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Infection Control and Cleanliness in Care Homes (Scotland) Policy

Aim

The aim of {{org_field_name}} is to ensure that staff, people who use services and their families and visitors are as safe as possible from acquiring infections because care home staff are aware of and put into practice effective systems of infection prevention and control.

Policy Statement

This care service understands that adherence to strict guidelines on infection prevention and control is of paramount importance in ensuring the safety of both people receiving care and staff.

The home understands the term “infection prevention and control (IPC)” to refer to a wide range of policies, procedures and techniques intended to prevent the spread of infectious diseases among staff, people who use services and communities. All of the staff working in a care home are at risk of infection or of spreading infection, especially if their role brings them into contact with blood or bodily fluids like urine, faeces, vomit or sputum. Such substances may well contain pathogens which can be spread if staff do not take adequate precautions. Infection prevention and control systems and procedures are also vital in minimising risk during outbreaks of communicable disease, or during pandemics.

The home is aware that health-related infections can be passed on by people receiving care to staff and by staff to people who use services in the course of care delivery. The aim is always to prevent any cycle of infection transmission occurring by making sure that care staff follow basic infection control measures as described in this policy.

The service will therefore always make sure that:

• people who use services, their families and staff are as safe as possible from acquiring infections from any source
• all health and care staff are aware of and put into practice the basic principles of infection prevention and control when carrying out their work.

Adherence to strict guidelines on infection control is of paramount importance in ensuring the safety of people who use services and staff. All staff are required to make infection control a key priority and to act at all times in a way that is compatible with safe, modern and effective IPC practice.

Legal Considerations

This care service will adhere to all relevant legislation, including:

• the Health and Safety at Work, etc Act 1974
• the Control of Substances Hazardous to Health Regulations 2002 (COSHH)
• the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013.

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

In addition to the above, the home must also comply with the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR). These place a duty on the home to report outbreaks of certain diseases as well as accidents such as needle-stick accidents.

Guidance

The policy has been written to ensure compliance with the requirements of applicable guidance and best practice, including:

• the NHS Scotland National Infection Prevention and Control Manual (NIPCM)
• Covid-19 — Information and Guidance for Social, Community and Residential Care Settings (Including Care Homes for Older People Registered with the Care Inspectorate) Version 2.7 (updated May 2023), Public Health Scotland.

{{org_field_name}} understands that the NIPCM manual should be adopted for infection prevention and control practices and procedures by all those involved in care provision. The manual is mandatory for NHS Scotland and best practice in all other care settings.

The NIPCM contains guidance on:

• Standard Infection Control Precautions (SICPs)
• Transmission Based Precautions (TBPs)
• Healthcare Infection incidents, outbreaks and data exceedance.

Infection Control Responsibilities

All staff in {{org_field_name}} have responsibilities for “playing their part” in the maintenance of high standards of hygiene and in implementing effective systems of infection prevention and control.

Specific responsibilities are as follows.

• _______________ is the infection control lead for the home.
• _______________ is responsible for infection control risk assessment and staff training.
• _______________ is responsible for checking fridge temperatures and ensuring that specimens are processed and handled safely.
• _______________ is responsible for the cleaning and hygiene of the home.

Managers will work closely with staff safety representatives in ensuring a co-ordinated approach by the entire workforce. Staff are required to make infection control a key priority and to act at all times in a way that is compatible with safe, modern and effective infection control practice.

Managers and supervisors are responsible for ensuring that staff have access to sufficient facilities and supplies of appropriate equipment to ensure that they can implement effective infection control procedures and techniques.

Any staff who do not feel they have access to sufficient resources have a duty to inform their line manager or supervisor.

Airborne Illnesses

{{org_field_name}} believes that general adherence to high standards of infection prevention and control is the best way to prevent the person-to-person spread of airborne pathogens such as coronavirus and maximise the safely of staff, people and visitors.

Care managers and supervisory staff should make sure that people:

• cover their mouth and nose with a tissue or their sleeve (not their hands) when they cough or sneeze
• put used tissues in the bin immediately
• wash their hands with soap and water regularly for 20 seconds and use hand sanitiser gel (at least 60% alcohol) if soap and water are not available
• try to avoid close contact with people who are unwell
• avoid touching their eyes, nose and mouth with unwashed hands
• wear face coverings, masks and personal protective equipment (PPE) as required
• clean and disinfect frequently touched objects and surfaces.

