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DC105-Acute Respiratory Infection, Including COVID-19, Management Policy

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Registration Number: {{org_field_registration_no}}

Acute Respiratory Infection, Including COVID-19, Management Policy

1. Purpose

The purpose of this policy is to set out the arrangements used by {{org_field_name}} to prevent, identify, assess and manage acute respiratory infections, including COVID-19, influenza and respiratory syncytial virus, while delivering regulated domiciliary care services in England.

{{org_field_name}} will apply standard infection control precautions at all times and will introduce additional transmission-based precautions where these are indicated by an individual risk assessment, the person’s symptoms, the care activity being undertaken, current national guidance or advice from a relevant health professional or UK Health Security Agency Health Protection Team.

Infection-control measures will be proportionate to the identified risk and will take account of the person’s safety, dignity, rights, communication needs, mental capacity, emotional wellbeing and preferences. Necessary care will not be withheld solely because a person has symptoms of, or has tested positive for, an acute respiratory infection. The service will instead assess how the care can be delivered safely.

2. Scope

This policy applies to all employees, agency workers, contractors, volunteers and other persons working on behalf of {{org_field_name}}. Relevant information will also be made available to service users, representatives, family members, visitors and professionals involved in a person’s care.

This policy applies to:

3. Legal and regulatory framework

This policy will be implemented with regard to the following legislation, statutory guidance and national guidance, as applicable:

Current national guidance will be followed where it is applicable to domiciliary care. Where local professional advice differs because of a specific incident or local risk, the advice and the reasons for following it will be documented.

4. Roles and responsibilities

The Registered Provider will:

The Registered Manager will:

The Infection Prevention and Control Lead will:

All care workers must:

5. Infection prevention and control measures

{{org_field_name}} will apply standard infection control precautions during all care delivery. Additional precautions will be introduced following an assessment of:

Hand hygiene

Staff must clean their hands:

Liquid soap and water must be used where hands are visibly dirty, after contact with diarrhoea or vomiting, and whenever alcohol hand rub would not be effective. Alcohol hand rub may be used where hands are visibly clean and it is safe and appropriate to do so.

Staff must keep fingernails short and clean and must not wear artificial nails or nail extensions when providing personal care. Hand and wrist jewellery must be restricted in accordance with infection-control requirements.

Respiratory hygiene

Staff will encourage and support service users to cover their nose and mouth when coughing or sneezing, dispose of tissues promptly and clean their hands. Used tissues and items contaminated with respiratory secretions must be disposed of safely.

Ventilation

Fresh air should be introduced where practical and acceptable to the service user, particularly when a person has symptoms of an acute respiratory infection. Ventilation decisions must take account of weather conditions, room temperature, security, privacy, the person’s comfort and any risk of falls or other harm.

Cleaning and decontamination

Frequently touched surfaces and shared care equipment must be cleaned at an appropriate frequency using products suitable for the surface, equipment and suspected organism. Staff must follow the manufacturer’s instructions concerning dilution, contact time, storage, compatibility and safe use.

Single-use equipment must not be reused. Reusable care equipment must be cleaned and, where required, disinfected between service users and after contamination. Equipment that cannot be safely decontaminated must not be shared.

The provider will not describe routine cleaning as “deep cleaning” without specifying the required method, product, concentration, contact time, equipment and person responsible.

6. Infection-risk assessment in the person’s home

Before the service starts, and whenever needs or circumstances change, {{org_field_name}} will assess infection risks associated with delivering care in the person’s home.

The assessment will consider:

Care workers must undertake a dynamic risk assessment at each visit. New symptoms, household infections, environmental changes, PPE shortages or other relevant concerns must be reported promptly and recorded in accordance with the service’s reporting procedures.

The provider is not responsible for the general cleanliness or condition of a person’s private accommodation unless this forms part of the agreed regulated care. However, risks arising from the environment that affect the safe delivery of care must be assessed, discussed with the person and, where necessary, escalated.

7. Personal protective equipment

PPE will be selected following an assessment of the care activity, anticipated exposure, route of transmission and current national guidance. PPE does not replace hand hygiene, ventilation, cleaning or other infection-control precautions.

Gloves

Disposable gloves must be worn where there is an anticipated risk of contact with:

Gloves must not be worn merely because personal care is being provided. Gloves must be changed between different care activities where contamination may be transferred, between service users, and immediately if torn or heavily contaminated. Hand hygiene must be completed after gloves are removed.

Disposable aprons and gowns

A disposable apron must be worn where there is a risk that clothing may be contaminated by blood, body fluids, respiratory secretions, excretions or contaminated items. A fluid-resistant gown or coverall will only be used where indicated by the risk assessment, current national guidance or advice relating to a particular procedure or infection.

Face masks

Face masks are not required routinely for every care visit or every episode of close-contact care.

A Type IIR fluid-repellent surgical mask must be made available and worn:

Staff who choose to wear a face mask in other circumstances should be supported following an appropriate risk assessment. Where mask use interferes with communication, causes distress or places the person at another risk, reasonable adjustments must be considered. These may include modifying communication methods or, where appropriate, using a transparent mask that meets applicable regulatory standards.

