Infection Control and Cleanliness in Care Homes (Wales) Policy

Policy Statement

This policy shows how {{org_field_name}} prevents and controls risks of infections and cross — infection in line with its statutory requirements as described in the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, particularly Regulations 56: Hygiene and Infection Control and 57: Health and Safety.

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

Communicable diseases refer to a range of diseases that can be spread due to poor infection control techniques or standards. Examples of such diseases include:

hepatitis
tuberculosis
MRSA
food poisoning, through organisms, eg Salmonella
legionnaires’ disease
coronavirus Covid-19
AIDS
E. coli.

Communicable diseases are the responsibility of Public Health and are managed by local health protection teams. The Public Health Infectious Diseases Regulations 1988 place a duty on employers to adopt safe practices to prevent the spread of infection (especially blood-borne infection) and organisations may be liable for prosecution and for paying compensation if they do not comply.

{{org_field_name}} believes that adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of both people who use the service and staff. It also believes that good, basic hygiene is the most powerful weapon against infection, particularly with respect to cleaning and handwashing. The home will work in collaboration with all local infection control agencies to maintain the highest standards of infection control at all times and ensure that, as far as is reasonably practicable, the people who use our service are protected from the spread of infection in the home.

The aim is always to prevent the spread of infection among staff, people who use the service and the local community, and ensure that:

people who use the service, their families and staff are as safe as possible from acquiring infections at the home
all staff at the home are aware of and put into practice the basic principles of infection control.

Legal Considerations

This care service will adhere to all relevant legislation, including:

the Health and Safety at Work, etc Act 1974
the Health Protection (Notification) (Wales) Regulations 2010
the Control of Substances Hazardous to Health Regulations 2002 (COSHH).

Under the above legislation, and associated codes of practice, {{org_field_name}} understands its legal and moral duty to ensure the health and safety of both staff and people who use the service, and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

In addition to the above, the home must also comply with the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). These place a duty on the home to report outbreaks of certain diseases as well as accidents such as needle-stick accidents.

Guidance

{{org_field_name}} is guided by Infection Prevention and Control: A Quick Reference Guide for Care Homes in Wales, published by Public Health Wales in 2018.

For greater detail than the quick reference guide, the organisation understands that Public Health Wales have collaborated with NHS Scotland to host and utilise the Scottish electronic National Infection Control Manual (NICM). All healthcare organisations in Wales are encouraged to access the manual and apply its standards.

Airborne illnesses

{{org_field_name}} believes that general adherence to high standards of infection prevention and control is the best way to prevent the person-to-person spread of pathogens such as coronavirus and flu maximise the safely of staff, people who use the service and visitors. To achieve this the organisation’s infection control policies and procedures will be implemented in full, especially those related to effective hand hygiene, sanitisation and environmental cleaning.

Staff should:

cover their mouth and nose with a tissue or their sleeve (not their hands) when they cough or sneeze
put used tissues in the bin immediately
wash their hands with soap and water regularly for 20 seconds and use hand sanitiser gel (at least 60% alcohol) if soap and water are not available
try to avoid close contact with people who are unwell
avoid touching their eyes, nose, and mouth with unwashed hands
wear personal protective equipment (PPE) as required
clean and disinfect frequently touched objects and surfaces.

Staff should comply fully with hand sanitisation policies and procedures. Managers will ensure that policies are supported by the provision of appropriate resources such as hand sanitiser gels.

Regular cleaning of frequently touched hard surfaces with a suitable disinfectant and cleanser will be carried out.

{{org_field_name}} will comply fully with all existing infection control and prevention guidance, including the National Infection Control Manual (NICM).

Effective Hand Hygiene

The home believes that, consistent with modern infection control evidence and knowledge, handwashing is the single most important method of preventing the spread of infection.

In {{org_field_name}}, the following applies.

All staff should at all times observe high standards of hygiene to protect themselves and the people who use the service from the unnecessary spread of infection.
All staff must therefore ensure that their hands are thoroughly washed and dried:
a. between seeing each and every individual where direct contact is involved, no matter how minor the contact
b. before putting on personal protective equipment (PPE) and after taking it off
c. after handling any body fluids or waste or soiled items
d. after handling specimens
e. after blowing the nose
f. after using the toilet
g. before handling foodstuffs
h. before and after any care or clinical activity.
Hands should be washed thoroughly according to the guidelines posted by each sink. Liquid soaps and disposable paper towels are used rather than bar soaps and fabric towels.
All cuts or abrasions, particularly on the hands, should be covered with waterproof dressings at all times.
Ordinary soap is considered to be effective for routine use in removing dirt and reducing levels of transient microorganisms on the skin to acceptably safe levels.
Effective standards of hand hygiene will be further supported by the use of antimicrobial alcohol-based hand rubs and sanitiser gels. These will be deployed around the home, including at entrances and exits to provide an additional hand hygiene resource. All staff and visitors will be asked to sanitise their hands on arrival and exit.
Where indicated by risk assessment, a portable alcohol-based sanitiser gel or hand rub will be provided to care staff, particularly for use in situations where effective handwashing requires additional support.
To be effective alcohol-based sanitiser gel or hand rub should not be used as the sole method of hand hygiene on hands that are visibly soiled as this may compromise their effectiveness.

