevant clinical details. Specimens to be sent by post must be

in an approved post office container surrounded by absorbent material. The specimen must

be sent by first class post.

17.2 Isolation

Some infections may require the isolation of clients. See Departmental Health and Illness Guidance (DHIG) list at Appendix 5 for specific diseases for clear guidance.

Managers and staff who are using isolation as a control measure should bear in mind that if a resident is deemed not to have capacity, the Mental Capacity Act 2005 Deprivation iaof Liberty Safeguards (DoLS) applies. If residents are to be confined to particular parts of the establishment as an infection control measure, advice should be taken from a senior manager as to whether specific action might need to be taken under the Mental Capacity Act or use of the Deprivation of Liberty Safeguards.

17.0 Recognising Infections

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An outbreak is defined as two or more cases of the same infection occurring around the same time, in clients and/or their carers or staff or an increase in the number of cases normally observed.

The most common outbreaks are due to viral respiratory infections and gastroenteritis. These organisms are usually spread by hand contact with body fluids or contaminated environments, and on occasions by other routes such as in food e.g. Salmonella.

How to recognise symptoms that may indicate a possible outbreak. For example:

• Cough and/or fever might indicate influenza/COVID-19.

• Diarrhoea and/or vomiting might indicate clostridium difficile, norovirus or food poisoning.

• Skin lesion/rash might indicate scabies.

The clients GP must be informed as soon as any of the above symptoms are noticed.

18.1 Managing the Outbreak

• Stop admissions to affected areas of the building during the outbreak. Only discharge clients who have had the infection and been 48 hours clear, or who have not had the infection and could manage at home should they become unwell.

• Inform visitors (particularly care workers and social workers) of the outbreak by putting up notices on the front door and consider limiting visits to family members only (Appendix 8).

• Emphasise the importance of hand washing with soap and water, to visitors and ask them to wash their hands before leaving. Visitors should preferably not eat or drink during their visit.

• Let the hospital know that there is an outbreak at the home if any client has to be admitted using the Transform Form (Appendix 9).

• Do not transfer any clients to another facility until the outbreak is over unless there is a clinical need.

• Visitors who have had sickness/diarrhoea must not visit until they are free from symptoms for 48 hours.

• Ensure that the GP or health professional that has identified the infection as an outbreak has informed the appropriate authorities.

• The manager must ensure that the Outbreak Form is completed and saved in their electronic team record (Appendix 10).

• The manager must monitor the outbreak using the Outbreak Monitoring Form (Appendix 11).

• Please appendix 15 which includes the latest government guidance with respect to dealing with periods of sustained community transmission of COVID-19

18.0 Infection Outbreak

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18.2 Monitoring and Reporting of Infections

Any member of staff working in a care home environment has a duty to notify their line

manager if they suspect a client has an infection. The client must then be assessed by their

GP as soon as possible.

The manager must inform Public Health England’s (PHE) local health protection team (HPT)

if they suspect that there may be an outbreak of an infection or infectious disease - that is two

or more clients present with the same symptoms of an infection. Prompt reporting of cases of

infectious disease to PHE is essential for the monitoring of infection and allows for early

investigation and prompt control of its spread.

You will need to ring the:

Public Health England - East Midlands East Midlands Health Protection Team Seaton House City Link Nottingham NG2 4LA

Telephone: 0344 2254524 and select option 1 (the voice message describes this as “clinical enquiries”).

You will be transferred to the admin team who will need the following information from you; Your name, the address of the home you are ringing from and a contact telephone number for follow up.

The following information is required:

• How many clients the home accommodates.

• How many clients are unwell.

• How many staff work at the home.

• Have any staff have reported as unwell, if yes how many.

Your will be transferred to a member of the clinical team who will discuss your concerns and offer you advice on how best to deal with your situation.

A record must be kept of the following information on clients, with suspected or confirmed

infections or infectious disease on the Outbreak Form (Appendix 10):

• Name, age / date of birth.

• GP’s 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, staff, visitors.

• Outcome.

• Whether the case was notified/ reported to proper officer/HPTand date of reporting.

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Information must also be kept for any staff members that develop similar symptoms.

