CH354. Infection Control — Acute Respiratory Infections

Policy Statement

This document describes the care home’s policies and procedures relating to the management of risks posed by acute respiratory infections (ARI). It builds on learning from the Covid-19 pandemic in the areas of emergency response, routine infection control and the importance of visiting.

This care service understands that adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of both people who use {{org_field_name}} and staff.

This policy is written to comply with relevant guidance, particularly Infection Prevention and Control (IPC) in Adult Social Care: Acute Respiratory Infection (ARI), published by the Department of Health and Social Care (DHSC) and last updated in March 2024.

It should be considered alongside {{org_field_name}}’s other policies on infection control and risk assessment:

[list here as applicable]

{{org_field_name}}’s response to a wider local outbreak of infectious disease or national pandemic is considered in its emergency planning documents:

[list here as applicable]

Acute Respiratory Infection (ARI)

ARI is defined as the acute onset of one or more of respiratory symptoms and a clinician’s judgment that the illness is due to a viral acute respiratory infection such as Covid-19 or influenza (flu).

Symptoms of Covid-19, flu and common respiratory infections include:

continuous cough
high temperature, fever or chills
loss of, or change in, your normal sense of taste or smell
shortness of breath
unexplained tiredness, lack of energy
muscle aches or pains that are not due to exercise
not wanting to eat or not feeling hungry
headache that is unusual or longer lasting than usual
sore throat, stuffy or runny nose
diarrhoea, feeling sick or being sick.

It can be difficult to distinguish between Covid-19, flu and illness caused by other respiratory viruses by symptoms alone. People with dementia may have a reduced ability to recognise or communicate when they feel unwell, and older adults often do not present with the common symptoms. It is therefore important that staff consider the possibility of ARI if there is a sudden deterioration in a person’s physical health or mental ability, with or without fever, in the absence of a known cause.

The home will ensure that staff are able to recognise and properly respond to symptoms of ARI and related urgent conditions such as hypoxia (low oxygen levels).

Principles

This home recognises that good infection control practice is key to reduce the risk of transmitting infections. This is addressed in depth in the relevant policies and procedures, but includes the following.

Staff follow best infection prevention and control procedures at all times, including effective hand hygiene.
The home is appropriately ventilated with fresh air.
The premises and equipment are properly cleaned and maintained.
Personal protective equipment (PPE) is in plentiful supply and properly used and disposed of.
Robust processes for the correct handling and segregation of waste and infectious linen.
Encouraging and supporting staff and people to be appropriately vaccinated.
Risk assessment of people’s infection control needs on admission, including identification of those eligible for Covid-19 treatments and flu antivirals.

When a Person Has Symptoms

In this home:

if a person living in the home has high temperature and any of the above symptoms, they should be supported appropriately to stay away from other people
the person will be supported to stay away from others until they no longer have a high temperature or feel unwell
a plan will be drawn up with the person to ensure their wellbeing while they have to avoid others, including [safely accessing the communal bathroom], accessing the garden, solo activities, etc
staff will continue to monitor the person’s symptoms and escalate any concerns immediately
the appropriate person will contact NHS 111 or the person’s GP if the person’s symptoms worsen, or 999 in an emergency.

The care home manager/responsible person will:

ensure that residents who undergo testing are informed of their test results
ensure that staff are informed of people’s test results and any relevant measures that have been implemented
inform people’s relatives in line with their wishes/ confidentiality arrangements
have a weekly check-in with the home’s [primary care network (PCN) or multidisciplinary team].

People Who Are Eligible for Covid-19 Treatments

People who are eligible for Covid-19 treatments will be tested. Tests are supplied by the home’s pharmacy:

[Name of pharmacy and supply arrangements here]

The home will ensure that there are always at least three tests available per eligible individual to enable them to test for three consecutive days if they develop ARI symptoms.

Eligible people who test positive for Covid-19:

will be supported to access appropriate treatments as quickly as possible
will be supported to stay away from others for a minimum of five days after the onset of respiratory symptoms
can return to their normal activities after five days if they feel well and no longer have a high temperature.

If the person is still unwell after five days:

they should be supported to continue to stay away from others until they feel well and they no longer have a high temperature, and for usually no longer than 10 days in total.

Clinical advice will be sought and followed.

People Who Tested Positive in Hospital

If a person receiving services tests positive while in hospital, the home will use their positive test date to estimate if and for how long the person needs to be supported to stay away from others on their return to the care home.

People new to the home who have a positive test before discharge can be admitted if the home is satisfied that they can be cared for safely. A risk assessment will be carried out and any arrangements or action required will be made before discharge.

The recommended period to stay away from others does not restart when they are admitted into the home, and further routine testing is not required. Medical advice will be sought if there is any concern about their condition.