A mask must:

Eye and face protection

Eye or face protection must be worn where there is a risk of splashing or spraying of blood, body fluids or respiratory secretions towards the eyes or face. Prescription spectacles are not suitable eye protection.

Respiratory protective equipment and aerosol-generating procedures

Where staff undertake an aerosol-generating procedure, the provider must complete a procedure-specific risk assessment and follow current national infection-control guidance. Any required filtering facepiece respirator must be suitable for the procedure and the wearer. Staff must receive fit testing, training and a fit check before use. Staff must not undertake an aerosol-generating procedure unless they have been trained and assessed as competent.

Putting on and removing PPE

PPE must be put on and removed in the correct sequence, away from the service user where reasonably practicable, and in a manner that prevents contamination of clothing, skin, equipment and the environment. Staff must receive practical instruction and competency assessment in putting on, removing and disposing of PPE.

PPE supply and storage

{{org_field_name}} will maintain sufficient suitable PPE for foreseeable needs. PPE will be stored securely, kept clean and dry, protected from contamination, used before its expiry date and transported between visits in a manner that separates clean supplies from used or contaminated items.

PPE shortages must be reported immediately. Staff must not be instructed to improvise unsuitable PPE or reuse single-use PPE.

8. Waste, laundry and sharps

Waste generated during care will be managed according to the type of waste, the care activity, the person’s agreed waste arrangements and applicable national and local requirements.

Staff must:

Laundry soiled with blood, body fluids or respiratory secretions must be handled as little as possible and must not be shaken. It should be placed directly into the agreed laundry container and washed at the highest temperature suitable for the fabric, using an appropriate detergent, in accordance with the person’s care plan and current guidance.

Sharps must be disposed of immediately into an approved sharps container at the point of use. Needles must not be recapped, bent, broken or removed by hand unless a specifically designed safety system requires this. Sharps containers must not be overfilled and must be stored and collected safely.

9. Symptoms, testing and staff attendance

Staff must be familiar with the recognised symptoms of acute respiratory infection and must report relevant symptoms to their line manager before attending work or as soon as symptoms develop during work.

A staff member who has symptoms of a respiratory infection and has a high temperature, or does not feel well enough to work, must stay away from work and avoid contact with other people where possible. The staff member should not return to work until they no longer have a high temperature and no longer feel unwell.

Before the staff member returns, the manager will complete and record a return-to-work risk assessment. This will consider:

Routine COVID-19 testing is not required for all staff or service users.

Staff and service users should normally test for COVID-19 only where:

A person who is eligible for COVID-19 treatments and develops symptoms must be supported to access testing and clinical advice promptly.

Contacts of a confirmed COVID-19 case do not routinely need to test. They should monitor their health, follow current public guidance and report symptoms promptly.

Testing decisions, results and related health information must be recorded and shared only where there is a lawful basis and a care, employment, public-health or safety need.

10. Staff member with a positive COVID-19 result

Staff should normally only undertake a COVID-19 test where they have symptoms and are eligible for treatment, or where testing has been advised by a clinician or Health Protection Team.

A staff member who tests positive for COVID-19 must stay away from work for a minimum of five days from:

After five days, the staff member may return when they feel well and do not have a high temperature, subject to a documented manager’s risk assessment.

Where respiratory symptoms remain, the manager must consider the nature of the symptoms, the staff member’s role, the vulnerability of the people supported and whether additional precautions or medical advice are required.

A positive test does not remove the need to seek clinical advice where symptoms are severe, worsening or otherwise concerning.

11. Management of a service user with symptoms or a positive test

Where a service user has symptoms of an acute respiratory infection, the care worker must:

A service user receiving care in their own home who has a high temperature or feels too unwell to carry out their usual activities should be advised and supported to avoid contact with other people until they no longer have a high temperature and no longer feel unwell.

The provider must not impose a restriction on the person’s movement without a lawful basis. Advice and support must take account of the person’s consent, mental capacity, communication needs, living arrangements, safety and wellbeing.

Where the person tests positive for COVID-19, they should be supported to follow current public guidance for people with a positive result. Those who are eligible for COVID-19 treatments must be supported to obtain treatment as quickly as possible.

Care must continue where it is necessary to meet the person’s needs. The manager will review the risk assessment and may make proportionate arrangements such as:

Any temporary change to the care plan must be risk assessed, agreed with the person or lawful representative where practicable, recorded and regularly reviewed.

12. Escalation, external advice and statutory notifications

The Registered Manager or delegated senior person will determine whether external advice or notification is required.

Advice should be sought from the relevant UK Health Security Agency Health Protection Team, local-authority public-health team, commissioner or healthcare professional where:

The Registered Manager will consider whether the incident requires notification to:

CQC notification is not automatically required for every positive COVID-19 result. The manager must apply the current notification requirements to the circumstances and document the decision.