Certain cases of infectious disease, whether suspected or confirmed (by laboratory tests),

must be notified by the client’s GP to the proper officer of the local authority (who may be part

of PHE’s local Health Protection Team) under the Health Protection (Notification) Regulations

2010.The proper officer will inform the HPT of such cases.

As at June 2017, there is no statutory requirement to notify the CQC about outbreaks of

infection.

The current system of mandatory reporting of specific infections to PHE, as applied to the

NHS, does not apply to care homes.

Ref: Department of Health & Health Protection Agency (2013) Prevention and Control of

Infection in Care Homes – an information resource

In relation specifically to COVID-19 where it is believed that the worker contracted the infection

whilst at work this must be reported to Health and Safety using the online report.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/214929/Care-home-resource-18-February-2013.pdf



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The precautions used during life for residents with an infectious disease remain necessary

after the person’s death.

The body of a person who has had an infectious disease may remain a hazard to those who

handle it. In addition, it may be necessary for the body to be placed in a waterproof body bag

before removal to the undertakers.

This information should be communicated to the undertaker without any breach in

confidentiality. The undertaker will normally supply a body bag, if it is required.

To minimise the risk of infection, disposable gloves and an apron must be worn by those

carrying out the laying-out procedure, whether this is done by staff, the undertaker, or by

relatives under supervision.

Relatives who wish to view the body should not be prevented from doing so. Clear advice

needs to be given to relatives if infection control precautions are required.

If relatives wish to take the body abroad for a funeral, certificates may be required from the

attending doctor to certify that the body is safe for transport. This will normally be organised

by the undertakers, in liaison with the doctor.

The furniture, curtains, carpets and any equipment in the resident’s room must be cleaned

thoroughly using hot water and disinfectant.

For COVID-19 requirements in this area please follow the guidance in appendix 15.

19.0 Care of the Deceased

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Staff must report any episodes or illness to their manager particularly after travel abroad following guidance from their medical practitioner. When necessary staff may need to be excluded from work until they have recovered. A list of these instances is given at Appendix 12.

Managers must offer immunisation in accordance to the information already given in Section 10 and the Departmental Health and Illness Guidance (DHIG) for specific diseases. Appendix 5

Prevention of occupational exposure to blood-borne viruses includes the application of standard infection prevention and control precautions and the safe handling and disposal of sharps. Please see the occupational exposure flowchart in Appendix 13.

All Derbyshire County Council, Adult Care employees, or employees of agents acting on their behalf, who may be involved in providing personal care and therefore infection control, must receive appropriate training commensurate with their duties.

Infection control training must be delivered at induction, with refresher training every 3 years.

Records of attendance at training for all staff must be maintained through Derbyshire Learning Online

DCC, Adult Care will provide such training as is necessary to enable staff to work safely to reduce the risk of them contracting or spreading infection.

It is important that all members of staff have a clear understanding of their responsibilities to prevent the spread of infection and are familiar with any infection prevention and control policies and procedures that are in place.

20.0 Occupational Health

21.0 Training

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Purpose of the Audits

In order to ensure effective infection control management systems are in place, it is

necessary to have a two tier auditing system:

Tier One – is to be completed by the establishment manager annually. It is designed

to check all areas meet the required standards for cleanliness and that all infection

control procedures are being followed. To enable ease of management the audit is

designed to be carried out in 12 monthly sections using the Infection Prevention and

control (IP&C) Audit Programme found at Appendix 2. High risk areas e.g. sluices,

toilets, laundry, etc. must be checked more frequently by the person allocated the

responsibility for that area as set out in Section 5 of this policy

Tier Two – is to be completed by the service manager to check the necessary

systems are in place to ensure compliance with the policy using the Service

Manager six monthly audit form found at Appendix 1.

It is the responsibility of the manager to discuss the infection control audit findings

with the relevant staff. Infection Prevention and Control must be a standing agenda

item at regular staff meetings where actions plans resulting from the monthly IPC

audits are discussed and actions allocated appropriately. A copy of the meeting

minutes must be made available to any staff who could not attend the meeting.

Action Plans

The action plan, located at the end of the monthly audit form is to be completed in

full by the manager and progress reviewed regularly by the service manager.