Cleaning and Procedures for the Cleaning of Spillages

All staff have a responsibility to help keep the home clean and tidy and to identify areas which fall below acceptable or safe standards.

Management of the routine cleaning of the home is the responsibility of: ____________________________

Staff must treat every spillage of body fluids or body waste as quickly as possible and as potentially infectious. They should wear protective gloves and aprons and use disposable wipes wherever possible. Eye protection should also be used if there is risk of splashing.

For a spillage of blood or body fluids a 10,000ppm hypochlorite solution should be used. Staff should do the following.

Put on disposable gloves and apron.
Prepare the hypochlorite solution.
Cover the spillage with paper towels.
Carefully wipe up the spillage with more towels soaked in hypochlorite.
Dispose of the waste in a yellow waste bag.
Wash hands in soap and water.

The Cleaning and Sterilising of Instruments and Equipment

{{org_field_name}} believes that using certain single use, disposable equipment supplied by the local sterile services department or equivalent organisation is preferable, wherever practical, to using equipment that requires sterilisation. All equipment that is not disposable must be cleaned after use. Non-risk equipment must be thoroughly cleaned with hot water and detergent. Higher-risk equipment must be sterilised by autoclave following the home’s autoclave protocol which identifies staff qualified and trained in the use of the autoclave.

All staff using the autoclave must follow the latest guidance in its proper use and maintenance and refer to our protocol on autoclave use.

Autoclave maintenance is the responsibility of:	_______________________________
The autoclave is serviced by:	_______________________________
Local sterile services’ contact details are:	_______________________________

The Handling and Disposal of Clinical and Soiled Waste

All clinical waste must be disposed of in sealed yellow plastic sacks and each sack should be clearly labelled with the home’s details. Non-clinical waste must be disposed of in normal black plastic bags. When no more than three-quarters full, yellow sacks should be sealed and stored safely to await collection by an authorised collector. Yellow bags must only be used in pedal-type bins in clinical areas.

Clinical waste removed from the home must be specified in a transfer note which is signed by both the home and by the authorised collector. Copies of transfer notes are kept in the waste control file.

The authorised collector is	___________________________________
Full sacks are stored	___________________________________

The Use of Protective Clothing

Gloves and disposable aprons are provided for staff who are at risk of coming into direct contact with body fluids.

Sterile gloves are provided for clinical procedures such as applying dressings. These must be worn at all times during contact with people who use the service, and changed between each person. On no account must staff attempt to wash and reuse the gloves.
Non-sterile gloves are provided for washing dirty or used instruments, clearing up blood or bodily fluids and for handling disinfectants.

The responsibility for ordering and ensuring that supplies of gloves and aprons are readily available and accessible lies with ______________________________.

Any member of staff who suspects that they or a person who uses the service might be suffering from an allergic reaction to the latex gloves provided should stop using them immediately and inform the home management. They should then consult their GP.

In {{org_field_name}} all use of PPE for infection prevention and control purposes will be based on the latest guidance.

Staff in {{org_field_name}} should continue to wear gloves, masks and aprons when providing direct, personal care. Eyewear should also be worn when providing direct, personal care to people with suspected or confirmed Covid-19.

The Handling and Storage of Specimens

Specimens are only to be collected if requested by a GP. All specimens must be labelled clearly and packed into self-sealing bags and stored in the designated fridge prior to being taken to the GP for collection by the local laboratory. Non-sterile gloves must be worn when handling specimen containers and hands should be washed afterwards. All specimens should be treated with equally high levels of caution.

The Disposal of Sharps (eg Used Needles and Ampoules)

Sharps — typically needles, blades and broken ampoules — are disposed of in proper, purpose-built sharps disposal containers complying with BS7320.

Staff must never resheath needles.
Boxes must never be overfilled.
When full, boxes should be sealed, marked as hazardous waste and clearly labelled with the home details.
Sharps boxes must always be placed out of the way of people who use the service, especially from children who may be attracted by the bright colours.
Used, filled boxes should be stored securely until collected for incineration.
Staff must never attempt to retrieve anything from inside a sharps box.
Staff should never attempt to compress or press down sharps to make extra room in a box.
Any sharps box which has been broken or damaged must be immediately taken out of use — broken sharps boxes should be sealed within a larger sharps box.

Sharps boxes are collected by:	________________________

Responsibility for ensuring sharps boxes are collected lies with:	________________________

While awaiting collection they must be stored:	________________________

In the event of an injury with a used or potentially contaminated needle, staff must do the following.