Staff should comply fully with hand sanitisation policies and procedures. Managers will ensure that policies are supported by the provision of appropriate resources such as hand sanitiser gels.

Regular cleaning of frequently touched hard surfaces with a suitable disinfectant and cleanser will be carried out.

Effective Hand Hygiene

{{org_field_name}} accepts that a significant cause of cross-infection in a care environment is from unwashed or poorly washed hands which provide an effective transfer route for microorganisms. The home believes that regular, effective hand hygiene, when done correctly, is a key element in preventing the spread of communicable diseases. Staff who fail to adequately carry out effective hand hygiene before and after contact with people who use services may transfer microorganisms from one person to another and expose themselves and others to infection.

All staff should, at all times, observe high standards of hand hygiene. NIPCM Standard Infection Control Precautions (SICPs) regarding hand hygiene apply.

Before performing hand hygiene staff should:

• expose forearms (bare below the elbows)
• remove all hand/wrist jewellery (a single plain metal finger ring is permitted)
• ensure finger nails are clean, short and that artificial nails or nail products are not worn
• cover all cuts or abrasions with a waterproof dressing.

To enable effective hand hygiene {{org_field_name}} will ensure that suitable hand washing facilities and alcohol based hand rubs (ABHRs) are available for staff as near to point of care as possible. Where this is not practical, personal ABHR dispensers will be supplied.

Hand hygiene should be performed with soap and water or with an ABHR:

• before and after touching a person receiving care
• between carrying out different care activities on a person receiving care
• before clean/aseptic procedures
• after body fluid exposure risk
• after touching an individual’s immediate surroundings
• before handling medication
• before preparing food
• after visiting the toilet or blowing the nose
• after removing PPE.

Staff should wash hands with non-antimicrobial liquid soap and water if:

• hands are visibly soiled or dirty
• caring for people receiving care with vomiting or diarrhoeal illnesses
• caring for a person receiving care with a suspected or known gastrointestinal infection, eg norovirus or a spore forming organism such as Clostridium difficile.

Staff should support any person who uses services with hand hygiene regularly where required.

Using Personal Protective Equipment (PPE) for Infection Control

In {{org_field_name}}:

• adequate and suitable personal protective equipment (PPE) for use in infection control will be provided (eg disposable gloves, disposable aprons, face masks and eye/face protection, etc
• infection control PPE will be worn and used by staff as required in applicable policies and procedures and according to national guidance, training and best practice
• the responsibility for ordering and ensuring that supplies of infection control PPE are readily available and accessible lies with ___________________
• any member of staff who suspects that they or a person who uses services might be suffering from an allergic reaction to the use of latex gloves should stop using them immediately and inform their line manager.

See associated policy on the use of infection control PPE.

All visitors to the home must comply with current visiting arrangements. Refer to the latest visiting policy for further information.

Environmental Cleaning and Decontamination

All staff have a responsibility to help keep the home clean and tidy and to identify areas which fall below acceptable or safe standards.

• Management of the routine cleaning of the home is the responsibility of: _________________________.

The NIPCM guidance states that the care environment must be:

• visibly clean, free from non-essential items and equipment to facilitate effective cleaning
• well maintained and in a good state of repair
• routinely cleaned in accordance with the Health Facilities Scotland (HFS) National Cleaning Specification.

In {{org_field_name}} environmental cleaning will be carried out according to agreed protocols between {{org_field_name}} and the cleaning provider. These will set out the required frequency of cleaning required and the standards which must be met. Staff should bring to the attention of the management any instances where cleaning does not meet the set standards.

During communicable disease outbreaks, the level of general environmental cleaning will be increased and additional standards for decontamination agreed. Special attention should be paid to commonly touched surfaces, such as door handles, and to bathrooms and toilets.

Procedures for the Cleaning of Spillages

Staff must clean up spillages of body fluids or body waste immediately and not wait for cleaning staff. Spillages should be treated as potentially infectious and precautions taken as specified in the NIPCM SICPs (including Appendix 9). Staff should wear protective gloves and aprons and use disposable wipes. Eye protection should be used if there is risk of splashing.

For a spillage of blood, a 10,000ppm hypochlorite solution or chlorine releasing granules should be used. Staff should do the following.