Any actions required identified on the plan must be entered onto the Service

Improvement and Development plan (SID).

Covid19 - IPC Audits

During periods of sustained community transmission of COVID 19 all

residential establishments must complete the COVID Infection Control return

by the 28th of every month. Where a premises has designated covid beds,

these returns must be completed on a weekly basis.

Following an outbreak of COVID-19 at an establishment an Outbreak

Learning Review will be completed involving public health, quality and

compliance and health and safety.

22.0 Audits

https://forms.office.com/Pages/ResponsePage.aspx?id=s46aQhAyGk6qomzN4N2rxYVtoGbw0CdCj_RcyFKPp4hURDQ2SE9RMUxVUzc4STNMS0xUMFpTMFZUWSQlQCN0PWcu

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23.1 Monitoring

For Derbyshire County Council, Adult Care, compliance with this policy will be monitored by:

• Establishment monthly Infection control audits carried out by the manager.

• Establishment 6 monthly management audit carried out by the service manager.

• Incident and outbreak reports.

• Incident and outbreak investigations.

23.0 Monitoring and Reviews

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The unit manager must produce an annual statement which provides a short review of:

• known outbreaks of infection;

• audits undertaken and subsequent actions;

• action taken following an outbreak of infection;

• risk assessments undertaken for prevention and control of infection;

• education and training received by staff; and

• review and update of policies, procedures and guidance

This statement must be submitted to the DCC, Adult Care Infection Control Lead by April of each year and will be published on the Derbyshire County Council website (Appendix 3).

24.0 Annual Statement

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Ref: Title Page No:

1 Service Managers 6 monthly audit sheet 40

2 Establishment Monthly Audit sheets 41

Jan Environment (Clients Personal) 41

Feb Environment (Clinical) 41

Mar Environment (Sluice) 41

Apr Environment (Domestics Room) 41

May Environment (Clients Communal/Shared) 41

Jun Environment (Staff) 41

Jul Linen and Laundry 41

Aug Food Hygiene 41

Sep Waste and Sharps Management 41

Oct Personal and Protective Equipment 41

Nov Clients Equipment 41

Dec Pets 41

3 Annual Statement 42

4 a Residential Individual Observation Record 43

b Day Services Individual Observation Record 43

c Home Care Individual Observation Record 43

5 Departmental Safety Guidance (DSG) & and Departmental Health & Illness Guidance (DHIG)

44

6 List of Diseases 45

7 Waste Segregation Poster 54

8 Visitor Outbreak Notice 55

9 Transfer Form 56

10 Outbreak Reporting Form 58

11 Outbreak Monitoring Record 61

12 Exclusion of Staff From Work 63

13 Occupational Exposure Flowchart 66

14 a Hand Washing Technique with Soap and Water 67

b Alcohol Hand-Rub Hand Hygiene Technique 68

25.0 Appendix List

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15 Admission and Care of Residents in Care Homes and in the Community During COVID-19

69

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Appendix 1 Service Managers 6 Monthly Audit – please follow link

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Appendix 2

Infection Prevention and Control (IPC) Audit programme for Adult Social Care Premises.

Welcome to the Infection Prevention and Control (IPC) Audit programme for Adult Social Care Premises.

Audit is a requirement of; The Health and Social Care Act 2008, Code of practice on the prevention and control of infections and related guidance (The Code).

This audit programme has been split in 13 modules;

Module 1, Infection Prevention and Control Management, is completed by the service manager, twice yearly, and must be forwarded to the IPC lead on the day of completion. (See the Adult Care IPC Policy).

Modules 2 – 13 are carried out, or delegated by the registered manager. Once completed to be sent to IPC lead, by the last Friday of each month.

Please ensure that accurate and detailed information is recorded. This is important information that will contribute to the development of service plans.

When this audit has been completed it must be discussed with the staff and management team.

