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Guidance for staff providing Care at Home
1
Preventing
Infection
Workbook Guidance for staff providing
Care at Home
Name Job Title
Guidance for staff providing Care at Home
3 Co
nte
nt
Contents Page Tick when completed
1. Introduction 4
2. Infection prevention and control 5
3. Standard precautions 10
4. Hand hygiene 11
5. Personal protective equipment 17
6. Sharps management 21
7. Blood and body fluids 25
8. Waste management 28
9. Laundry 30
10. Decontamination of equipment 32
11. Cleaning the environment 36
12. Personal health and hygiene 38
13. Specimen collection 40
14. Urinary catheter care 42
15. Viral gastroenteritis/Norovirus 46
16. Clostridium difficile 50
17. MRSA 55
18. MRGNB 59
19. CPE 61
Commentary 65
Key references 66
Certificate of completion 67
Secti
on
1:
Secti
on
2:
Sta
nd
ard
pre
ca
uti
on
s
Secti
on
3:
Ke
y t
op
ics
Secti
on
4:
Sp
ec
ific
in
fec
tio
ns
S
ecti
on
5:
Preventing Infection Workbook
4
1. Introduction We are a community NHS Infection Prevention and Control
(IPC) team based in North Yorkshire. Our aim is to support staff
who provide care at home by ensuring that guidance and best
practice in infection prevention and control is available in this
Workbook. It is evidence-based, includes national guidance and
complements a range of educational infection prevention and
control resources which can be viewed at:
www.infectionpreventioncontrol.co.uk
This Workbook is suitable for a wide range of staff providing
care at home, such as, domiciliary and rehabilitation teams, who
undertake personal care or assist with daily living activities.
Completion helps your organisation demonstrate compliance
with the Health and Social Care Act 2008 and Care Quality
Commission registration requirements in relation to infection
prevention and control training.
By applying the principles within the Workbook you will
demonstrate commitment to high quality care and patient safety.
The Francis Report 2013 states “It is unacceptable for a patient
to be injured by contracting certain types of infection as a result
of the failure to apply methods of hygiene and infection control”.
The Workbook has been designed to be undertaken in stages.
This will allow you to complete the ‘Test your knowledge’
questions before moving on to the next section. On completion,
your manager will check that you have achieved 100%
competency in your infection prevention and control knowledge
and then sign the ‘Certificate of completion’. You should keep
the Workbook as evidence of learning and as an on-going
reference guide to provide you with easily accessible
advice.
Dr Jenny Child
Director of Infection Prevention and Control/
Consultant Microbiologist
Harrogate and District NHS Foundation Trust
1.
In
tro
du
cti
on
Guidance for staff providing Care at Home
5 2.
In
fec
tio
n p
rev
en
tio
n a
nd
co
ntr
ol
2. Infection prevention and control The Health and Social Care Act 2008: Code of Practice on the
prevention and control of infections and related guidance
(Department of Health, July 2015), states that, “Good infection
prevention (including cleanliness) is essential to ensure that
people who use health and social care services receive safe and
effective care”.
Infection prevention and control is a key priority for the
Department of Health, reinforced with the standards set out in
the Health and Social Care Act 2008 and the Care Quality
Commission (CQC) registration requirements. Infection
prevention and control spans the five key questions the CQC will
be asking about your service:
Is it safe?
Is it effective?
Is it caring?
Is it responsive to people’s needs?
Is it well-led?
An infection occurs when micro-organisms (germs/bugs) enter
the body and cause damage. These micro-organisms can come
from a variety of sources and often take advantage of a route
into the body provided by a wound or an invasive medical
device, e.g., urinary catheter.
Some infections can reach the bloodstream. When this occurs it
is known as a bacteraemia, which can cause serious or life
threatening infection and can result in death.
Infection prevention and control means doing everything
possible to prevent infection from developing and spreading to
others. Understanding how infections occur and how different
micro-organisms spread, such as bacteria and viruses, is
essential in preventing infection.
Preventing Infection Workbook
8 2.
In
fec
tio
n p
rev
en
tio
n a
nd
co
ntr
ol
The chain of infection
The spread of harmful micro-
organisms to a person is known as
the ‘chain of infection’ which is made
up of six links. Each link represents
one of the six factors required to
spread infection.
