D351. Infection Control — Acute Respiratory Infections

Infection Control — Acute Respiratory Infections

Policy Statement

This document describes this care service’s policies and procedures relating to the management of risks posed by acute respiratory infections (ARI).

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 the service 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.

{{org_field_name}} 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 service 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.
Personal protective equipment (PPE) is in plentiful supply and properly used and disposed of.
Encouraging and supporting staff and people to be appropriately vaccinated.
Risk assessment of people’s infection control needs, including identification of those eligible for Covid-19 treatments and flu antivirals.

When a Person Has Symptoms

If a person receiving services has high temperature and any of the above symptoms, they should be encouraged to stay away from other people until they no longer have a high temperature or feel unwell.

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.

Should infection be a particular risk to the symptomatic person’s household members or other people receiving services, such as those with pre-existing conditions that make them particularly vulnerable, then any necessary extra precautions should identified, such as:

the supply and use of extra PPE as required
supporting a person to isolate and protect vulnerable household members.

{{org_field_name}} may also consider, as appropriate:

rearranging visit schedules so that the potentially infectious person is seen last
rearranging visit schedules so that the person who is at risk is not on the same round.

As far as possible, in line with {{org_field_name}}’s usual policy, changes to schedules will be made following proper discussion with everyone affected and with their consent but may occasionally need to be made at short or emergency notice.

{{org_field_name}} expects people receiving services and their household members to advise the office of any infectious diseases or positive Covid tests and to take any reasonable precautions, per the guidance for People with Symptoms of a Respiratory Infection Including Covid-19, to keep {{org_field_name}}’s staff and other vulnerable people safe from infection, for example:

opening windows to ventilate the room before staff arrive
extra shopping/domestic tasks to ensure suitable cleanliness of surfaces, etc
household members with illnesses remaining in another part of the house while staff attend.

The guidance is available in an easy read version, accessible formats and several languages and will be shared with staff and people as needed.

People Who Are Eligible for Covid-19 Treatments

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

On commencement of service, the assessor will check that there are three tests available to enable the person 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 if required as part of their care and support plan
will be encouraged to stay away from others for a minimum of five days after the onset of respiratory symptoms.

If the person is still unwell after five days:

they should be encouraged 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

People new to the service or resuming services who have a positive test before discharge from hospital can be discharged home and commence services if the responsible person 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.

Medical advice will be sought if there is any concern about their condition.

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 {{org_field_name}} and staff kept informed of the current expectations and arrangements for collection/delivery of any additional items required.

Care and other field staff who feel that for any reason they cannot meet {{org_field_name}}’s changed PPE expectations for their work should speak to the manager immediately.

Face masks

Care workers do not routinely need to wear a face mask when providing care in people’s own homes.

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 the person being cared for would prefer staff or visitors to wear a mask while providing them with care or visiting.

An assessment should be undertaken by a provider when considering how to support the personal preferences of care workers and visitors who wish to wear a face mask in situations beyond the above recommendations.

{{org_field_name}} will consider mitigations if a person receiving care 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 between different people’s homes.

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, or when leaving the house of a care recipient. For donning and doffing instructions for AGPs refer to the PPE guidance for AGPs.

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 person’s home. 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 home
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 visor for eye protection.

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: {{next_review_date}}