Wash the area immediately and encourage bleeding if the skin is broken.
Report to the home manager immediately and fill in an incident form.
Report immediately to a GP, Occupational Health Department or, if none are available, Accident and Emergency.

The Storage, Preparation and Serving of Food

See the home’s policy on food preparation and handling. Any storage or handling of food in the home raises a potential risk of food poisoning so the highest standards of hygiene must be observed by all staff at all times. Food stuffs brought into the home by staff must be stored in the foodstuffs fridge, never the specimens fridge, and outdated food should be disposed of. Staff must follow all food storage recommendations and observe sell-by dates scrupulously.

Any staff suffering from food poisoning, diarrhoea or vomiting must report it to the home and see their GP immediately.

Preventing and Controlling Cross-Contamination from Electronic Device Handling

With the increasing use of key-board based computers and portable electronic devices such as smart phones and touch pads as care practice tools, research shows that there is a relatively low but identifiable risk of cross-infection from the collection and transmission of bacteria and micro-organisms on and from these devices that require risk assessing and controlling. There will be clearly greater risks of cross-contamination from their use in environments where the risks of contamination are also higher such as in nursing homes, or with outbreaks of infectious illness, for example.

The home adopts a common-sense approach to the prevention and control of possible cross infection from the use of electronic devices in the course of daily work, which is consistent with other infection control measures. These are:

To ensure effective handwashing procedures are followed, which will reduce the risk of contamination on to the device.
To keep the device suitably covered when not in use with either an easily disposable plastic cover or cover that can be easily wiped after each use or similar protective materials, depending on the type of device used. (Here it should be noted that any cover could also run the risk of contamination).
Regular eg daily cleaning of the device, or after use in high risk situations, usually by wiping with a suitable cloth, which is usually sufficient, or such as an alcohol-based wipe — taking into account the vulnerability of the product to be damaged by the cleaning methods adopted, and always following many manufacturer’s instructions.
Where necessary, eg in high risk situations the person using the device will be encouraged to set alerts to remind them of the necessity to keep their devices clean.
All staff will be expected to keep their devices and equipment used in service delivery as clean and free from infection as possible in line with this policy.
In very high risk situations and circumstances, the home might stop the use of electronic devices to help deliver care to cut out any contribution they might make to the spread of any infections or infectious illnesses; though this measure is likely to be rare.

Reporting

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) obliges the home to report the outbreak of notifiable diseases to the Health and Safety Executive (HSE). Notifiable diseases include: cholera, food poisoning, smallpox, typhus, dysentery, measles, meningitis, mumps, rabies, rubella, tetanus, typhoid fever, viral haemorrhagic fever, hepatitis, whooping cough, leptospirosis, tuberculosis and yellow fever.

Records of any such outbreak must be kept, specifying dates and times and a completed disease report form must be sent to the HSE.

In the event of an incident, _________________________ is responsible for informing the HSE.
RIDDOR forms are kept __________________________.

The HSE states that the reporting requirements relating to cases of illness or deaths from Covid-19 under RIDDOR apply only to occupational exposure, that is, as a result of a person’s work. There is no requirement under RIDDOR to report incidents of disease or deaths of members of the public, patients, people who use the service from Covid-19.

Reporting Emergencies

In the event of the suspected outbreak of an infectious disease at the home, the outbreak should be reported to the local health protection team and/or the Health Protection (All Wales Acute Response) Team. The home should follow any expert infection control advice given.

Contact details: ____________________________.

Support and Outbreaks

The home will work in collaboration with the local Health Protection Team (HPT) to maintain the highest standards of infection control at all times and ensure that, as far as is reasonably practicable, people who use the service and staff are protected from the spread of infection.

Contact details: ____________________________

On identification of a new suspected or confirmed Covid-19 case, {{org_field_name}} must immediately contact the local HPT who will undertake an assessment of the situation including the adequacy of infection prevention and control measures and will advise on the need for testing of people who use the service and staff.

Personnel

_______________ is the infection control lead for the home.
Other infection control personnel in the home are: _______________.
_______________ who is responsible for infection control risk assessment and staff training.
_______________ who is responsible for checking fridge temperatures and ensuring that specimens are processed and handled safely.
_______________ who is responsible for the cleaning and hygiene of the home.

Infection Control Training

All new staff are required to read and understand the policy on infection control and food preparation and handling as part of their induction process, which is based on the All Wales Induction Framework for Health and Social Care.

Existing staff receive specialised accredited training about infection control and hygiene (including food hygiene) which is relevant to their roles and responsibilities.

In-house refresher training sessions are conducted at least annually and all relevant staff attend.

___________________________ is responsible for organising and co-ordinating training.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

WCH147. Infection Control and Cleanliness in Care Homes