Infection, Prevention & Control Audit Module 2 Environment (Residents personal) – please follow link Infection, Prevention & Control Audit Module 3 Environment (Clinical) – please follow link Infection, Prevention & Control Audit Module 4 Environment (Sluice) – please follow link Infection, Prevention & Control Audit Module 5 Environment (Domestics room) – please follow link Infection, Prevention & Control Audit Module 6 Environment (Residents communal areas) – please follow link Infection, Prevention & Control Audit Module 7 Environment (Staff) – please follow link Infection, Prevention & Control Audit Module 8 Linen & Laundry – please follow link Infection, Prevention & Control Audit Module 9 Food Hygiene – please follow link Infection, Prevention & Control Audit Module 10 Waste & Sharps Management – please follow link Infection, Prevention & Control Audit Module 11 Personal Protective Equipment – please follow link Infection, Prevention & Control Audit Module 12 Residents/clients Equipment – please follow link Infection, Prevention & Control Audit Module 13 Resident’s pets/Therapy Pets/visitor’s pets – please follow link

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Appendix 3

Infection Control Annual Statement – please follow link

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Appendix 4 Residential Individual Observation Record – please follow link

Day Services Individual Observation Record – please follow link

Home Care Individual Observation Record – please follow link

https://staff.derbyshire.gov.uk/secure-area/secure-site-elements/secure-documents/adult-care/residential-individual-observation-records.doc

https://staff.derbyshire.gov.uk/secure-area/secure-site-elements/secure-documents/adult-care/day-services-individual-observation-record.doc

https://staff.derbyshire.gov.uk/secure-area/secure-site-elements/secure-documents/adult-care/homecare-individual-observation-record.doc

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Appendix 5

Department Safety Guidance (DSG) and Departmental Health & Illness Guidance (DHIG) are produced for managers and others to refer to for, enabling them to carry out the correct procedures when dealing with specific infections and injuries.

The following guidance is available on the DCC electronic staff information system:

DHIG Clostridium difficile procedures for Home Care DHIG Clostridium difficile procedures for Residential Homes DHIG Hepatitis A, B & C Advice to Managers

DSG Jewelry Clothing Footwear Finger Nails and Personal Belongings DSG Prevention of Needle Stick Injuries DHIG Tuberculosis Advice to Managers DHIG Shingles DHIG Candida Auris DHIG E-coli DHIG MRSA DHIG Keeping Animals DHIG MSSA DHIG Respiratory Illness DHIG Diarrhoea & Vomiting DSG Jewelry clothing footwear fingernail and personal belongings includes the following instructions:

• No false nails

• No nail varnish

• Fingers nails are short and clean

• Wedding band -check

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45

Appendix 6

List of Diseases

Disease or causative organism

Mode of transmission Period of infectivity Additional Infection control precautions

Notes Notify local HPU

Bacillus cereus food poisoning

• Food (preformed toxin)

Not infectious. None. Retain food samples. Yes

Body lice • Person-to-person Until treated. If new resident, single room until treated.

Launder resident’s clothing and bedding.

No

Campylobacter spp.

• Food • Hand-to- mouth • Pet faeces

While diarrhoea persists.

Single room if incontinent.

Separate toilet. Increased cleaning of areas contaminated with body fluids.

A local risk assessment should be undertaken to determine if pets in contact with resident need to be examined by a vet.

Yes, as the infection could be the result of food poisoning.

Chickenpox (varicella)

• Airborne • Contact with rash

Infectious for 1–2 days before the onset of symptoms and 6 days after rash appears or until lesions are crusted (if longer).

Single room. Pregnant staff and visitors who are not immune should avoid contact. Local HPU will advise on the management of contacts and may advise immunoglobulin and early antiviral therapy.

Yes

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Clostridial food poisoning

(C. perfringens)

• Food Not infectious. None. Toxin formed in gut after ingestion. Retain food samples.

Yes

Clostridium difficile

• Hand-to-mouth • Environmental

contamination


Single room whilst symptomatic.

Separate toilet. Increased cleaning of equipment and high contact surfaces that could be contaminated with body fluids.

May need treatment with antibiotics. Can cause outbreaks if standard precautions are not adhered to.

Yes- if there is a risk of cross infection

Cold sore (herpes simplex)

• Direct contact with lesions

Until lesions crusted. Use gloves for handling lesions, feeding or mouth care.

No

Conjunctivitis • Direct contact with the discharge

Until 48 hours after treatment.

