Respiratory Illnesses in Residential Care Policy

This care service believes that having effective, up to date infection prevention and control policies and procedures in place is of paramount importance in ensuring the safety of both people who use their services and staff and visitors from infectious organisms such as those that cause communicable respiratory illnesses, including influenza and coronavirus (Covid-19).

This care service complies with government guidance and any person displaying symptoms of respiratory illness will be isolated immediately as a precautionary measure.

This care service policy is based on the Department of Health and Social Care (DHSC) supplement to the infection prevention and control resource for adult social care. This includes Covid-19 as this remains an ongoing issue, and other similar respiratory viruses.

People, particularly those with co-morbidity and chronic medical conditions remain likely to be particularly vulnerable to severe disease caused by this virus as immune functions diminish with age.

Definitions and Theory

Respiratory disease is the term for diseases of the respiratory system. These include diseases of the lung, pleural cavity, bronchial tubes, trachea, upper respiratory tract and of the nerves and muscles of breathing. Respiratory diseases range from the common cold through to serious and life-threatening diseases such as asthma, chronic obstructive pulmonary disease (COPD), tuberculosis, influenza, legionella and bacterial pneumonia.

Respiratory infections often affect elderly people in residential settings and can be particularly dangerous. In the elderly such infections can cause serious illnesses such as pneumonia and even death, often because elderly people may have underlying chest problems and compromised immunity.

Respiratory infections can be transmitted by direct physical contact but are more often transmitted through the air by coughing and sneezing and by the inhalation of droplets or aerosol.

Both influenza and Covid-19, are infectious respiratory illnesses. Although the symptoms of Covid-19 and influenza can appear similar, the two illnesses are caused by different viruses.

The route of spread of coronavirus from person to person is via contact and respiratory droplets, and as similar viruses are spread in cough droplet infection, this should be treated in the same way. The virus has also been detected in urine, faeces and blood samples so robust infection control processes remain crucial. Both cause fever, cough, aches and pains and fatigue. In coronavirus, a change in sense of smell or taste (anosmia) has been reported, but in older people symptoms may also be more nebulous and some people with Covid-19 are asymptomatic with other symptoms ranging from mild to severe.

Generally, coronavirus can cause more severe symptoms in those with weakened immune systems, older people and those with long-term conditions such as diabetes, cancer and chronic lung disease or are obese.

Both may be fatal in some cases, especially in those aged 80 and over and can result in pneumonia.

Treatment Options

For the treatment of influenza, some antiviral medications are available that address symptoms and sometimes shorten the duration of the illness.

For Covid-19, a great deal has been learnt about treatment. Antiviral therapies have been shown to be of greatest effect administered early during Covid-19 treatment, whereas immunosuppressive/anti-inflammatory drugs appear to have optimum effect later in the course of the disease and there is ongoing research.

Vaccinations

Influenza vaccine is available and effective to prevent some of the most dangerous types or to reduce the severity. In this care service they are routinely administered to people who use our services. The pneumococcal vaccine protects against serious and potentially fatal pneumococcal infections. It is also known as the pneumonia vaccine pneumococcal polysaccharide vaccine (PPV) is given to people aged 65 and over and people at high risk because they have long-term health conditions.

{{org_field_name}} will comply with the ongoing Covid-19 vaccination and booster programme for the UK.

See Coronavirus (Covid-19) Vaccination of People Receiving Care and Staff in Care Homes Policy.

Covid-19 Vaccinations and Care Homes

{{org_field_name}} will ensure that people who use their services have information regarding the ongoing Covid-19 vaccination programme, and that where due a booster dose, that consent forms are completed in advance of an arranged session.

{{org_field_name}} will also provide relevant information to enable people to make the decision to consent and support them in this. Where individuals lack capacity, care home procedures and policies on mental capacity under requirements of the Mental Capacity Act 2005 will be applied.

Post vaccination, people will be monitored for possible side-effects or reactions to the vaccine and concerns reported to the person in charge and recorded.

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 who use their services, and to protect them, wherever practicable, from dangerous substances in the workplace, including the risk of transmission of infections.