Each link of the chain must be
present for an infection to occur.
Breaking the chain will stop the infection spreading, this
requires the removal of one of the six links. Good infection
prevention and control practice (standard precautions) applied
at all times and in all settings will break a link in the chain.
Bacteria or
virus
Micro-organisms (bacteria, viruses), e.g., Clostridium
difficile, MRSA, Norovirus.
Source Where the micro-organisms are, e.g., people,
animals, food, contaminated equipment or surfaces.
Exit The way in which micro-organisms leave the body,
e.g., coughing, diarrhoea, blood, wound discharge.
Route The way in which micro-organisms are transmitted,
e.g., hands, equipment, airborne, injection, ingestion
(eating).
Entry The way in which micro-organisms enter the body,
e.g., mouth, nose, urinary tract, exposed wounds,
non-intact skin, mucous membranes, needlestick
injury.
People at
risk
A person’s risk to developing an infection is
determined by their age, health, level of immunity,
invasive devices and any medical interventions.
Bacteria or virus
Route
Source
Entry
Peo
ple a
t
risk
Exi
t
Chain of infection
Preventing Infection Workbook
10 3.
S
tan
da
rd p
reca
uti
on
s
3. Standard precautions All care staff in all situations involving the care of service
users or contact with their environment must use infection
prevention and control ‘standard precautions’.
There are seven control measures known as standard
precautions (see table below). These underpin routine safe
practice and break the chain of infection which in turn protects
service users, visitors and staff. There is often no way of
knowing who is infected, so by applying standard precautions
to all people and at all times, best practice becomes second
nature and the risks of infection are minimised.
In most cases, without a laboratory test, it is impossible to
tell who has or is carrying an infection. Since every person
is a potential infection risk, it is essential that all staff apply
safe systems of working at every opportunity.
Safe working practices take the guesswork out of
protecting yourself and others as you provide care.
Standard precautions
Hand hygiene
Personal protective equipment
Sharps management
Blood and body fluids
Waste management
Laundry
Decontamination of equipment 7
Guidance for staff providing Care at Home
11 4.
H
an
d h
yg
ien
e (S
tan
dard
pre
ca
uti
on
)
There are two categories of micro-organisms present on
the skin of the hands
Transient bacteria are found on the surface of the skin.
They are called ‘transient’ as they do not routinely live on the
hands. They are transferred to hands after contact with
people or the environment and are easily removed by routine
handwashing with liquid soap and warm running water.
Resident bacteria are found on the hands in the deep layers
and crevices and live on the skin of all people. They play an
important role in protecting the skin from harmful bacteria
and are not easily removed by routine handwashing with
liquid soap and warm running water.
4. Hand hygiene Hand hygiene is the process of physically removing dirt,
blood or body fluids and the removal of micro-organisms from
the hands.
Evidence and national guidance identifies that effective hand
hygiene results in significant reduction in the carriage of
harmful micro-organisms on the hands. Effective hand
hygiene reduces the number of healthcare associated
infections (HCAIs) leading to a reduction in morbidity
(disease) and mortality (death) of service users.
Hand hygiene is the single most important way to prevent the
spread of infection. Hands may look visibly clean, but micro-
organisms are always present, some harmful, some not.
Hands may become contaminated by direct contact with a
service user, handling equipment and contact with the
general environment.
Removal of transient micro-organisms is the most important
factor in preventing them from being transferred to others.
Removal of resident micro-organisms is only required before
surgery and invasive procedures, it is not required by carers.
Tra
nsie
nt
Re
sid
en
t
Preventing Infection Workbook
20 5.
P
ers
on
al p
rote
cti
ve
eq
uip
men
t (S
tan
dard
pre
ca
uti
on
)
Test your knowledge Please tick the correct answer True False
1. Alcohol handrub can be applied to gloved
hands.
2. A new disposable apron should be worn
for each new task.
3. Before putting on and after removing
gloves, hands must be washed.
4. Gloves should be removed before an
apron.
Remember
Alcohol handrub should not be applied to gloves as it may
affect the integrity of the gloves.
Protect yourself and service users by wearing the correct
personal protective equipment.
