Infection Prevention & Control Manual Care Home: Care Home Manager: Infection Prevention & Control Link Staff: Version 1.0 - November 2017 (Review date 2019)
Introduction The aim of this manual is to provide guidance and direction of where to access national guidance, key documents, local contacts details and audit tools to support your existing infection prevention and control policies (IPC) and practices. These resources should not replace your corporate and local policies but should be used as an additional resource and reference. IPC National Guidance: The Department of Health Guidance Prevention of Infection in care homes (2013) and the NICE Clinical Guideline (2017) provide guidance and information on the structure and management of infection prevention within care homes including how infections are spread, basic IPC practices and useful information such as reporting outbreaks. Water: Water may pose a risk of infection to vulnerable individuals. The Health & Safety Executive guidance of the control of Legionella bacteria in water systems (2013) provides guidance for duty holders regarding their legal duties to manage the risks of Legionella. It is important that you keep your records up to date including the name of the responsible person, the latest water risk assessment and action plan, records of flushing and temperature recordings as directed by your water risk assessment. Vaccinations: The Health & Safety at Work Act (1974) states that employers, employees and the self-employed have a specific duty to protect as far as reasonably practical those who may be affected by their work. The Department of Health Immunisation against infectious disease Chapter 12 (2014) gives specific advice on occupational health management and the immunisation of health and social care workers. Employers need to demonstrate that there is an employee vaccination programme in place and have records of the immune status of staff. Winter Readiness: Winter brings additional infection risks and Public health England: winter readiness information for London care homes (2017) is a document providing guidance, information, resources and a checklist specifically for care homes. It is prudent to undertake a self-audit using the check lists to measure how prepared your facility is for winter. Carbapenemase Producing Enterobacteraiceae (CPE) Toolkit: These multidrug resistant organisms are an emerging gut organism causing outbreaks in hospitals across London and the UK. This toolkit gives specific guidance on managing these patients when they are living in the community which includes care homes. Audit tools: These are a selection of audit tools that you may wish to use to undertake your routine self-audit of infection prevention and control management and practices including environmental assessments and hand hygiene. National guidance is updated regularly and this resource manual contains guidance that is correct at November 2017. 2
Index Useful Contact details Pg 4 Resources available online (Links included in manual) Department of Health Guidance: Prevention of infection in care homes An information resource 2013 Department of Health Summary for staff: Prevention and control of infection in care homes 2013 NICE Clinical Guideline 139: Healthcare associated infections: prevention and control in primary and community care 2017 Water Health & Safety Executive: Legionnaires disease: Approved Code of Practice and guidance on regulations 2013 Vaccinations Department of Health: Immunisation against infectious disease, Chapter 12, Immunisation of healthcare workers and social care staff 2014 Pg 5 Pg 6 Pg 7 Pg 8 Pg 9 Public Health England: Winter-readiness information for London care homes 2017 Pg 10 Public Health England: Toolkit for managing carbapenemase-producing Enterobactericeae in non-acute and community settings Pg 11 Audit tools included in manual Audits IPC Environmental and clinical practice audit for Care homes (self- audit every 6 months or sooner if indicated) Pg 12 Hand hygiene audit (self- audit every month or sooner if indicated) Pg 20 Own resources Water Care home records of water risk assessments, risk management plan and details of care home duty holder Care home records of water temperature control and flushing Vaccinations Care home record of employees vaccinations and immune status Audits Other care home audit tools/records Care home cleaning schedules and plans 3
