Infection Control and Cleanliness: Invasive Devices in Care Homes Policy

Policy Statement

It is vitally important that all medical devices are used properly if people who use the service are to be protected and cared for effectively.

This policy provides guidance on the use and maintenance of invasive medical devices in line with statutory requirements for care services to maintain high standards of care in their use with people who use the service, and of the devices used to ensure that they are used safely and kept clean with the risks of cross-infection kept to a minimum.

Legal Considerations and Guidance

This care service must comply with all relevant legislation, including:

the Health and Safety at Work, etc Act 1974
the Public Health Infectious Diseases Regulations 1988
the Control of Substances Hazardous to Health Regulations 2002 (COSHH)
the applicable national standards, regulations and guidance for health and social care services.

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.

This policy should be read and used in relation to other cleanliness and infection control policies.

Applicable best practice infection control guidance includes the following.

NICE CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care (2017), NICE.
NICE PH36: Healthcare-associated Infections: Prevention and Control (2011), NICE.
HSE HSG220 Health and Safety in Care Homes (2nd edition) (2014), HSE.

Specialist advice and support will be obtained from the local public health protection team and from relevant primary healthcare teams.

Regulation

{{org_field_name}} recognises that it must comply with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in order to meet its legal requirement for registration with the Care Quality Commission (CQC).

With respect to infection control, the home understands that a range of regulations may apply, including:

Regulation 12: Safe Care and Treatment — this requires providers to assess the risk of, and prevent, detect and control the spread of, infections, including those that are healthcare associated
Regulation 15: Premises and Equipment — this states that premises and equipment must be clean, suitable for the purpose for which they are being used, properly used and properly maintained.

Guidance for Providers on Meeting the Regulations, published by the CQC in March 2015, provides guidance on how this service should comply with the regulations.

Under regulation 15(2) the guidance states that:

where applicable, premises must be cleaned or decontaminated in line with current legislation and guidance, and equipment must be cleaned, decontaminated and/or sterilised in line with current legislation and guidance and manufacturers’ instructions
equipment must be cleaned or decontaminated after each use and between use by different people who use the service
multiple-use equipment and devices must be cleaned or decontaminated between use
single-use and single-person devices must not be reused or shared
all staff must understand the risk to people who use services if they do not adhere to these requirements.

Background

This care service understands invasive devices to refer to medical devices that are designed to be introduced into the body. Common examples that might be used in a care setting include:

intravenous devices
urinary catheters
chest drains
surgical wound and wound drains
gastrostomy tubes.

The use of invasive devices increases the risk of infection because their use:

exposes the person who uses the service to the operator’s microbial flora
provides the person with sustained local and systemic access to their own microbial flora
exposes the operator to the person’s blood and body fluids.

Procedures

Invasive medical devices will be:

made available as and when needed by people who use the service
supplied with the necessary technical information so that the risk of using them incorrectly is minimised
procured only from reliable sources and only if they meet the necessary legal and safety requirements
used only by appropriately trained and competent staff
used only in line with research based best practice guidelines
monitored while being used and action will be taken if they do not appear to be working correctly
routinely maintained in line with the manufacturer’s instructions and repaired when they break down by people who are competent to do so
cleaned, sterilised or reprocessed in line with the manufacturer’s published guidance and instructions
disposed of or recycled, safely and securely.

In meeting the requirements of this policy, care managers and staff will:

consider any guidance or usage warnings from the Medicines and Healthcare products Regulatory Agency (MHRA)
carefully consider the health and safety implications of any equipment before fitting or purchase and base the use of all such equipment on an appropriate risk assessment
identify, assess and then manage the risks involved
make sure that equipment and tools are suitable for the task and well maintained
ensure that the equipment is used properly
train all employees to use and store the equipment or tools appropriately
consider whether employees could use different equipment or tools where the risks are lower
consider what will happen in the event of electricity, water or gas supply failure, or other emergencies that affect equipment
actively listen to people’s preferences and thoughts about the equipment they need and how it is used
support people who use the service to understand how and why the equipment is being used
take care in the way they use the equipment to make sure the person is comfortable and safe
use the equipment in a way that ensures privacy and dignity at all times.

Covid-19 Infection and Prevention Measures

Key guidance for care homes in England includes:

Infection Prevention and Control (IPC): Resource for Adult Social Care (2022), DHSC
Infection Prevention and Control in Adult Social Care: Covid-19 Supplement (2022), DHSC.

{{org_field_name}} is aware of the danger of Covid-19 being transmitted from one person to another via contaminated equipment. The appropriate use of single-use sterile equipment and the effective cleaning and decontamination of reusable equipment is therefore of extreme importance.

In {{org_field_name}}:

where possible, during outbreaks of Covid-19, single-use devices should be used wherever practicable (for example, thermometers, blood pressure cuffs, pulse oximeters, etc)
where equipment is re-used it should be cleaned and disinfected (including mobility aids) before re-use with another person who uses the service in accordance with manufacturer’s instructions
particular attention should be paid to cleaning of any reusable equipment taken between the people who use the service’s bedrooms.

Low-risk equipment can be cleaned sufficiently with hot water and detergent.

Equipment Failure

{{org_field_name}} has in place clear arrangements for adverse events, incidents, errors and near-miss reporting which relates to the use of medical devices. The manager will ensure that these arrangements are robustly and fully implemented and that all such equipment failures are recorded as an untoward incident and an investigation held to look at possible ramifications, pointers for the future and lessons for procurement.

All invasive medical devices that are suspected to be defective will be removed from use immediately and the circumstances of the failure fully investigated.

All MHRA warning notices will be circulated to all relevant staff.

Implementation

All staff are responsible for the implementation of this policy. Overall responsibility for ensuring the policy is implemented, monitored and reviewed rests with the care manager.

Information on the policy will be:

circulated to all staff
provided to all new employees
included in the Clinical Waste Policy, the Work Equipment Policy, the Infection Control Policy, the Sterilising of Equipment Policy, the Untoward Incidents Policy and the Single-use Medical Devices Policy.

The manager will keep records of maintenance, servicing and adjustment or upgrading throughout the working life of each piece of equipment and whenever a fault occurs it will be corrected and full details noted. Instruction leaflets that accompany equipment will be stored conveniently and be made accessible.

Audit Programme

To ensure that the guidelines are working effectively an annual audit programme will be undertaken by the Infection Control Lead for {{org_field_name}}.

Training

All new staff should read this policy as part of their induction. Those with specific duties and responsibilities under the policy will be offered additional training.

No member of staff will care for any invasive device unless trained and assessed as competent to do so.

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}}

CH162. Infection Control and Cleanliness: Invasive Devices in Care Homes