For people living in care homes, infections can have serious implications for health and wellbeing, and, in some cases, these infections can be life-threatening (NICE, 2017). The regular contact that residents have with different members of staff and visitors, combined with communal areas within the home, means that infections can spread very easily. Elderly residents are at particular risk of infections: the immune system weakens with age; illnesses such as cancer and the treatments for it may reduce resistance to infection further; and conditions such as pressure ulcers and osteoarthritis will also reduce mobility, increasing the risk of chest infections, for example. It is vital, therefore, that all staff within the care setting are aware of how infection spreads and steps that can be taken to minimise this (NICE, 2017). This module covers some of the important steps that care home staff must take in order to reduce the spread of infections: good hand hygiene; correct use of personal protective equipment (PPE) such as gloves and aprons; safe management of laundry; safe disposal of waste; and effective cleaning policies. Such measures are important ways of breaking the chain of infection (see below). Infections occur when disease-causing bacteria, viruses or other microorganisms, or multicellular parasites (see below), enter the body or come into contact with it. Such microorganisms can pass from person to person, from surfaces to a person (and then back onto other surfaces), and from the environment onto food, for example.
Bacteria can multiply rapidly at body temperature and cause illness very quickly, especially in a resident who already has a chronic illness. A common example is Clostridium difficile, which causes severe diarrhoea.
Viruses can survive on surfaces and in food, but can only multiply in living cells. Norovirus is an example of a virus that causes illness; it can cause serious outbreaks of vomiting and diarrhoea within a home.
Fungi are organisms which live on hosts and can spread. An example of a fungal infection is thrush (Candida albicans).
Parasites can live on humans, who are known as the host. For example, tiny parasitic mites that burrow under the skin are to blame for the disease known as scabies, which causes severe itching.
Protozoa are single-celled organisms that live in water or as parasites. Two diseases that are caused by protozoa are malaria (transmitted by insect bites) and amoebic dysentery (via contaminated food and water).
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Standard 15: Infection prevention and control By Karen Murrell, Independent Healthcare Educator
Always take the advice of a properly trained, experienced and competent person, usually your line manager.
To limit the spread of infectious diseases, the “chain of infection” must be broken
Care CertificateCarers
Infectious microbe Reservoir of infection Portal of exit
Portal of entry Modes of transmissionNon-immune person, immune deficiency, babies, elderly, immunosuppressed
Break the chain by:• Treating disease• Immunising against disease
Bacteria, fungi, virus, protozoa
Break the chain by:• Diagnosing and treating disease• Using antibiotics appropriately
Places where the microbe lives and multiplies, e.g. people, equipment, water, food, animals
Break the chain by:• Cleaning • Disinfecting • Sterilising • PPE • Hand hygiene
Place where the microbe leaves the reservoir,e.g. coughing, sneezing, bleeding, faeces
Break the chain by:• Hand hygiene • PPE• Coughing and sneezing politely• Correct disposal of waste
Direct contact (hands, sharps injury), airborne droplets, waterborne, insect vector
Break the chain by:• Hand hygiene • PPE• Food safety measures • Cleaning• Disinfecting • Sterilising
Entry point such as a wound, oral ingestion, nasal mucosa, urinary catheter, intravenous infusion, eyes
Break the chain by:• Hand hygiene • PPE • First aid • Minimising use of urinary catheters• Avoiding touching your eyes• Food safety including safe water supplies
Susceptible host
Pathogens that can cause infection
Hand decontamination: use either soap and water or alcohol-based sanitiser Skin care
It is very important for all staff in a care home to learn and put into practice the correct method for washing or decontaminating their hands. Hands should be washed before and after all care procedures; before and after handling food; after dealing with used linen, waste and body fluids, or contaminated equipment; and after removing gloves (DH/HPA, 2013). When washing your hands, wet them first. Then apply soap or a cleanser. Alternatively, apply alcohol-based sanitiser (on dry, visibly clean hands). For more information on hand hygiene, including the World Health Organization’s “Five moments for hand hygiene”, refer to the clinicalskills.net procedure on ”Routine hand hygiene”.
For skin care, apply hand moisturiser regularly, e.g., during a break, at the end of your shift and before going to sleep, in order to help keep your skin in good condition. See your occupational health department or general practitioner if you experience skin irritation or dermatitis (Loveday et al., 2014).