1. Put on PPE.
2. Apply chlorine releasing granules directly to the spill.
3. If granules not available place disposable paper towels over spillage to absorb and contain it applying solution of 10,000 parts per million available chlorine (ppm av cl) solution.
4. Follow manufacturers’ instructions on contact time or leave for three minutes.
5. Discard the gross contamination into a clinical waste bag.
6. Wash area with disposable paper towels and a solution of general purpose detergent and warm water.
7. Perform hand hygiene.

Staff should note that chlorine releasing disinfectants such as hypochlorite should never be used directly on urine spills as this can release irritant chlorine gas. Health Protection Scotland advise that spills containing only urine, faeces, vomit or sputum should be initially cleaned up using towels and a gelling agent. The area can then be decontaminated with a solution of 1,000 parts per million available chlorine (ppm av cl) solution or a combined detergent/chlorine releasing solution with a concentration of 1,000 ppm av cl.

Soft furnishings (eg carpets) may be damaged by disinfectant products such sodium hypochlorite. The Health and Safety Executive (HSE) recommends that contaminated carpets that cannot tolerate chemical disinfection should be cleaned using a detergent and steam cleaned.

When using chlorine releasing agents, staff should always follow the manufacturer’s guidelines. In {{org_field_name}}, all such procedures should be subject to an appropriate COSHH risk assessment.

Mops and buckets should never be used for cleaning up body fluid spills.

Further information and guidance is provided in Standard Infection Control Precautions Literature Review: Management of Blood and Body Fluid Spillages in Health and Care Settings, published by Health Protection Scotland.

Cleaning and Sterilising Instruments and Equipment

Care equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious agents. It must therefore be kept clean.

{{org_field_name}} uses single-use, disposable equipment wherever practical rather than equipment that requires sterilisation. Such single-use equipment must never be reused.

All equipment that is not disposable must be cleaned/decontaminated:

• between each use
• after blood and/or body fluid contamination
• at regular predefined intervals as part of an equipment cleaning protocol
• before inspection, servicing or repair.

At all times staff must adhere to manufacturers’ guidance for use and decontamination instructions.

Recommended procedures for how to decontaminate reusable non-invasive care equipment can be found in Appendix 7 of the NIPCM guidance. Low-risk equipment should be thoroughly cleaned with hot water and detergent.

The Handling and Disposal of Clinical Waste

NICPM guidance requires that infection prevention waste (eg soiled dressings, sharps) must be disposed of into the correct waste stream. This will generally mean disposal as clinical waste.

All clinical and potentially infectious waste must be disposed of in appropriately coloured clinical waste sacks (usually yellow or orange) according to the home’s clinical waste disposal policies. In clinical areas pedal-type lidded bins should be used to hold sacks. When no more than three-quarters full, the sacks must be sealed and stored safely to await collection by an authorised collector. Each sack should be clearly labelled with the home’s details.

Non-infectious offensive/hygiene waste should be disposed of in its own waste stream in yellow bags with a black stripe. Non-clinical waste should be disposed of in normal black plastic bags.

Where a care home has a clinical waste contract, the guidance requires all waste that has been used in the care of a person who uses services with Covid-19 is placed in the clinical waste and disposed of immediately.

If {{org_field_name}} does not have a clinical waste contract, staff must ensure that all waste items that have been in contact with the affected person who uses services are disposed of securely within disposable bags. When full, the plastic bag should then be placed in a second bin bag and tied. These bags should be stored in a secure location for 72 hours before being put out for collection.

The authorised clinical waste collector for {{org_field_name}} is:

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Full clinical waste sacks are stored here:

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The Handling and Storage of Specimens

In {{org_field_name}}:

• specimens should be collected as requested by a GP
• all specimens should be treated with equally high levels of caution
• specimens should be labelled clearly and packed into self-sealing bags and stored in the designated fridge prior to being taken to the GP for collection by the local laboratory
• non-sterile gloves should be worn when handling the specimen containers and hands should be washed afterwards.

Sharps Safety

{{org_field_name}} complies fully with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 and associated guidance from the HSE, according to which the unnecessary use of medical sharps should be avoided wherever possible.

