Check that you and your staff are doing what you need with the Audit: Premises — Infection Control in Care Homes Checklist and follow our 11 top tips with handy documents for you to use.
Adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of service users and staff. Good, basic hygiene is the most powerful weapon against infection, particularly with respect to cleaning and handwashing.
The majority of cross-infection is caused by unwashed or poorly decontaminated hands which provide an effective transfer route for microorganisms. Staff should wash their hands regularly, including between seeing each and every service user where direct contact is involved, after using the toilet and before handling foodstuffs.
Effective hand hygiene is so fundamental that managers should consider having and implementing a handwashing policy.
Ordinary soap is effective for removing dirt and reducing levels of microorganisms on the skin to acceptably safe levels. Antibacterial alcohol rubs were originally introduced to provide higher levels of infection control for sterile aseptic procedures such as wound care and catheterisation. However, with the advent of MRSA, alcohol rubs or gels have become popular as an additional weapon against the spread of the infection.
Disposable medical gloves are often used in delivering care as a method of reducing the risk of contamination of care workers’ hands with blood and other body fluids and preventing the spread of infection through the hands. However, it is important that good hand hygiene procedures are followed before putting gloves on and immediately after taking them off. Disposable gloves should be discarded after use and hands should be washed and dried following removal.
Care staff should also ensure that they use a new pair of gloves for each new task, even if performed for the same service user. See the Personal Protective Equipment for Infection Control in the Care Home Policy for more guidance.
Cleaning of spillages
Spillages of body fluids or body waste, such as blood, faeces and urine, should be cleaned up as quickly as possible.
Body fluid spills, such as blood, urine, faeces and vomit, can spread disease and produce unhygienic conditions if not cleaned up as soon as possible. An agreed process for cleaning spillages should be in place.
Staff should be encouraged to treat a spillage as potentially infectious. For blood spillages, an appropriate disinfectant should be used. For most spills, a 10,000ppm hypochlorite solution is typically used.
Clinical and sharps waste disposal
All care services should have a policy on the disposal of hazardous clinical waste. Such waste systems should be subject to regular risk assessment.
Waste is considered hazardous if it is potentially harmful to humans or the environment. Clinical waste includes items such as body fluids, blood, incontinence pads and soiled surgical dressings. Unless properly managed and handled, such waste can present a health hazard by spreading infection.
Find a template Clinical Waste in Care Homes Policy here.
Great care must be taken in the use of sharps and the disposal of sharps waste.
The main danger from sharps is of scratches to the skin or of actual puncturing of the skin by contaminated needles. The significance of a “needlestick” injury is that the sharp may have been contaminated with blood or another hazardous substance, thus raising the possibility of infection with blood-borne diseases such as hepatitis B, hepatitis C or HIV.
If sharps waste becomes mixed with standard waste, then people can come in contact with them and may be injured. In addition, if sharps waste is not disposed of properly and removed from the environment, particularly in the case of syringes, then it may be reused or misused.
A Sharps in Care Homes and Nursing Homes Policy can be found here.
Staff in a care home or nursing home may be required to help in obtaining a specimen of faeces or urine from a service user at the request of the GP, particularly in the case of an outbreak of infection.
All specimens should be treated with caution and as potentially infectious. They should be labelled clearly and packed into self-sealing bags before being stored in a designated clinical fridge prior to being taken to the GP or hospital. Care home managers should ensure that fridges designated for clinical storage are not used for also storing foodstuffs. Non-sterile gloves should be worn when handling specimen containers and hands should be washed afterwards.
A Specimens Policy can be found here.
Equipment and instruments
Care homes, nursing homes and home care providers must keep any equipment they use in a clean and hygienic condition.
All clinical equipment that is not disposable and is not required to be sterile, eg basins, trays, commodes, should be cleaned after use. Low-risk equipment can be cleaned sufficiently with hot water and detergent.
If sterile equipment is required, it is highly recommended for service providers to obtain single-use, disposable sterile equipment wherever practical. The use of such equipment should be covered by a policy that reflects current guidelines.
Where equipment does need to be sterilised and reused, it is recommended that decontamination services are provided by a local Central Sterile Services Department (CSSD). Where it is not practicable to use a CSSD provider, a care provider may have to sterilise its own equipment, usually with a benchtop steriliser or autoclave (find an Autoclaves Policy here).
Staff should be protected from the risk of infections and the Health and Social Care Act 2008: Code of Practice for the Prevention and Control of Infections requires providers to have a system in place to manage the occupational health needs and obligations of staff in relation to infection.
The impact of seasonal influenza on frail and vulnerable service users in communities and care homes can be fatal. All social care organisations should ensure that staff are able to access flu vaccinations as soon as vaccine is available so that service users and staff are protected when flu begins to circulate towards the end of each year. A Staff Vaccinations and Immunisations in Care Homes Policy is useful to have.
Efficient laundry services are responsible for removing infected soiling and general dirt from both bed linen and clothes, preventing the spread of infection from person to person. A laundry area is also a potentially high-risk source of cross-infection itself, especially where items soiled due to incontinence or illness are being processed, and care home managers need to pay particular attention to hygiene practices.
For large or medium-sized homes, commercial washers and dryers are most appropriate in a dedicated laundry area. At least one washing machine should incorporate a sluice/disinfectant programme which should be used to clean all soiled materials at a high temperature. There should be a flow of laundry from “dirty” to “clean” and the two should never be stored together.
A Laundry and Linen Decontamination in Care Homes Policy can be found here.
The possibility of transmitting infections through uniforms is an important issue for employers. The proper laundering of uniforms is essential with a 10-minute wash at 60°C being sufficient for the removal or killing of most microorganisms on fabric, but this can be done either in a commercial machine or a domestic one.
Useful advice is that care staff should avoid wearing long sleeves when providing care, should avoid wearing neck-ties and should not wear excessive jewellery or false nails.
For more detailed information, see How to Control Infection Risks Relating to Uniforms.
It is up to service users themselves whether or not they wish to be immunised, eg with the annual flu jab or against a specific flu such as swine flu. However, adult social care staff can help to ensure that service users have sufficient information about vaccinations, presented in a way that they can access and understand, so that they are able to make informed decisions for themselves.
Service users should be supported by care staff to obtain the immunisations that they want.
For advice, see Immunisation of Service Users Policy.
It is important that all members of staff have a clear understanding of their responsibilities for hygiene and in preventing the spread of infection.
Staff should be trained in:
the basic principles of hygiene, especially the importance of effective handwashing, etc
general knowledge of infectious diseases, including modes of spread
the need to report personal illness and exclude themselves from work if suffering from an infectious disease
the need to wear disposable waterproof gloves in situations where contact with blood or body fluids is expected, such as when cleaning up body fluids.
Managers should ensure that infection control is covered in induction for new staff who should be made aware of all the relevant policies. Regular refresher training should also be provided.
You can find an Infection Control in Care Home Settings Training Presentation here which you can distribute to your staff.
Last reviewed 9 October 2018