2. Palm to back of hand, fingers overlaced
4. Interlock your fingers
Interlock the fingers in opposing palms and rub vigorously to decontaminate the backs of the fingers.
Decontaminate the backs of the hands by rubbing the palm of one hand over the back of the other hand with fingers overlaced and vice versa.
3. Palm to palm, fingers interlaced
Decontaminate the interdigital spaces, which are often heavily contaminated, by interlacing the fingers and rubbing vigorously.
If washing your hands, lather the soap well for a minimum of 10 to 15 seconds, ensuring that your hands remain outside of the running water while lathering. These illustrations show hand washing, but you need to perform the same movements, whether using soap and water, alcohol sanitiser or hand cream. First rub hands palm to palm.
1. Palm to palm
Standard 15: Infection prevention and control Page 2
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Always take the advice of a properly trained, experienced and competent person, usually your line manager.
Care CertificateCarers
6. Rub fingertips of one hand in other palm, rotating
8. Hand washing only: rinsing your hands
If you have washed your hands, rinse hands and wrists thoroughly under running water; residual soap can dry the skin and damage its integrity. After rinsing, do not touch the taps with your hands. Turn off hand-operated taps with paper towels to prevent cross-contamination onto hands. Ideally, use hands-free taps, operated by elbows or the foot.
Decontaminate the fingertips and nails of both hands: rub the fingertips of your left hand in the palm of the right hand and vice versa.
7. Rub each wrist, rotating
Rotate your right hand around your left wrist and vice versa. If using alcohol-based sanitiser, continue rubbing until it has fully evaporated and omit the next two steps.
Areas most frequently missed
Effective hand hygiene involves methodically rubbing all parts of the hands and wrists. This illustration shows the areas of the hands that are most frequently missed and which therefore need particular attention. Refer to hand washing for more information on hand washing policy and procedure.
9. Hand washing only: drying your hands
Following washing, dry hands thoroughly using good-quality paper hand towels. Dispose of these as domestic waste after use. When disposing of used paper hand towels, take care not to recontaminate hands; use a foot-operated pedal bin.
Rotate your right hand around your left thumb and vice versa.
5. Rub each thumb in each palm, rotating
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Always take the advice of a properly trained, experienced and competent person, usually your line manager.
Care CertificateCarers
Standard 15: Infection prevention and control Page 3
When putting an apron on, put the neck strap over your head and then tie the straps up at the back.
Using PPE: (a) Put on an apron (b) Put on goggles if appropriate
If there is a risk of splashing body fluids, remove goggles from their wrapper and put them on.
Remove eye protection and decontaminate your hands
If wearing goggles, remove these without touching your face and dispose of them according to local policy. Having removed all the PPE you were wearing, always decontaminate your hands immediately.
FIRE RETARDENT
Infectious Waste!
e.g. Body Fluids or Bloodi.e. Aprons, Dressings & Gloves
Remove apron and roll it up without touching your clothes. Dispose of it according to local policy. If you are wearing no other PPE, decontaminate your hands.
Remove the apron and decontaminate your hands
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Always take the advice of a properly trained, experienced and competent person, usually your line manager.
Care CertificateCarers
(c) Clean hands and select gloves
Decontaminate hands and dry thoroughly (Loveday et al, 2014).
When putting on clean gloves, remove the gloves from the box and carefully insert a hand into each one. You are now ready to start the work task.
If putting on sterile gloves, do this without touching the outside of the gloves (refer to clinicalskills.net procedure on “Standard precautions: use of personal protective equipment” for detailed procedure).
(d) Putting on non-sterile gloves (e) Putting on sterile gloves Removing PPE: (a) Gloves first
Remove the glove from one hand, turning it inside out, and then remove the other glove, also turning it inside out; dispose of the gloves according to local policy. If you are wearing no other protective equipment, decontaminate your hands immediately. Otherwise, remove your apron next.
Standard 15: Infection prevention and control Page 4
Ideally items should be washed in a dedicated laundry. Staff should wear gloves when handling soiled/used linen.
Laundry: Handling soiled linen
It is the responsibility of the person handling the linen to ensure that it is segregated appropriately. Separate trolleys are used for clean and soiled linen to avoid cross contamination.