Note
To minimise the risk of cross/self-contamination, gloves,
which are potentially the most contaminated item, should
always be removed first, followed by the apron and then
eye protection and mask.
Gloves are not a substitute for handwashing.
All PPE should be disposed of as soon as the activity is
completed and as per local policy.
Gloves are not required to be worn when serving plated
food, but remember, good hand hygiene is essential.
Guidance for staff providing Care at Home
23 6.
S
ha
rps
ma
nag
em
en
t (S
tan
da
rd p
rec
au
tio
n)
In the event of a sharps or inoculation injury
1. Encourage bleeding of the wound
by squeezing under running water,
this will help to remove any
viruses. Do not suck the wound.
2. Wash the wound with liquid soap
and warm running water and dry.
3. Cover the wound with a
waterproof dressing.
4. Report the injury to your manager
immediately.
5. Immediately contact your GP.
During ‘out of normal office hours’, attend the nearest
Accident and Emergency (A&E) department.
6. If you have had a needlestick/sharps injury from a sharp
instrument which has been used on a service user
(source), the GP in charge of their care may take a blood
sample from the service user to test for hepatitis B, C and
HIV (following counselling and agreement of the service
user).
7. At the A&E department or GP surgery:
a blood sample will be taken from you to check your
hepatitis B vaccination/antibody levels and you will be
offered immunoglobulin if they are low. The blood
sample will be stored until results are available from the
service user’s blood sample, if taken
if the person (source) is known or suspected to be HIV
positive, you will be offered Post Exposure HIV
Prophylaxis (PEP) treatment. This should ideally
commence within 1 hour of the injury, but can be
given up to 2 weeks following the injury
PEP treatment is only available from A&E departments.
Guidance for staff providing Care at Home
27 7.
B
loo
d a
nd
bo
dy f
luid
s (S
tan
dard
pre
ca
uti
on
)
Note *Chlorine-based disinfectants, such as household bleach,
should not be used on soft furnishings, untreated wood and
carpets as it will cause ‘whitening/bleaching’. Therefore,
only detergent and warm water, a carpet shampoo
machine or steam cleaner should be used.
Splashes of blood or body fluids to the eyes or mouth must
be treated as potential exposure to a blood-borne virus.
Rinse eyes or mouth with copious amounts of water and
then follow steps 4 to 7 on page 23.
Personal protective equipment should always
be worn when dealing with blood and/or body
fluid spillages.
Always add household bleach to cold water. If
hot water is used, it breaks down the active
ingredient of bleach, making the solution
ineffective (meaning the bleach does not work).
Test your knowledge Please tick the correct answer True False
1. It is not necessary to wear personal
protective equipment when dealing with
blood spillages.
2. The area should be ventilated when using
a chlorine-based disinfectant solution.
3. A chlorine-based disinfectant solution can
be placed directly on urine.
4. Splashes of body fluids to the eyes should
be rinsed with copious amounts of water.
Preventing Infection Workbook
28 8.
W
as
te m
an
ag
em
en
t (S
tan
dard
pre
ca
uti
on
)
8. Waste management All staff are responsible for the safe management and
disposal of waste. Waste is potentially hazardous and, if not
disposed of correctly, can result in injury or infection.
Any waste that is generated during the care of a service user,
e.g., catheter bags, continence pads, personal protective
equipment (PPE), should be disposed of as per local policy.
Waste will usually be disposed of as household waste, unless
alternative arrangements are in place with the Local Authority.
Disposal of waste
Appropriate personal protective
equipment should be worn when
handling waste.
All waste bags should be 2/3 full or
less, this allows enough space for the
bag to be tied securely.
Avoid expelling air from a waste bag
while leaning over it as harmful micro-organisms may be
released into the air.
Make sure all waste bags are securely tied using a suitable
plastic tie or secure knot, as pictured.
Waste should be securely bagged and disposed of as
household waste.
When handling tied waste bags, only hold by the neck of
Good waste management is important to ensure:
Reduction of health and safety risks from waste.
Protection of the environment.
Compliance with environmental legislation.
Preventing Infection Workbook
34 10
. D
eco
nta
min
ati
on
of
eq
uip
me
nt
(Sta
nd
ard
pre
ca
uti
on
)
1. Wash
hands thoroughly with liquid soap and warm running water.
