Infection Outbreak Management in Care Homes (England) Policy

Policy Statement

{{org_field_name}} believes that infection control is a critical element in the running and management of any residential care facility as serious infections can easily be spread if inadequate controls are in place. The home is acutely aware that infectious diseases can spread easily among people in a care home — particularly in the winter — with the commonest outbreaks being flu, gastroenteritis, diarrhoea and vomiting.

The protection of people from such diseases is a key aim of {{org_field_name}}, which expects all of its staff and volunteers to adhere strictly to a range of policies relating to the control of infection including this one, which is designed to protect people from the risks of outbreaks of infectious diseases.

Legal Considerations

This care service will adhere to 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).

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 receiving care and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

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 health care 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 CQC in March 2015, provides guidance on how this service should comply with the regulations.

Guidance

{{org_field_name}} seeks at all times to comply with evidence-based best practice in infection control, particularly with the Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infection and Related Guidance published by the Department of Health and Social Care (the Hygiene Code). The home understands that in England compliance with this guidance is an effective way to help it to meet its regulatory requirements with the Care Quality Commission under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition, the home will comply with all other relevant best practice infection control guidance.

For instance, applicable guidance from the National Institute for Health and Care Excellence (NICE) includes:

CG139: Healthcare-associated Infections: Prevention and Control in Primary and Community Care (updated February 2017)
PH36: Healthcare-associated Infections: Prevention and Control (November 2011).

Guidance is also available from the Department of Health and Social Care (DHSC) and from the Health and Safety Executive (HSE) in the form of:

Infection Prevention and Control (IPC) Resource for Adult Social Care, DHSC
Prevention and Control of Infection in Care Homes: An Information Resource (2013), DHSC
HSG220 Health and Safety in Care Homes (2^nd edition) (2014), HSE.

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

Definitions and Theory

{{org_field_name}} understands an infection “outbreak” to refer to occurrences of infectious disease that affect two or more people who use the services. {{org_field_name}} recognises that the commonest outbreaks are flu, gastroenteritis, diarrhoea and vomiting.

Diarrhoea and vomiting bugs are usually transmitted by direct contact and can spread rapidly through a care home population. Contact with contaminated people, surfaces or objects, particularly those contaminated with faeces or vomit, can easily spread the bugs responsible, as can consuming contaminated food or water.

Procedure

To fully protect people from the associated risks, the following precautions should be taken during any infectious outbreak.

People receiving care who have influenza should remain in a segregated area for at least five days. They should be given plenty of fluids and their specific symptoms should be treated.
People with diarrhoea and vomiting should be isolated in their own rooms while symptomatic and should have their own toilet facilities or a designated commode if en-suite facilities are not available. Special attention should be paid to ensuring that they drink enough fluids.
When a decision about segregating or isolating an infected person is taken, care staff will take into account the likely psychological and social effect on the person and ensure that appropriate support is in place.
Cleaning and hygiene will be prioritised with particular attention paid to the cleaning of toilets, bathrooms, door handles and support handrails.
People who use the services should be encouraged to wash their hands after using tissues or the toilet or commode, and before eating.
Linen used during an infected person’s care should be treated as infected linen and staff should take great care over the cleaning of their uniforms.
Staff should pay close attention to all infection control practices, particularly the washing of hands and wearing of protective clothing. A new pair of gloves and a plastic apron should be worn for each person and all staff handwashing areas, and the rooms of symptomatic people should have an antibacterial liquid dispensed soap (or an alcohol hand rub following handwashing with a regular liquid soap) for the duration of an outbreak.
Symptomatic staff should not come to work or should be sent home and remain off work until symptom-free for 48 hours.
Visitors should be informed of the outbreak and unnecessary visits should be discouraged. Those who choose to visit should wash their hands as they enter and leave the home and comply with all other hygiene practices in place.
If any person requires admission to hospital the receiving unit must be informed of the outbreak so that they can institute appropriate measures.
In all outbreaks, the advice of a GP should be sought, and the Infection Control Lead should co-ordinate actions and ensure contact with the local Community Infection Control Team.
Where expert advice or support is required, {{org_field_name}} manager or Infection Control Lead should confer with the local public health protection team. The team will advise the home of any immediate action necessary for control and this may require identifying those at higher risk and separating those who have symptoms from those who do not.
During the Covid-19 pandemic all measures for isolation introduced as a response to an outbreak of infectious disease must be implemented with reference to the rules in place for the isolation of people receiving care and the self-isolation of staff who have coronavirus symptoms or who test positive for the virus.
During the Covid-19 pandemic, people who test positive for coronavirus, regardless of whether or not they have been vaccinated, should self-isolate. This should be done in their room, wherever possible. During their isolation period, people who use the services should be supported to leave their room to go outdoors as appropriate, providing that they can safely transit through {{org_field_name}} without mixing with other people.
In all cases care home staff should minimise the risk of Covid-19 virus transmission through safe working procedures and through the implementation of appropriate infection control policies. They should use personal protective equipment (PPE) for activities that bring them into close personal contact, such as washing and bathing, personal hygiene and contact with bodily fluids.
If a person with a confirmed Covid-19 infection is required to self-isolate and they cannot be cared for in their own room it may be possible to care for them in a cohort with other similar people where this can be done safely.

Reporting

{{org_field_name}} manager or Infection Control Lead will report any suspected outbreak of infectious disease immediately to the local public health protection team.

According to the Health and Social Care Act 2008: Code of Practice for Health and Adult Social Care on the Prevention and Control of Infections and Related Guidance, the infection control lead should produce an annual report on the systems in place for the prevention and control of infection and how these are monitored. The report should contain information on incidents and outbreaks of infection, risk assessment, training and education of staff, and infection control audit and the actions that have been taken to rectify any problems.

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 Infection Control Lead.

The Infection Control Lead will work closely with the manager to ensure that all infection control policies are effectively implemented and that the home has adequate supplies of handwashing materials and facilities, personal protective equipment and sterile clinical equipment. An outbreak of infection is likely to have considerable resource implications for the home and may lead to staffing shortages, therefore the Infection Control Lead and the manager will have in place suitable contingency plans for extra staffing and increased use of disposable items or extra laundry capacity.

Individual staff practitioners are responsible for ensuring that they implement this policy wherever necessary and exercise adequate infection control precautions at all times, seeking further advice from the Infection Control Lead as required.

Information on the policy will be:

circulated to all staff
provided to all new employees
included in the Infection Control Policy, the Clinical Waste Policy, and the Disinfection of Medical Devices Policy.

Training

All new staff should be encouraged to read this policy as part of their induction process. Clinical staff and cleaning staff who are required to have additional knowledge and skills in infection control will have appropriate access to ongoing training and refresher training and assessment in infection control.

Audit

The Infection Control Lead is responsible for completing a regular audit of infection control outbreaks and for ensuring that evidence-based policies and procedures in relation to the control of infection are developed and their implementation is monitored.

The Infection Control Lead will monitor carefully any incident reports relating to infection control matters in order to identify any trends or patterns.

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}}

CH165. Infection Outbreak Management in Care Homes