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Always take the advice of a properly trained, experienced and competent person, usually your line manager.
Care CertificateCarers
Pillow cases
Sheets
Hand towels
Bath towels
Linen storage
Clean linen should be stored in a dry area, above floor level. Clean and soiled linen should never be stored together.
DANGERCONTAMINATED SHARPS ONLY
WARNING DO NOT
FILL
DESTROY BY INCI
LICENCE No. KM 28577
CONTAMINATED
2.5 Litre
SHARPS ONLY
Order Code: DD472YL
Hospital........
...............
............
..........
.........
....
Assembled by........
.............
...........
..........
........
Closed/Disposed by.......
............
..........
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...
Nominal Capacity 2.5 litre
s
BS7320: 2014
DANGER
WARNING DO NOT FILL ABOVE THE LINE
CONTAMINATED SHARPS ONLY
TO BE INCINERATEDDANGER
Non-clinical waste can be disposed of as municipal waste in black bags. Waste bins should have lids that are “hands-free” or pedal operated. It is important not overfill waste containers.
Clinical waste that has been exposed to body fluids will be disposed of in yellow or orange bags or containers (follow local policy). Always wear appropriate PPE when handling clinical waste. Do not to overfill waste containers.
Disposal of waste: Non-clinical waste Clinical waste Sharps
Sharps bins and boxes should be assembled correctly and never overfilled. After using sharps, dispose of them immediately. Never pass sharps from one hand to another and never resheath used needles.
STERILIZING AND For Medical Devices
BUFFER SOLUTION
DISINFECTING SOLUTION
ALCOHOL WIPES
STERILIZING AND
For Medical Devices BUFFER SOLUTION
DISINFECTING SOLUTIONALCOHOL WIPES
• NO GLASS
• NO LIQUIDS
• NO GENERAL WASTE
CLINICAL
WASTE ONLY
100
200
300
400
100
200
300
400
A cleaning plan should be in place to regularly clean all items that are handled even if there is no visible soiling. Cleaning should be completed before carrying out disinfection or sterilisation (NPSA, 2010).
Disinfection reduces the number of certain viable microorganisms. A sterilising solution removes all viable microorganisms including viruses and bacterial spores. Follow manufacturers’ instructions to make up solutions of the correct strength.
Cleaning policies Disinfection/sterilisation
Cleaning equipment such as buckets, mops and dustpans will be colour-coded according to the areas in which they should be used (NPSA, 2010), to prevent spreading infectious agents from one area to another. Follow local policy.
Bathrooms, washrooms,showers, toilets, basins and
bathroom floors
General areas includinglounges, offices, corridors and
bathroom
Kitchen areas including satellitekitchen areas and food storage
areas
Bedrooms when someone hasan infection and is cared for in
their own room (isolated)
Red Blue
Green Yellow
Colour-coded cleaning equipment
Segregating linen
Standard 15: Infection prevention and control Page 5
Segregating linen
Care CertificateCarers
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Always take the advice of a properly trained, experienced and competent person, usually your line manager.
SMALLMEDIUMLARGE
100
200
300
400
100
200
300
400
Ensure commode is left empty and lid is in place to prevent contamination with body fluids
Safe medicationLid on medication in bathroom should be in place to prevent contamination and maintain effectiveness of medication
Hand hygieneAlthough residents may choose to use bars of soap, a liquid soap dispenser should be available for staff use
Use of PPEGloves and aprons are nearby for ease of use; stocks of all sizes must be available, to avoid putting staff and residents at risk
Linen and laundryFace cloths should not be left drying in a resident’s room. Wash them immediately or use disposable ones
Food hygieneSweets/food left in room should be covered or stored in a sealed container
Catheter careWear an apron and use disposable gloves when emptying the resident’s catheter bag and follow infection control guidelines (see clinicalskills.net procedure, “Emptying a urinary catheter bag”)
Disposal of wasteJug used for emptying catheter bag should not be stored on resident’s table or cabinet
Linen and laundryDisposal of wasteEnsure linen is stored appropriately and soiled linen removed promptly
Effective cleaningEquipment such as walking frames and commodes should be regularly cleaned; decontaminate all surfaces that are touched frequently
Assessing risk: the “key to breaking the chain”
Standard 15: Infection prevention and control Page 6