Gloves/no touch technique when dealing with discharge. Personal hygiene/hand hygiene.

If two or more related cases are suspected

COVID-19 • Air borne • Surface contact • Droplet

Yes 10 days from onset of symptoms or positive test result (14 days for resident)

See appendix 15

Yes

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Cryptosporidiu m spp.

• Water • Hand-to-mouth


Single room. Separate toilet.

Yes

Escherichia coli including verotoxin- producing E. coli (VTEC)

• Food • Hand-to-mouth

Variable, but unlikely to infect others by 48 hours after diarrhoea stops unless poor hygiene/

Incontinent.

Single room until 48 hours after diarrhoea stops.

Separate toilet.

Retain food samples. Complications include haemolytic uraemic syndrome. Contact the HPU for advice on contact tracing and sampling.

Yes

Fleas • From pets • Person-to-person

Until treated. If new resident, single room until treated.

Treat pets. Launder resident’s clothing and bedding.

Vacuum room of infected person daily for several days, with particular attention to pest resting sites.

No

German measles (rubella)

• Droplet, direct contact with infectious secretions.

Incubation period of 14–17 days. (range 14

– 21). Individuals are infectious from about one week before, and at least four days after, the onset of the rash.

Single room Pregnant staff should know their immune status and seek advice if not immune.

Non-pregnant staff should be immunised if susceptible.

Yes

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Giardia lamblia • Water • Hand-to-mouth

Until treated Single room, if incontinent. Separate toilet.

Yes

Head lice • Person-to-person Until treated Combing egg cases (nits) and live lice from hair.

No

Hepatitis A • Hand-to-mouth • Food

The incubation period is 15 –50 days,

average 28–30 days. Maximum infectivity occurs during the latter half of the incubation period and continues until 7 days after jaundice appears.


May be asymptomatic, but can be severe and prolonged in older people.

Yes

Hepatitis B • Contact with infected blood or other body fluids

• Sexual transmission

Variable, but can be for life.

Strict application of standard precautions, including care with sharps and body fluids

Immunisation of some staff may be recommended.

Yes – for acute infection (jaundice)

No – for chronic carrier state

Hepatitis C • Contact with infected blood or other body fluids

For one or more weeks prior to onset of the first symptoms; may persist in most persons indefinitely. May be infectious for life

Standard precautions including care with sharps and body fluids.

Yes – for acute infection (jaundice) No – for chronic carrier state

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HIV/AIDS • Contact with infected blood or other body fluids

• Sexual transmission

For life. Standard precautions, including care with sharps (see pages 30 - 31) and body fluids.

Resident’s GP, consultant and the Local HPU will collaborate with management.

No

Impetigo (staphylococcal Or streptococcal)

• Direct contact with lesions

Until crusted over. Single room until 48 hours after treatment started.

Cover lesions if mixing with other residents.

The bacterium may be carried in the nose of infected resident, other residents or staff.

If more than two cases suspected

Infectious mononucleosis (glandular fever)

• Contact with saliva Variable – may be several weeks.

Care with articles soiled with nasal or throat discharges. Encourage hand hygiene.

No

Influenza or influenza-like illness

• Droplet • Direct and indirect

contact.

While symptomatic. Single room. Reinforce the importance of respiratory and hand hygiene.

See page 38 Immunisation of residents.

If influenza is confirmed by laboratory.

Otherwise if more than two cases suspected

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Measles • Airborne, direct contact with infectious secretions.

Incubation period is approximately 10 days

(range 7 – 18 days) from exposure to onset of fever and, usually, 14 days before the rash appears. The

person is infectious from four days before the rash onset and 4 days after rash appearance.

Single room Local HPU will advise on the management of contacts.

Pregnant staff should know their immune status and seek advice if not immune. All staff should have received 2 doses of MMR or have natural immunity.

Yes

Mumps • Droplet Incubation period around 17 days (range 14 - 25). Greatest infectivity is from 2 days before the onset of symptoms to 4 days after symptoms appear.

Single room. Local HPU will advise on the management of contacts. Staff should have received 2 doses of MMR.