Useful Contact Details Name Role and Organisation Contact Details Care Home Manager Infection Control Link Person Infection Control Team Debbie Calver Epsom & St Helier NHS Trust Infection Control Nurse Specialist Sutton CCG 020 8209 2000 ext 3411/2768 debbie.calver@nhs.net 020 3668 1311 Accident & Emergency Epsom & St Helier NHS Trust 020 8209 2000 Public Health Health Protection Team London Borough Sutton Consultant for Communicable Diseases PHE South London Health Protection Team molly.jordan@sutton.gov.uk 020 8770 5585 Phone: 0344 326 2052 Fax: 0344 326 7255 4
Resources available online Department of Health Guidance: Prevention of infection in care homes An information resource 2013. Link to website: https://www.gov.uk/government/publications/infection-prevention-and-control-in-carehomesinformation-resource-published 5
Department of Health Summary for staff: Prevention and control of infection in care homes 2013. Link to website: https://www.gov.uk/government/publications/infection-prevention-and-control-in-carehomesinformation-resource-published 6
NICE Clinical Guideline 139: Healthcare associated infections: prevention and control in primary and community care 2017. Link to website: https://www.nice.org.uk/guidance/cg139/resources/healthcareassociated-infectionsprevention-and-control-in-primary-and-community-care-pdf-35109518767045 7
Health & Safety Executive: Legionnaires disease: Approved Code of Practice and guidance on regulations 2013. Link to website: http://www.hse.gov.uk/pubns/priced/l8.pdf 8
Department of Health: Immunisation against infectious disease, Chapter 12, Immunisation of healthcare workers and social care staff 2014. Link to website: http://media.dh.gov.uk/network/211/files/2012/09/green-book-updated-140313.pdf 9
Public Health England: Winter-readiness information for London care homes 2017. Link to website: http://www.nellpc.org.uk/wp-content/uploads/2017/09/winter-readiness-information-for- London-care-homes-2017-and-2018.pdf 10
Public Health England: Toolkit for managing carbapenemase-producing Enterobactericeae in non-acute and community settings 2015. Link to website: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/439801/cpe- Non-AcuteToolkit_CORE.pdf 11
Audit tools Care Home Audit Date of audit: Location: Auditor: Accompanied by: Number of Residents: Additional information: AUDIT RESULTS % Standard Audited Environment 1 IPC Management 2 Staff Training 3 Communal Area 4 Bedrooms 5 Bath/Shower rooms/toilets 6 Environmental Cleaning 7 Linen and Laundry Management 8 Food Hygiene and Handling 9 Sharps Management 10 Waste Management 11 Personal Protective Equipment 12 Resident Equipment % Compliance Average % 12
Standard: Infection prevention and control management is seen as an integral part of the overall business of the Care Home and is afforded high priority. Infection Prevention and Control Management including guidelines and policies 1 Is there a named lead person responsible for infection prevention and control? 2 Are there up to date local contact telephone numbers available to obtain advice pertaining to infection prevention and control? 3 Can the person in charge (on any shift) state how they would manage an outbreak? 4 Are up to date infection prevention and control policies and guidelines available and accessible by staff? 5 Are staff offered immunisation in line with current national guidelines and an in house record kept? 6 Does the establishment have an exclusion from work policy for staff? Infection Prevention and Control Management - Staff Training 1 Is infection prevention and control included in all staff induction programmes? 2 Have staff received mandatory training in infection prevention and control in line with local policy and training needs analysis? 3 Is food hygiene training provided for all staff that handles or serves food? 4 Do staff working in the laundry receive training on handling linen and laundry processes? Additional Comments Standard: To reduce the risk of microbial contamination in every day practice and to ensure there is a managed environment that minimises the risk of cross infection to residents, staff and visitors. Communal Areas including Entrance, Reception, Lounge, Dining room 1 Is the environment visibly clean? 2 Is the environment free from any visible damage? 3 Is furniture made of impermeable and washable materials? 4 Are all furnishings and fittings visibly clean? 13