The Health Protection (Coronavirus) Regulations 2020 have recently been issued and supplement the health protection regime found in Part 2A of the Public Health (Control of Disease) Act 1984. These regulations may be cited as the Health Protection (Coronavirus) Regulations 2020 and came into force immediately.

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.

There have been multiple versions of government guidance across the four UK nations over the past few years, and care home managers should ensure they have access to the most recent versions.

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:

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
Supplement to the Infection Prevention and Control Resource for Adult Social Care (2022), Department of Health and Social Care (DHSC)

Specialist advice and support will be obtained from the local public health protection team and from governement websites. General flu guidance will be obtained from local general practices.

Any staff known to be in an at-risk group should also be taken into consideration and all staff protected as fully as possible with correct PPE.

Visiting

Details of {{org_field_name}}’s visiting policy is displayed and communicated to all potential visitors.

{{org_field_name}} follows guidance outlined in the DHSC’s Supplement to the Infection Prevention and Control Resource for Adult Social Care (2022).

To minimise the risk of Covid-19 transmission, this care service has reviewed its visiting policy and we request visiting should not be undertaken by anyone who is unwell or has a family member who is unwell.

Microbicidal handrubs (alcohol-based) are available on entry to {{org_field_name}}, and good hand hygiene required. A log of visitors is maintained.

This care service considers the wellbeing of people who use its services and the positive impact of seeing friends and family but reserves the right to limit access in the event of an outbreak. All visitors to {{org_field_name}}, including family members and visiting health professionals, must follow the same PPE guidance as care home staff to protect both people who use our services and those visiting.

Testing

All staff, including agency staff, and other and care partners at {{org_field_name}} remain vigilant for symptoms of respiratory illness including Covid-19. Symptomatic lateral flow device (LFD) testing is available for staff and all people who live in care homes, as well as extra care and supported living services.

If anyone develops symptoms within {{org_field_name}}, they are advised to test immediately with an LFD test in line with current guidance.

Care homes and homecare organisations are eligible for free testing for Covid-19 if they are regulated by the Care Quality Commission (CQC).

Full information on testing regimens for adult social care are available on the Government website, which are regularly checked and followed.

Admissions to Care Homes

{{org_field_name}}s follows current guidance with regards to admissions to the care setting: Infection Prevention and Control in Adult Social Care: Covid-19 Supplement.

This outlines how care homes, local health protection teams, local authorities and registered providers of accommodation for people who need personal or nursing care admits and care for people who use their services safely, protects care home staff and used in conjunction with:

If a Person Who Uses Services Develops Symptoms of Respiratory Illness

This care service does not have dedicated isolation facilities, but will implement isolation precautions if and when a person who uses the services displays symptoms of any respiratory illness. This applies to Covid-19 or influenza. If isolation is needed, a person’s room will be used, which has en suite facilities (wherever possible).

All necessary steps will be taken to minimise the risk of transmission through safe working procedures.

Staff use appropriate PPE for personal care and effective use of PPE is essential for effective infection control in care homes .

Staff must wear recommended PPE for contact with all people who use their services. The table included in: Infection Prevention and Control in Adult Social Care: Covid-19 Supplement is referred to ensure current and correct use of PPE — to ensure requirements when caring for a person not known or suspected to have Covid-19 are followed.

Decontamination Guidance

This care service follows DHSC guidance on environmental cleaning, appropriate disposal of materials, the disinfection of equipment and hard surfaces, and PPE.

Procedure

Much of the care delivered in care homes will require close personal contact. Any practicable steps will be followed to minimise the risk of transmission through safe working procedures. To fully protect people who use our services in {{org_field_name}} from the risks associated with infectious respiratory diseases, in {{org_field_name}} the following applies.