Yes

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Norovirus • Hand-to-mouth • Droplet

Up to 48 hours after symptoms have resolved.


Strict adherence to standard precautions and prompt isolation of affected individuals/areas to prevent spread. Increased cleaning of items contaminated with body fluids and high contact points eg. door handles.

Very likely to cause outbreaks. Yes

Pinworms, threadworms

• Hand-to-mouth

• Airborne during bed making

Until treated. Personal hygiene, including hand hygiene.

Vacuum room of infected person daily for several days.

If more than two cases suspected

Pulmonary tuberculosis

• Airborne if ‘open’ case (sputum smear positive). Otherwise not infectious

Normally 2 weeks after starting treatment.

Single room if sputum smear positive.

Local HPU will advise on the management of contacts (residents and staff).

Yes

Rotavirus • Hand-to-mouth • Droplet

Up to 48 hours after symptoms have resolved.

Single room. Separate toilet. Increased cleaning of items contaminated with body fluids and high contact points

Very likely to cause outbreaks. Yes

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Salmonella spp. • Food • Hand-to-mouth

Variable, but unlikely to infect others by 48 hours after diarrhoea stops, unless poor hygiene/

incontinent.


Separate toilet. Increased cleaning of items contaminated with body fluids and high contact points eg. door handles.

Retain food samples. Organism can be in stools for weeks/ months after infection.

Yes

Scabies • Person-to-person (close contact)

Until treated. Single room until 24 hours after treatment Launder resident’s clothing and bedding

Untreated or the immune suppressed may develop more severe form of scabies. In this case it may be necessary to treat other residents, staff and family members.

If more than two related cases suspected

Shigella spp. • Hand-to-mouth • Water or food

contaminated by infected water

Variable, but unlikely to infect others by 48 hours after diarrhoea stops unless poor hygiene/

incontinent.


Separate toilet.

Very likely to cause outbreaks. Complications include haemolytic uraemic syndrome.

Yes

Staphylococcal food poisoning

• Food (preformed toxin)

Not infectious. None Retain food samples. Food contamination from infected fingers, eyes, etc. of food handlers likely.

Yes

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Shingles (herpes zoster)

• Usually reactivation (of chickenpox)

• Direct contact with rash

• Airborne

Until lesions crusted Single room until rash has crusted.

A resident with shingles may mix with other residents if rash can be covered.

Staff and residents should not be in contact unless immune to chickenpox.

If management of case poses difficulties

Viral gastroenteritis (undiagnosed)

• Hand-to-mouth • Droplet

Variable. May be several days after symptoms resolve

Single room. Separate toilet. Increased cleaning of items contaminated with body fluids and high contact points eg. door handles.

Very likely to cause outbreaks. If more than two cases occur

Whooping cough (pertussis)

• Droplet Five days after start of appropriate antibiotic treatment.

Single room Local HPU will advise on the management of contacts.

Yes

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Appendix 7

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Appendix 8

NOTICE TO ALL VISITORS

We are currently experiencing an infectious outbreak. Please contact the Manager in charge for further advice

with regards to visiting.

Help stop the spread of infections

Thank you

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Appendix 9

TRANSFER FORM

Inter-Health and Social and Social Care Transfer Form The Health and Social Care Act 2008: Code of Practice on the prevention and control of infection and related guidance (Dept. of Health 2015) states that “suitable accurate information on infections be provided to any person concerned with providing further support or nursing/medical care in a timely fashion”. This form has been developed to help you share information with other health and social care providers. This form should accompany the patient and, where possible, a copy filed in the patient’s notes.

Patient name: GP name & contact details:

Address:

NHS no:

Date of birth:

Current location:

Receiving facility e.g. hospital ward, hospice:

If transferred by ambulance, has the service been notified? YES / NO (please delete)

Is the patient an infection risk? Please delete as appropriate & give details of the confirmed or suspected organism.