If More Than One Person Has Symptoms

An outbreak may be suspected when there is an increase in the number of people displaying symptoms of a respiratory infection.

If two or more people develop symptoms of a respiratory infection within five days of each other, the care home will undertake a risk assessment as soon as possible and the responsible person will inform the health protection team (HPT) of a suspected outbreak.

[Local contact details and instructions]

The risk assessment should help to determine if there is an outbreak and if control measures are needed. However, the home will not wait for advice from the HPT if it is possible to initiate the risk assessment and the control measures independently.

The risk assessment should determine whether the cases are likely to have been the result of transmission within the care home, and if cases are therefore linked. In determining whether they are linked, the risk assessment should consider:

whether there is a known source of infection
whether there was contact between people while one or more had suspected or confirmed ARI
whether there is a staff member in common
whether the cases all live in the same area of the home or if they are in separate areas and do not have other links
whether the first identified case originated in the home.

Cases would be less likely to be considered linked if:

symptom onset was more than five days apart
the affected people had no contact with each other in the last five days.

Wider outbreak testing will only be done if advised by the HPT. The home will follow any further instructions given by the HPT around further testing and management and will contact the HPT for further advice as required. These may include wider testing if there are specific issues of concern, such as:

greater severity of illness than expected
more deaths or hospitalisations than expected
rapidly increasing cases despite control measures
a suspected outbreak of more than one ARI (eg flu as well as Covid-19).

The responsible manager will seek advice from [the relevant local authority contact] if there are operational issues such as staffing shortages or concerns about safety.

Outbreak Control Measures

This care home’s outbreak control measures will be proportionate, risk assessed and time limited. Examples of outbreak control measures may include and are not limited to:

increased cleaning frequency of frequently touched surfaces in shared areas
use of 1000 ppm chlorine-based solution or other product effective against respiratory viruses to clean the room, toilet and shower services used by symptomatic people
reminders to regularly let fresh air in, in all areas
universal use of type IIR fluid repellent surgical masks when providing care
reminders on hand and respiratory hygiene
proportionate reductions or postponement of communal activities
monitor everyone living in the home for elevated temperature and other respiratory symptoms
proportionate reductions in admissions which may include temporary closure of the home to further admissions
restricting movement of staff who provide care, where possible, for example between wings, or between different care settings (for example for agency staff)
cohorting of staff to care for symptomatic/positive or non-symptomatic/negative residents (where feasible and safe to do so)
proportionate changes to visiting — these will be in line with the home’s separate policy on visiting during an outbreak
any additional measures as advised by the HPT.

Any measures that the care home chooses to implement will be proportionate and risk-based and will be person-centred. Outbreak control measures will usually be lifted, following a risk assessment, five days after the onset of symptoms in the most recent case.

The care home manager will ensure staff, residents and their loved ones are informed of the outbreak and any relevant measures that have been implemented.

Personal Protective Equipment (PPE)

All PPE will be worn in line with guidance and the particular item’s instructions.

Any extra PPE required will be supplied by the home and staff kept informed of the current expectations.

Care and domestic staff who feel that for any reason they cannot meet the home’s changed PPE expectations for their work should speak to the manager immediately.

Face masks

Care workers and visitors to the home do not routinely need to wear a face mask. However, type IIR fluid-repellent surgical masks should be worn:

if the person being cared for has symptoms of ARI
when cleaning the room of a person with symptoms of ARI
if there is an outbreak of ARI in the home and the risk assessment favours the introduction of universal masking as one of the outbreak control measures
if the person would prefer staff or visitors to wear a mask while providing them with care or visiting.

An assessment will be undertaken when considering how to support the personal preferences of staff and visitors who wish to wear a face mask in situations beyond the above recommendations.

The home will consider mitigations if a person finds that the use of face masks impairs communication or is distressing. This may particularly be the case when caring for people with learning disabilities, cognitive conditions such as dementia, or people who rely on lip reading or facial recognition.

It may be appropriate in certain circumstances to consider using transparent face masks. Only transparent masks compliant with the Medicines and Healthcare Products Regulatory Agency (MHRA) standards can be considered as an alternative to type IIR surgical masks.

Face masks will be:

well fitted to cover the nose, mouth and chin
worn according to the manufacturer’s recommendations (for example checking the coloured side is worn outwards, unless the manufacturer states otherwise)
worn by staff only following a risk assessment
not allowed to dangle around the neck at any time, or rest on the forehead or under the chin
not touched once put on
removed and disposed of appropriately, with the wearer cleaning their hands before removal and after disposal
changed if either moist, damaged, contaminated or soiled, uncomfortable to wear
changed after providing care for someone or a single cohort of several people with symptoms of ARI.