5 Are all furnishings and fittings in a good state of repair 6 Is the floor visibly clean? 7 Is the flooring in a good state of repair? 8 Are curtains/blinds visibly clean? Bedrooms 1 Is the environment visibly clean? 2 Is the environment free from any visible damage? 3 Are all furnishings and fittings visibly clean? 4 Are all furnishings and fittings in a good state of repair? 5 Is the floor visibly clean? 6 Is the flooring in a good state of repair? 7 Is the hand wash basin accessible? 8 Is liquid soap available for staff use? 9 Are paper towels available from an enclosed dispenser? 10 Are commodes in a good state of repair? 11 Are the commodes visibly clean and ready for use? 12 Is manual handling equipment visibly clean? 13 Are en-suite toilets visibly clean? Bath/Shower Rooms/Toilets 1 Is the environment visibly clean? 2 Is the environment free from any visible damage? 3 Is the floor visibly clean? 4 Is the floor covering washable and impervious to moisture? 5 Is the flooring in a good state of repair? 6 Is the hand wash basin accessible? 7 Are hand wash basins free from extraneous items? 8 Is liquid soap available? 9 Are paper towels available from an enclosed dispenser? 10 Are baths/showers visibly clean? 11 Are shower curtains visibly clean? 12 Are anti-slip bath mats visibly clean and free from mould? 13 Are hoists visibly clean and in a good state of repair? 14 Are appropriate cleaning materials available for staff to clean the bath/shower between uses? 14
15 Are bathrooms free from inappropriate items? 16 Are all toiletries single resident use? Environmental Cleaning 1 Is there a colour coding system in place for cleaning equipment? 2 Is there provision for the separate storage of domestic cleaning equipment? 3 Is there a disposal unit for the disposal of contaminated waste water? 4 Are mops and buckets stored clean and dry? 5 Are mop heads laundered or disposable? 6 Are cleaning cloths laundered or disposable? 7 Does the establishment have suitable equipment to clean carpets? 8 Are staff aware of the procedures to be used when removing body fluid spillages? 9 Is a high level disinfectant available e.g. hypochlorite for environmental/equipment disinfection? Additional Comments Standard: The laundry room and linen are managed appropriately to prevent cross infection Linen and Laundry Management 1 Is there a designated area for the storage of clean linen which is separate to used linen? 2 Is all linen stored off the floor? 3 Is the area / room used to store clean linen free from inappropriate items? 4 Is used linen placed directly into appropriate colour coded bags/containers at the point of use? 5 Are water-soluble bags used for soiled and/or infected linen? 6 Is used linen stored in a designated area until collection, e.g. sluice room, dirty utility room? 7 Do staff wear disposable gloves and aprons when handling soiled linen? 15
8 Is there a designated area for laundering used linen, which is well away from food preparation areas OR used linen, is laundered via a commercial laundry/hospital? 9 Is there a dirty to clean flow in the room? 10 Is the environment visibly clean? 11 Is the floor visibly clean? 12 Is the floor covering washable and impervious to moisture? 13 Are all work surfaces visibly clean? 14 Is there a designated hand wash basin? 15 Is the hand wash basin accessible? 16 Is the soap dispensed from a single use cartridge? 17 Is the liquid soap dispenser wall mounted? 18 Are paper towels available from an enclosed dispenser? 19 Is there a promotional hand hygiene poster displayed? 20 Is there written guidance regarding how to use the washing machine/tumble dryer? 21 Is the washing machine an industrial machine? 22 Is the tumble dryer an industrial machine? Additional Comments Standard: Procedures will be in place to ensure that food will be prepared, stored and served to minimise the risk of cross infection. Food Hygiene and Handling 1 Is food belonging to individual residents stored in the fridge labelled with their name/date and expiry/eat by date? 2 Is staff food in the fridge labelled with their name and date when it should be consumed by? 3 Is the fridge free from medicines and specimens? 4 Are food supplement drinks discarded 4 hours after opening or in accordance with labelling instructions? 5 Do staff wash their hands when entering the kitchen area? 6 Do staff serving meals or feeding residents wear clean designated tunics OR colour coded disposable aprons? 16