Confirmed risk YES / NO Organism(s):

Suspected risk YES / NO Organism(s):

No known risk YES / NO

Has the patient been exposed to others with infection? e.g. COVID19, D & V, Influenza YES / NO / UNAWARE (please delete) If yes, please give details:

If the patient has a diarrhoeal illness, please indicate bowel history for the last week (if known, based on Bristol Stool Form Scale). Is diarrhoea thought to be of an infectious nature? YES / NO (please delete)

Relevant specimens: (if results available)

Specimen:

Date:

Result:

Treatment details:

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Is the patient aware of their diagnosis / risk of infection? YES / NO (please delete) Does the patient require isolation? YES / NO (please delete) If the patient requires isolation, phone the receiving facility in advance. YES / NO / N/A (please delete)

Additional information:

Form completed by: Designation: Date: Phone number:

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Appendix 10

Reporting Outbreak: Information for Public Health England’s Health Protection Units

Date Completed:

Reported by (Print Name):

Name of care setting: Address:

Post Code: Telephone number of care setting: E-Mail address:

Name of Manager/Contact person:

SUSPECTED OUTBREAK OF:

TYPE OF SYMPTOMS AND ANY INFORMATION ABOUT THE SUSPECTED CAUSE OF THE OUTBREAK:

ACTION TAKEN: (isolation/ exclusion of cases/ enhanced hand washing/ cleaning/ closure to admissions etc):

INFORMATION: ANY FURTHER ACTION REQUIRED:

INFORMATION REPORTED

DETAILS SUBMITTED TO PHE?

Yes

SUBMITTED TO PHE?

No 1. Number of residents, staff or visitors who are affected. Include number of staff off-sick

2. Total number of residents / clients in the home

3. Total number of staff employed within the home, including agency and bank staff who may have worked shifts during the incubation period / outbreak

4. Date of onset of first symptoms

5. Names and date of birth of Case(s) with

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symptoms involved in the outbreak

6. Type of specimens taken and results if they are available

7. Medical History of residents with symptoms (to identify vulnerable people). Including recent hospital admissions and discharges

8. Details of any resident admitted to hospital as a result of the outbreak

9. Details of any resident/client that has died as a result of the outbreak

10.Details of vulnerable residents/clients within the care home

11.Layout of the environment: Number single rooms, wings, units, floors within the care home (including names of these)

12.Facilities within the Care home: Floor plans, catering arrangements, toilet/bathing facilities.

13.Is food cooked on the premises?

14.Is any food prepared by external companies? If Yes: Name of Company?

15.Have any residents/staff eaten out or attended social gatherings at other venues?

16.Is any food brought in by relatives, staff or visitors?

17.Details of vaccination programmes or clinical history will be needed in certain circumstances.

This may include both

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staff and residents (e.g. Flu, pneumococcal MMR, Hepatitis, BCG, Meningitis, Chickenpox)

18.Any other information that Care Home feels needs to be included

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Appendix 11 OUTBREAK MONITORING RECORD FORM

Establishment

Date Notified

Contact Name Health and Safety

Environmental Health Officer

Service Manager

Care Commission (if applicable)

Name (and address if member of staff)

Resident (R)

Staff (S)

Date of Birth Date and Time of Onset

Symptoms *

Date of Recovery

Stool Sample Date

Sample Result

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Name (and address if member of staff)

Resident (R)

Staff (S)

Date of Birth Date and Time of Onset

Symptoms *

Date of Recovery

Stool Sample Date

Sample Result

* Diarrhoea (D) Vomiting (v) Diarrhoea and Vomiting (D & V) HS61d Send the completed copy of this form to the Health and Safety Section at Matlock once the outbreak is over.

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Appendix 12

Exclusion of staff from work

The following table gives advice on the minimum period of exclusions from work for staff members suffering from infectious disease (cases) or in contact with a case of infection in their own homes (home contacts). Advice on work exclusions can be sought from the care home occupational health advisor or local HPU/HPN/CIPCN.

DISEASE PERIOD OF INFECTIVITY PERIOD OF EXCLUSION

Chickenpox Infectious for 1–2 days before the onset of symptoms and until all vesicles are dry

Until all vesicles are dry

Conjunctivitis Until 48 hours after treatment Until discharge stops

COVID-19 10 days from onset of symptom or date of first positive test. In case of contact only 14 days isolation

Return on day 11 if well and without a temperature for 48 hours. Day 15 if still symptom free

Diarrhoea and/or vomiting

Depends on causative organism. Until clinically well and 48 hours without diarrhoea or vomiting.