People should not wear masks which have exhalation valves or vents. Cloth face coverings should not be used in situations where surgical masks are advised in adult social care settings.

Type IIR fluid-repellent masks

Type IIR fluid repellent surgical masks are recommended for use in adult social care. This is in line with the PPE recommendations for ARIs in adult social care.

These masks protect the wearer against blood or body fluid splashes, and against respiratory droplets. They also protect others from the wearer’s respiratory droplets.

Type I and type II masks

These do not meet the requirements of PPE. They are worn only for source control to protect others from the wearer’s respiratory droplets. Type I and type II masks can be used only in situations where the use of masks at all times is introduced during an outbreak and the care worker is not in close contact with symptomatic individuals.

Filtering face piece class 3 (FFP3) respirators for use during AGPs

FFP3 respirators are required when undertaking an aerosol generating procedure (AGP) on a person with symptoms of ARI or another infection spread by the airborne or droplet route. FFP3 respirators should be removed and disposed of outside of the room where the AGP was carried out.

The use of FFP3s is governed by health and safety regulations, and they should be fit tested to the user to ensure the required protection is provided. FFP3 respirators must be fit checked each time they are used. The HSE provides information and tools to help select and manage the use of respiratory protective equipment (RPE).

Gloves and aprons

Gloves and aprons should be used when there is a risk of exposure to mucous membranes, blood or body fluids. They should be worn if carrying out an AGP on a person. If there is an extensive risk of splashing, fluid repellent gowns should be worn instead of aprons.

When required, gloves should be changed between tasks. Hand hygiene should be performed between tasks, after removing and disposing of gloves, and upon leaving the room. Improper use of gloves may provide a false sense of reassurance to staff and visitors and reduce compliance with hand hygiene recommendations.

Eye protection

Eye protection should be worn:

when within one metre of a person with ARI infection, including when cleaning their room
if carrying out an AGP on a person. If a non-fluid resistant FFP3 is worn, use a full-face visor covering the eyes, nose and mouth.

Eye protection should:

be removed upon leaving the person’s room
be removed when taking a break (to drink, eat, use the toilet)
be discarded and replaced if damaged
not be worn around the neck or top of the head
be adjusted or discarded and replaced as appropriate if uncomfortable
be cleaned and disinfected between use or if visibly dirty and stored safely if reusable
be discarded after use or if visibly dirty if single use.

Prescription spectacles do not provide adequate eye protection; therefore, those wearing spectacles should use a suitable visor for eye protection.

Precautions for Visitors

The home expects visitors to take their infection prevention and control responsibilities seriously to keep our staff and other vulnerable people safe from infection. It also recognises the potential risks to visitors (and their household members) who might be vulnerable to a negative outcome from ARI.

The home’s expectations are in line with its infection control policies and guidance for People with Symptoms of a Respiratory Infection Including Covid-19, which is available in an easy-read version, accessible formats and several languages and will be shared with staff and people as needed.

Visitors should not enter the care home if they are feeling unwell, even if they have tested negative for Covid-19 and have had any flu or Covid vaccines they are eligible for.
Visitors should advise us of any infectious diseases or positive Covid tests in their household before visiting and take any reasonable precautions, per the guidance.
Visitors will follow the IPC processes put in place by the care home.
Visiting professionals should follow the same PPE recommendations as other visitors.
Visitors will be warned of any ongoing outbreak and any symptomatic people so that they are aware of the risks and can decide whether to go ahead with the visit or postpone if they wish to do so.
Additional requirements for face masks or other extra PPE may be in place during a confirmed outbreak of ARI, in line with local and national advice and instructions.

If a Staff Member Has Symptoms

Staff who have symptoms of respiratory infection and who have a high temperature or do not feel well enough to go to work are advised to stay home and try to avoid contact with other people.

Staff should not return to work until they no longer have a high temperature (if they had one) or until they no longer feel unwell.

Managers should undertake a risk assessment before staff return to work in line with normal return to work processes.

The staff member is expected to follow the guidance for People with Symptoms of a Respiratory Infection Including Covid-19.

Staff members do not need to take a Covid-19 test if they develop symptoms of a respiratory infection unless they are eligible for treatments. Staff members who are eligible for treatments and have symptoms of a respiratory infection should take a lateral flow test immediately and follow the guidance for people who are eligible for Covid-19 treatments.

Training

Staff with specific infection control responsibilities are provided with the relevant training for their role, duties and levels of responsibility, including appropriate instruction in using lateral flow tests, pulse oximeters or any other tools or equipment required to support people with ARI.

All training is updated as required by changes of legislation, policy and guidance.

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

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.