In {{org_field_name}}:

• where sharps are used, “safer sharps” are employed wherever possible, such as safer syringes, etc
• sharps — typically needles or blades — are disposed of in proper, purpose-built sharps disposal containers complying with BS EN ISO 23907-1:2019
• sharps are never disposed of in ordinary or clinical waste bags
• staff should never re-sheath needles
• boxes should never be overfilled
• when full, boxes should be sealed, marked as hazardous waste and clearly labelled with the individual’s details
• staff should never attempt to force sharps waste into an overfilled box
• used, filled boxes should be stored securely until collected for incineration according to individual arrangements.

In the event of an injury with a used or potentially contaminated needle:

• staff should wash the area immediately and encourage bleeding if the skin is broken
• staff should report the injury to their line manager immediately and ensure that an incident form is filled in
• staff should make an urgent appointment to see a GP or, if none is available, accident and emergency
• managers should record and investigate the incident and ensure that the member of staff is offered appropriate “post-exposure prophylaxis” and counselling as required.

Laundry Areas

{{org_field_name}} recognises that the provision of clean, well laundered clothing, bed linen and towels is not only a critical element in the provision of high-quality care but it is also an essential part of infection control in the home. A laundry area is also a potentially high-risk source of cross infection itself, especially where soiled items are being processed, and care home managers need to pay particular attention to hygiene practices.

In {{org_field_name}}:

• effective infection control procedures and established best practice will be followed to guard against the risk of cross-infection
• staff will ensure that all machines, surfaces and storage areas within the laundry are kept clean and tidy and that areas used for foul linen are disinfected and cleaned after use
• foul laundry will be washed at appropriate temperatures (minimum 65°C for not less than 10 minutes) to thoroughly clean linen and control risk of infection
• foul linen should never be mixed with clean laundry and a flow of laundry from “dirty” to “clean” will be maintained.

During the coronavirus pandemic HPS guidance states that any towels or other laundry used by a person who uses services diagnosed with Covid-19 should be treated as infectious and placed in a bag before removing it from an isolation room and placing directly into the laundry hamper/bag.

Reporting

RIDDOR requires an organisation to report the outbreak of notifiable diseases to the HSE. Notifiable diseases include: cholera, food poisoning, smallpox, typhus, dysentery, measles, meningitis, mumps, rabies, rubella, tetanus, typhoid fever, viral haemorrhagic fever, hepatitis, whooping cough, leptospirosis, tuberculosis and yellow fever.

Records of any such outbreak must be kept, specifying dates and times and a completed disease report form must be sent to the HSE.

• In the event of an incident, _________________________ is responsible for informing the HSE.
• RIDDOR forms are kept here: _______________________________.

The HSE has clarified its position regarding RIDDOR reports associated with the coronavirus pandemic. HSE states that the reporting requirements relating to cases of illness or deaths from Covid-19 under RIDDOR apply only to occupational exposure, that is, as a result of a person’s work. There is no requirement under RIDDOR to report incidents of disease or deaths of members of the public, patients or people who use services from Covid-19.

Support and Outbreaks

The home will work in collaboration with the local Health Protection Team (HPT) to maintain the highest standards of infection control at all times and ensure that, as far as is reasonably practicable, people who use services and staff are protected from the spread of infection.

Contact details: ____________________________

During the coronavirus pandemic, on identification of a new suspected or confirmed Covid-19 case, {{org_field_name}} must immediately contact the local HPT who will undertake an assessment of the situation including the adequacy of infection prevention and control measures and will advise on the need for testing of people who use services and staff.

Infection Control Training

All staff will be trained in basic infection prevention and control measures in line with the home’s policies and procedures. Records of training completion and performance will be kept, along with details of any required competency achievement. Training should be updated as required by changes of legislation, policy and guidance. It will take the form of a blended learning approach which will include face-to-face sessions and online web-based e-learning.

Staff with specific infection control responsibilities or specialist roles will be supported in accessing the relevant training for their role, duties and levels of responsibility.

All new staff should be required to read this policy, and other infection control and health and safety policies, as part of their induction process. All new care staff will be trained in the effective use of PPE at the point of care as part of their induction infection control training.

Monitoring and Review

All safety incidents or accidents relating to infection control should be reported and a record made. This must include near misses. The infection control lead and {{org_field_name}} manager will investigate any incidents and regularly review incident records.

This policy will be subject to regular ongoing monitoring and review as required.

Signed Declaration

This policy reflects current compliance with all applicable infection prevention and control legislation, regulations, guidance and best practice.

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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}}

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