Staff will be vigilant to the symptoms of respiratory illness amongst people who use the services throughout the year but should be especially vigilant between October and March every year, when many respiratory illnesses such as influenza circulate, or in circumstances where there is pandemic as with Covid-19.
Staff should look out for the symptoms of Covid-19/influenza-like illnesses such as the sudden onset of fever, headache, sore throat, persistent cough, aches and pains, loss of appetite or a change in sense of smell or taste (anosmia). Early identification of infection is essential in preventing the spread of disease.
People at risk, such as those over 65 years, people with chronic respiratory and cardiovascular diseases, chronic renal diseases, diabetics and those who are immunocompromised, are entitled to free yearly seasonal influenza vaccinations and should be encouraged to access these unless contraindicated — seasonal flu immunisation should be encouraged and re-offered to unvaccinated people.
All people who use services will be offered the Covid-19 vaccination and boosters, as indicated and provided with information to help them make an informed decision. Vaccination records will be maintained, as per other vaccinations.
Staff should also be vaccinated with the seasonal influenza vaccination as part of the home’s occupational health programme. Research shows that high levels of staff vaccination can reduce the risk of influenza outbreak considerably.
All care home staff will be offered the opportunity to have the Covid-19 vaccination to protect themselves their families and vulnerable people.
During a flu/Covid-19 outbreak:
a. people should be encouraged to wash their hands frequently and where they are unable to they should be assisted to wash them
b. staff on duty should pay attention to all infection control practices; staff should clean their hands thoroughly with soap and water or a handrub (microbicidal handrubs, particularly alcohol-based) before and after any contact with people who use services; they should wear gloves and an apron when attending to symptomatic people and wash hands after each contact; the use of masks and eye protection is based on risk assessment or situations requiring close contact when aerosol-generating procedures are being carried out, such as suctioning
c. when Covid-19 or influenza is suspected, ill people should be isolated in their rooms until they are recovered and have been symptom-free for four or five days; the unnecessary movement of symptomatic people should be avoided. If they are transferred to hospital, the receiving unit and ambulance should be advised of their condition
d. environmental cleaning should be increased and DHSC guidance checked regularly and adhered to
e. dirty laundry should not be shaken in order to minimise the likelihood of dispersing virus through the air. Items should be washed as appropriate in accordance with the manufacturer’s instructions. Dirty laundry that has been in contact with an ill person can be washed with other people’s items. Items heavily soiled with body fluids, such as vomit or diarrhoea, or items that cannot be washed, should be disposed of, with the owner’s consent
f. symptomatic individuals’ clothes, linen and soft furnishings should be washed on a regular basis, and their rooms kept clean as per IPC current guidance from UK Health Security Agency Covid-19 Supplement to the Infection Prevention and Control Resource for Adult Social Care
g. general interventions may include increased cleaning activity to reduce risk of retention of virus on hard surfaces, and keeping rooms properly ventilated by opening windows whenever safe and appropriate
h. people should be provided with an adequate supply of tissues as well as convenient and hygienic ways of disposing of used tissues; used or contaminated paper tissues should be disposed of as infectious waste — follow the “Catch it. Bin it. Kill it” campaign
i. any reasonable measures will put in place to support care home providers in maintaining individual’s independence and mobility and prevent or delay deterioration and loss of function
The pneumococcal vaccination status of all those new to the service should be assessed and any unvaccinated person over the age of 65, who is in one of the high-risk groups recommended by the DHSC, should be offered a single dose of the pneumococcal vaccine when they are admitted as advised by their GP, unless contraindicated.
Where expert advice or support is required, {{org_field_name}} manager or Infection Control Lead should confer with the local public health protection team.

Reporting

Care homes have a duty to report suspected outbreaks or incidents of infections to the local health protection team.

Health and social care settings should inform their local Health Protection Team as soon as possible to report any serious or unusual illness.

Notifiable diseases and causative organisms: how to report has been updated in 2022 and includes information of all notifiable diseases.

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 in the home 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
infection control audits
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 for the home. The Infection Control Lead will work closely with the manager of the home to ensure that all infection control policies are effectively implemented.

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.

Training

All new staff should be encouraged to read this policy as part of their induction process. Clinical 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.

All care home staff should have access to thermometers to measure temperatures of both people who use services and staff and be trained to interpret results. Staff have both skills and equipment to be able to conduct pulse oximetry on people with suspected or confirmed Covid-19.

All care home staff should be trained in how to identify and respond to people who use services who deteriorate medically.

Audit

The Infection Control Lead for the home 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 regularly check for updated DHSC guidance and ensure this is complied with.

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}}

CH265. Respiratory Illnesses in Residential Care