2. Put on
disposable apron.
3. Put on
disposable gloves.
4. Starting
from the top, clean the back rest and arms (remember to clean under the arms).
5. Remove
the lid and clean the lid of the commode, topside first then underside.
6. Remove
the seat, if the design allows, and clean the top then underside.
7. Clean the
seat frame, legs, and then foot pedals and wheels if there are any.
8. Remove
gloves (these should be removed before your apron) and dispose of.
9. Remove
apron and dispose of.
10. Wash
hands thoroughly with liquid soap and warm running water.
Cleaning a commode
Always use disposable cleaning cloths.
Preventing Infection Workbook
36 11
. C
lea
nin
g t
he
en
vir
on
men
t (K
ey t
op
ic)
11. Cleaning the environment Cleaning and disinfecting are different:
cleaning with detergent and warm water removes dirt and
reduces the number of germs to a safe level
cleaning must be carried out before disinfection if
disinfection needs to be performed
disinfecting destroys most, but not all bacteria and also
depends on the type of disinfectant used.
What you need for cleaning
Wear appropriate personal protective equipment.
A general purpose detergent, e.g., washing up liquid, is
suitable for cleaning most surfaces.
Wash and leave mops and cloths to air dry after each use.
Do not leave mops or cloths soaking overnight.
Use separate cloths for cleaning kitchens and toilets/
bathrooms.
Staff should wash their hands before putting on gloves.
Re-usable domestic gloves should be worn for routine
household duties, disposable gloves for cleaning toilets.
Domestic gloves can be worn by other staff providing skin
is intact and hands are washed before wearing them.
Always wash domestic gloves before taking them off and
then wash hands with liquid soap and warm running water.
What you need for disinfecting
The routine use of disinfectants for general home cleaning is
unnecessary. A disinfectant such as household bleach may
be required in some circumstances. For example, equipment
soiled with body fluids, the area must first be cleaned and
then be disinfected using 1,000 parts per million (ppm)
household bleach (dilution of 1 in 100, e.g., 10ml of
household bleach in 1 litre of cold water).
Preventing Infection Workbook
44 14
. U
rin
ary
ca
the
ter
ca
re (K
ey t
op
ic)
When detaching the used bag from the catheter, do not
touch the end of the catheter. This will help prevent
contamination and infection.
When removing the protective cap from the new catheter
bag tube, do not touch the end of the tube. This will help
prevent contamination and infection.
Place the used catheter bag in a plastic bag, tie the bag
and dispose of as household waste.
Remove disposable gloves and apron and wash hands.
Always record the date when the catheter bag is
changed.
Overnight drainage bags
If a person has a leg bag during the
day, an additional larger linked
drainage bag (night bag) should be
used for overnight use. The night
bag should be attached to the leg
bag to keep the original system
intact.
Standard precautions must be applied.
When attaching a night bag, always wash hands and
wear disposable gloves and apron.
Attach the night bag to a stand to ensure that the
drainage tap is not touching the floor, to prevent
contamination of the tap.
When removing the protective cap from the new night bag
tube, to prevent contamination and infection, do not touch
the end before attaching it to the drainage tap on the leg
bag.
Remove disposable gloves and apron and wash hands.
Preventing Infection Workbook
46
15. Viral gastroenteritis/Norovirus Norovirus is the most common cause of viral gastroenteritis
and between 600,000 and 1 million people in the UK are
affected every year. Many people refer to it as gastric flu or
winter vomiting. Viral gastroenteritis is highly infectious and
can spread easily from person-to-person, therefore, it is
important to use infection prevention and control precautions.
What does viral gastroenteritis cause?
Signs of viral gastroenteritis include:
sudden onset of diarrhoea* and/or vomiting
vomiting - can be projectile (forceful)
nausea
abdominal/stomach cramps
headache and/or low-grade fever.
Symptoms usually begin around 12-48 hours after being
infected with the virus. (*Refer to page 53 for the definition of
diarrhoea.)
Illness is usually of a short duration and most people are
better within 48 hours with no long-term effects. However,
some people, especially the elderly and those with existing
long-term illness, may have symptoms that last longer.
Why does viral gastroenteritis cause outbreaks?