Erythema infectiosum (slapped-cheek syndrome) Erythrovirus B19

Four days before until 4 days after onset of rash

Until clinically well

Gastroenteritis (including salmonellosis and shigellosis)

As long as organism is present in stools, but mainly while diarrhoea lasts

Until clinically well and 48 hours without diarrhoea or vomiting. Local HPU or EHP may advise a longer period of exclusion

Glandular fever When symptomatic Until clinically well

Giardia lamblia While diarrhoea is present Until 48 hours after first normal stool

Hand, foot and mouth disease

As long as active ulcers are present One week or until open lesions are healed

Hepatitis A The incubation period is 15–50 days, average 28-30 days. Maximum infectivity occurs during the latter half of the incubation period and continues until 7days after jaundice appears

One week after onset of jaundice

HIV/AIDS For life None

Influenza/influenz a type illness

Adults usually infectious for up to five days after symptoms begin, children can be infectious up to 7 days

Until recovered

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Measles About 10 days (range 7-18 days) From one day before the beginning of the prodromal period to four days after the appearance of the rash

Meningitis Varies with organism Until clinical recovery

Mumps Greatest infectivity from2 days before onset of symptoms to 4 days after symptoms appear

Four days from onset of rash

Rubella (German measles)

One week before until 4 days after onset of rash

Four days from onset of rash

Streptococcal sore throat and scarlet fever

As long as organism is present in throat, usually up to 48 hours after antibiotic is started

Until clinically improved (usually 48 hours after antibiotic is started)

Shingles Until after the last of the lesions are dry Six days from onset of rash - until all lesions are dry

Tuberculosis (TB) Depends on site of infection. In the case of smear positive pulmonary TB, until cleared by TB clinic. No exclusion necessary in other situations

Threadworm As long as eggs present on perianal skin None but requires treatment

Typhoid fever As long as case harbours the organism Seek advice from Local HPU

Whooping cough One week before until 3 weeks after onset of cough (or 5 days after start of antibiotic treatment)

Until clinically well, but check with Local HPU

Impetigo As long as purulent lesions are present Until skin has healed or 48 hours after treatment started

Head lice As long as lice or live eggs are present Exclude until treated

Ringworm

1. Tinea capitis (head)

2. Tinea corporis (body)

3. Tinea pedis (athlete’s foot)

As long as active lesions are present



Exclusion is not necessary unless an outbreak is suspected None

None

Scabies Until mites and eggs have been destroyed Until day after treatment is given

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Verrucae (plantar warts)

As long as wart is present None (warts should be covered with waterproof dressing for swimming and barefoot activities)

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Appendix 13

Source: Prevention and control of infection in care homes – an information resource

February 2013

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Appendix 14a

Hand washing technique with soap and water

Hands should be washed before and after all care procedures, and handling food. Also after dealing with used linen, waste and body

fluids or contaminated equipment and after removing gloves.

Steps 3-8 should take at least 15 seconds

Source: Source: Department of Health Prevention and control of infection in care

homes – an information resource February 2009

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Appendix 14b

Alcohol hand-rub hand hygiene technique for visibly clean hands

Rub hands for hand hygiene! Wash hands when visibly soiled.

Alcohol hand rubs are an effective and rapid means of hand decontamination and

should only be used on visibly clean hands

Source: Department of Health Prevention and control of infection in care homes – an

information resource February 2009

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Appendix 15

Admission and Care of Residents in Care Homes and in the Community During COVID-

19

Overview of adult social care guidance on coronavirus (COVID-19) – please follow this

link

For care home specific guidance – please follow this link

COVID19 Essential Cleaning Guidance for

Care Settings Caring for Residents or Service

Users with Confirmed or Suspected COVID19

https://www.gov.uk/guidance/overview-of-adult-social-care-guidance-on-coronavirus-covid-19

https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-homes

https://staff.derbyshire.gov.uk/site-elements/documents/working-here/adult-care/covid-19-essential-cleaning-guidance-for-care-settings-caring-for-residents-or-service-users.pdf



adult care infection prevention and control policy

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