Where a medical practitioner has the statutory duty to notify a notifiable disease, the provider will cooperate and provide relevant information lawfully. The provider will not assume that its contact with a Health Protection Team replaces the medical practitioner’s statutory duty.

13. Vaccination and immunisation

{{org_field_name}} recognises vaccination as one component of infection prevention and workforce health. The organisation will:

Vaccination will not be described as a mandatory condition of employment unless a specific lawful requirement applies to the role at the relevant time. Staff will not be subjected to unlawful discrimination or detriment because of a protected characteristic, medical condition or disability.

Vaccination status does not remove the requirement to follow standard infection control precautions or to stay away from work when unwell.

14. Communication, consent, equality and safeguarding

Information about respiratory infection, testing, PPE, temporary changes to care and infection-control precautions will be communicated in a form the service user can understand.

The service will make reasonable adjustments where a person:

Consent must be obtained for testing, sharing information, changes to care and other relevant interventions. Where there is reason to doubt capacity, the Mental Capacity Act 2005 must be followed. Any best-interests decision must be decision-specific, proportionate, recorded and involve the person and appropriate representatives as far as practicable.

Infection-control measures must not result in unlawful discrimination, degrading treatment, avoidable social isolation, neglect, inappropriate restraint or an unjustified restriction of the person’s rights.

Staff must report safeguarding concerns arising from infection-management arrangements, including:

Necessary changes to visits, care workers or visit times must be communicated promptly. The person must be involved in decisions and the impact on continuity, dignity, safety and wellbeing must be considered.

15. Confidentiality and information sharing

Information about symptoms, test results, vaccination, medical conditions and treatment is special-category personal data. It will be collected, used, shared, retained and disposed of in accordance with the UK GDPR, Data Protection Act 2018 and the organisation’s data-protection policies.

Information will be limited to what is necessary and shared only with persons who require it for:

Staff must not disclose the identity or health information of an affected service user or colleague to other service users, families or unauthorised persons. General risk information may be shared without identifying the individual where this is sufficient to protect others.

Records relating to symptoms, tests, risk assessments, advice, decisions and care changes must be accurate, contemporaneous, secure and accessible to authorised staff.

16. Staff training, competency and support

Before working without direct supervision, staff must receive infection prevention and control training appropriate to their role. Training will include, where applicable:

Training must include practical assessment where the skill cannot be safely demonstrated through knowledge-based learning alone. This includes hand hygiene, putting on and removing PPE, and use of respiratory protective equipment where applicable.

Training and competency records must include:

Refresher training will be provided at intervals determined by risk, audit findings, changes in guidance, incidents, observed practice and staff learning needs. Training will not rely solely on an arbitrary annual or pandemic-specific schedule.

Staff will be supported to raise concerns without fear of detriment. Where a staff member has a health condition that may affect infection risk or PPE use, a confidential occupational-health or management risk assessment will be undertaken and reasonable adjustments considered.

17. Occupational exposure and staff safety

Staff must immediately report:

Following exposure, staff must:

The manager will ensure that the staff member has access to timely post-exposure assessment and will consider whether the incident requires RIDDOR reporting, safeguarding action, investigation, staff support or changes to risk controls.

18. Monitoring, audit and continuous improvement

The Registered Manager and Infection Prevention and Control Lead will maintain an audit programme proportionate to the size, complexity and risks of the service.

Monitoring will include:

Audit frequency will be determined by risk. Additional audits will be undertaken following:

Audit findings must identify:

Themes and learning will be shared with staff in an appropriate format. Serious or repeated concerns will be escalated through the organisation’s governance arrangements.

19. Business continuity and safe staffing

{{org_field_name}} will maintain a business-continuity plan addressing the impact of acute respiratory infection on staffing and service delivery.

The plan will include:

Visits must not be cancelled or reduced solely for organisational convenience. Any unavoidable change must be individually risk assessed, recorded and communicated. Where the service cannot safely meet a person’s essential needs, the Registered Manager must escalate the concern immediately to the relevant commissioner, local authority, health professional or emergency service.

20. Management of blood and body-fluid spills

Blood and body-fluid spills must be managed promptly by trained staff using PPE appropriate to the risk.

Staff must:

Cleaning products must be subject to a COSHH assessment and stored securely. Staff must not use a chlorine-based product on a surface or item where the manufacturer advises that it is unsuitable.

21. Transfer of care and shared care

Where responsibility for a service user’s care is shared with or transferred to another person or organisation, relevant infection information must be communicated safely and without avoidable delay.

Information may include:

Only information necessary for safe care will be shared. The service user’s consent must be obtained unless another lawful basis permits or requires disclosure.

Handover arrangements must be documented. Staff must not assume that another provider, family member or healthcare professional has received relevant information unless this has been confirmed.

22. Policy review

This policy will be reviewed:

The Infection Prevention and Control Lead will monitor relevant national guidance between formal review dates. Where guidance changes, interim instructions will be issued promptly and incorporated into the policy without waiting for the scheduled review.

Changes will be communicated to affected staff and, where relevant, to service users and representatives. Additional training or competency assessment will be provided where the amendment changes staff practice.

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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