Viral gastroenteritis often causes outbreaks
because it is easily spread from person-to-
person and without effective cleaning, the
virus is able to survive in the environment for
many days. Outbreaks tend to affect people
in hospitals, schools, care homes, sheltered
housing or where there is a large group of
people.
15
. V
ira
l g
as
tro
en
teri
tis
/No
rov
iru
s
Preventing Infection Workbook
52 16
. C
los
trid
ium
dif
fic
ile
Standard precautions must be applied.
Disposable gloves and apron should be worn when caring
for a service user until they are symptom free for 48 hours
and passed a formed stool. Gloves and apron should be
changed after each activity is completed and hands
washed with liquid soap and warm water after removal.
Encourage the service user to drink fluids and ensure their
fluid balance is monitored to prevent dehydration.
Thorough handwashing is essential for staff using liquid
soap and warm running water. Alcohol handrub does
not kill spores and must not be used.
Encourage service users to wash their hands after using
the toilet and before meals. If unable to access hand
washing facilities, moist hand wipes can be used.
After an episode of diarrhoea, encourage service users to
close the toilet seat lid before flushing the toilet to reduce
possible spread and disinfect with household bleach.
The service user should use a separate towel to dry their
hands and this should not be used by other people. The
towel should be washed daily.
Alcohol wipes should not be used for cleaning and
disinfection of equipment as they do not kill spores.
Clean surfaces in toilets and bathrooms at least daily, with
a household bleach, see page 36.
Items such as hoists, frames and frequently used surfaces,
e.g., tables, should be cleaned daily as above.
Wash soiled clothing or bedding separately as soon as
possible at the highest temperature advised on the label.
The service user should have a shower or bath daily, as
C. difficile spores may be on other areas of their body.
Staff are not usually at risk of acquiring C. difficile infection.
Guidance for staff providing Care at Home
57 17
. M
RS
A
Service user’s in their own home can socialise in and
outside of their home without restrictions. Any visitors to
their home should be advised to wash their hands on
leaving.
If a service user has MRSA in a wound, it should be kept
covered with a dressing.
Linen and clothing should be washed in the service user’s
or communual washing machine at the highest
temperature stated on the washing label.
No special precautions are required for washing crockery
or cutlery and they should be dealt with in the normal way,
e.g., by washing with washing up liquid and warm water.
When cleaning, e.g., surfaces in a service user’s home,
detergent and warm water are sufficient.
Are staff at risk of MRSA?
By applying standard precautions at all times the risk of
spreading MRSA is reduced.
MRSA is not usually a risk to healthy people including
children and pregnant women. Research has shown that
staff who do become colonised have usually acquired the
bacteria through their work, but it is usually present for a
short time only.
Staff should ensure cuts and grazes are covered with a
waterproof plaster.
Report any skin conditions to your manager.
Note
Studies show MRSA colonisation may affect approximately
20% of service users in care home establishments.
Preventing Infection Workbook
64 19
. C
PE
Note
There are a number of local initiatives
across the country where service users
found to be positive for CPE either
colonised or infected, should have been given advice
about CPE and a CPE card. The card should be shown to
healthcare providers involved in their care. For further
details visit www.infectionpreventioncontrol.co.uk.
Remember
Using standard precautions will minimise the spread of
CPE and should be rigorously implemented, but no
additional infection control precautions are required.
Further advice will be given by your local Community
Infection Prevention and Control (IPC) or Public Health
England (PHE) team.
Test your knowledge Please tick the correct answer True False
1. There are very few antibiotics for the
treatment of CPE infections.
2. Hand washing is not necessary when
dealing with a service user with CPE.
3. Colonisation with CPE is more common
than infection.
4. Toilets should be cleaned with household
bleach if a service user has diarrhoea.
Linen and clothing should be washed in the service user’s
or communual washing machine at the highest
temperature stated on the washing label.
Keep toilet and bathroom areas clean.
Preventing Infection Workbook
68
Written and produced by Community Infection Prevention and Control
Harrogate and District NHS Foundation Trust
Tel: 01423 557340
www.infectionpreventioncontrol.co.uk
March 2016
© Harrogate and District NHS Foundation Trust, Community Infection Prevention and Control 2016