7 Do staff wash their hands prior to serving meals/feeding residents? 8 Are residents always offered the opportunity to wash their hands before meal times? Additional Comments Standard: Sharps are managed safely to reduce the risk of inoculation injury. Sharps Management 1 Are staff aware of the procedure for managing an inoculation contamination injury? 2 Do the sharps containers conform to BS7320 (1990)/UN 3291 standards? 3 Are sharps containers assembled correctly? 4 Are all sharps containers labelled or tagged with date, locality and a signature on assembly? 5 Are all sharps bins free from protruding items? 6 Are the contents of all sharps containers below the `fill line`? 7 Are in use sharps containers safely positioned and out of reach of vulnerable people? 8 Are sharps container lids temporarily closed in between use? 9 Are sharps disposed of safely and at the point of use? 12 Are locked sharps containers stored in a secure facility away from public access until collected for disposal? Additional Comments 17
Standard: Waste is managed safely and in accordance with legislation so as to minimise the risk of infection or injury to residents, staff and the public. Waste Management 1 Are infectious/healthcare risk waste bags labelled before storage and disposal? 2 Are offensive waste bags labelled before storage and disposal? 3 Is infectious/healthcare risk waste stored separately to domestic waste in a secure designated storage facility/area? 4 Are outside waste containers or storage/waste compound areas secure? Additional Comments Standard: Personal protective equipment is available and is worn for asepsis, transmission based precautions and contact with body fluids. Personal Protective Equipment 1 Are single use plastic aprons available? 2 Is a single use apron worn when in contact or anticipated contact with body fluids or contaminated items or significant physical contact? 3 Are single use aprons worn as single use items and changed between every resident? 4 Are single use aprons changed between different episodes of care on the same resident? 5 Is there a range of sizes of sterile and nonsterile powder free gloves available? 6 Are gloves worn when any invasive procedure is performed? 7 Are gloves worn when in contact or anticipated contact with body fluids or in potential contact with contaminated items? 8 Are gloves removed after care activity and hand hygiene performed? Additional Comments 18
Standard: All resident equipment is cleaned and maintained appropriately to prevent cross infection. Resident Equipment 1 Is all equipment in a good state of repair? 2 Is blood glucose monitoring equipment visibly clean? 3 Is manual handling equipment stored appropriately? 4 Are manual handling slings/sheets single use or laundered after use? 5 Are hoists visibly clean and in a good state of repair? 6 Are PAT (Patient Assisted Transfer) slides stored off the floor? 7 Are aids such as walking sticks, Zimmer frames, helping hands visibly clean and stored in a suitable area? 8 Are wheelchairs visibly clean and in a good state of repair? Additional Comments 19
Infection Prevention Quality Improvement Tools Clinical Practice Process Improvement Tool: Hand Hygiene Technique Functional Area: Start Date: Overall Auditors: Module: Hand Hygiene Technique Date: Auditors:. Standard: Hand hygiene is performed by correctly prepared staff using an appropriate technique Question Set: Hand Hygiene Technique Technique Observation: 1 Question Guidance Yes No N/A Comment 1 Is there an indication for hand hygiene to be performed? (90) 2 Are health and social care workers hands free of false fingernails or fingernail extenders? Check hand hygiene is performed if one of the Five Moments for Hand Hygiene is observed. Check both hands. 3 Are health and social care workers hands free of nail polish? Check both hands. 4 Is health and social care workers fingernails short? Nails should not be seen when viewing the palm. 5 Is health and social care workers fingernails clean? Check both hands. 6 Are hands free from prohibited rings? Check policy e.g. only one plain band can be worn. 7 Are wrists free from all clothing and other articles? Watches and bracelets should not be worn and wrist area should be free from clothing or bare below elbow according to local guidelines. 8 Are hands wetted before applying wash products? Observe practice. 9 Is the correct amount of hand hygiene product used? Single shot from a dispenser. 10 Is the correct 6 step technique used? See WHO how to hand wash/how to hand rub images/posters or local guidelines. 11 Are the taps turned off using a no-touch technique Using elbow/knee or a sensor tap. following hand washing? 12 Are the hands dried thoroughly? Observe practice. 13 Are paper towels disposed of without touching the domestic waste bin by hand? Observe practice. Question Set Comments/Recommendations for Hand Hygiene Technique Technique World Health Organisation (2009) Guidelines on hand hygiene in health care. Geneva, Switzerland: World Health Organisation 20