Prevention And Control Of Infection In Care Homes .

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Prevention and control ofinfection in care homesSummary for staff1

DH INFORMATION READER BOXPolicyHR / WorkforceManagementPlanning / PerformanceClinicalCommissioner DevelopmentProvider DevelopmentImprovement and EfficiencyDocument PurposeBest Practice GuidanceGateway Reference17405TitleEstatesIM & TFinanceSocial Care / Partnership WorkingPrevention and control of infection in care homes: Summary for staffAuthorDepartment of Health and Health Protection AgencyPublication Date18 February 2013Target AudienceCare Trust CEs, GPs, Communications Leads, Consultants inCommunicable Disease Control, Community Infection Control Nurses,Health Protection Nurses, Care Home Managers, Care QualityCommissionCirculation ListLocal Authority CEs, Directors of Adult SSsDescriptionAn information resource to assist staff in taking all reasonable steps toprotect residents and staff from acquiring infections and prevent crossinfection; and to provide information and guidance on infection preventionand control that will assist managers in undertaking risk assessments andin developing policies.Cross RefThe Health and Social Care Act 2008: Code of Practice on the preventionand control of infections and related guidanceSuperseded DocsAction RequiredInfection Control Guidance for Care Homes (Department of Health, 2006)N/ATimingN/AContact DetailsPhilip PughHealthcare Associated Infection and Antimicrobial Resistance ProgrammeHealth Protection AgencyCentral Office, 151 Buckingham Palace Road, LondonSW1W 9SZPhilip.Pugh@hpa.org.ukFor Recipient's Use

Chain of infectionThe chain of infection provides an overview of the process by which a residentacquires any type of infection. The characteristics of each link show howorganisms are transferred. Breaking the link or cycle is necessary to prevent thespread of any infection. MRSA Clostridium difficile Pseudomonasaeruginosa Norovirus InfluenzaVirus, bacteria& fungus Break in skin (wound)cut or needlestickinjury Mucous membranes(mouth, eyes,nose) Inhalation – (breathing)Way intothe body Contact - Hands Contact - Equipment Droplet - Influenza Airborne - TBMethod ofspread

Standard infection prevention & control precautionsA simple, consistent and effective approach to infection prevention & controlHand hygieneSafe handling ofsharpsUse of glovesSafe handling ofwastePersonal protectiveequipmentSafe handling ofsoiled linenUse ofgowns/apronEnvironmentalcleaningMinimise contact with blood and body fluids by ensuring safe workingpractices, protective barriers and a safe working environment

Hand washing technique with soap and waterWash hands when visibly soiled! Otherwise, use handrub.Hands should be washed before and after all care procedures, and handling food.Also after dealing with used linen, waste and body fluids or contaminated equipmentand after removing gloves.tap;Adapted from World Health Organisation ‘Clean Care is Safer Care’ About Save Lives: Clean Your nts/en/

Asepsis and aseptic techniqueThe principles of asepsis play a vital role in the prevention of infection in allenvironments and is the responsibility of all care staff to understand theseincorporating them into their everyday practice where it is relevant.The principles of asepsis/aseptic technique require that: Exposure of anysusceptable areasis kept to aminimum. Correct handdecontaminationshould be carriedout.HandhygieneExposure Uniform andclothing isprotected with adisposable plasticapron. Correct type ofgloves are used asappropriate.Gloves All fluids andmaterials used aresterile. Sterile packs arechecked fordamage, expiry ormoisturepenetration.MaterialsClothing Contaminated nonsterile items are notplaced in the sterilearea.Non-sterileSterile Single use itemsare never reused.Single use

My 5 Moments for Hand HygieneThe ‘My 5 moments for Hand Hygiene’ approach defines the keymoments when health care workers should carry out hand hygiene.This evidence based, field tested, user-centred approach is designedto be easy to learn, logical and applicable in a wide range of settings.This approach recommends health-care workers to clean theirhands: 1. before touching a resident,2. before clean/aseptic procedures,3. after body fluid exposure/risk,4. after touching a resident, and5. after touching a persons surroundings.1BEFORETOUCHING ARESIDENT4AFTERTOUCHING ARESIDENTAdapted from World Health Organisation ‘Clean Care is Safer Care’ About Save Lives: Clean Your nts/en/

Alcohol hand-rub hand hygiene techniquefor visibly clean handsRub hands for hand hygiene! Wash hands when visibly soiled.Alcohol hand rubs are an effective and rapid means of hand decontamination andshould only be used on visibly clean hands.Adapted from World Health Organisation ‘Clean Care is Safer Care’ About Save Lives: Clean Your nts/en/

Outbreaks of communicable infection oran infection control incidentA number of infectious diseases may spread readily to other residentsand cause outbreaks within any care setting.The commonest outbreaks are due to viral respiratory infections andgastroenteritis. The organisms may be spread by hand contact and onoccasion by other routes which may include food. an outbreak isdefined as two ormore related cases ofinfectious disease. Manager/owner Health Protection Unit Infection control lead All staff Residents/relatives General practitioner Ensure relevant personshave been informed. seek advice asappropriate recollection ofmicrobiologicalspecimens.Definition ofan outbreakWhen andwho to informOutbreak planand response It is important tostart a record keepingfile and collect alldata for futurereference. By using standardprecautions the riskof spreadinginfectious disease isreduced. Consider stoppingadmissions, day careand transfers toother homes untilconsidered safe to doso.Record keepingGeneral controlmeasuresAdmissions,discharges.

My 5 Moments for Hand HygieneThe ‘My 5 Moments for Hand Hygiene’ approach defines the keymoments when health care workers should carry out hand hygiene.This evidence based, field tested, user-centred approach is designedto be easy to learn, logical and applicable in a wide range of settings.This approach recommends health-care workers to clean theirhands: 1. before touching a resident,2. before clean/aseptic procedures,3. after body fluid exposure/risk,4. after touching a resident, and5. after touching a persons surroundings.1AFTERTOUCHING ARESIDENT4AFTERTOUCHING ARESIDENT5AFTER TOUCHINGRESIDENTSSURROUNDINGSAdapted from World Health Organisation ‘Clean Care is Safer Care’ About Save Lives: Clean Your nts/en/

My 5 Moments for Hand HygieneThe ‘My 5 Moments for Hand Hygiene’ approach defines the keymoments when health care workers should carry out hand hygiene.This evidence based, field tested, user-centred approach is designedto be easy to learn, logical and applicable in a wide range of settings.This approach recommends health-care workers to clean theirhands: 1. before touching a resident,2. before clean/aseptic procedures,3. after body fluid exposure/risk,4. after touching a resident, and5. after touching a persons surroundings.1AFTERTOUCHING ARESIDENT4AFTERTOUCHING ARESIDENT5AFTER TOUCHINGRESIDENTSSURROUNDINGSAdapted from World Health Organisation ‘Clean Care is Safer Care’ About Save Lives: Clean Your nts/en/

Isolation for residents witha communicable infectionIsolation of infected residents may be necessary to prevent furthercases of infection. Ideally single rooms should be available for thispurpose and consideration needs to be given to how best achieve this.Standard infection prevention & control precautionsPrevention and control measures include implementation of standardinfection control precautions as good practice. Isolation precautionscan be implemented for a resident in their own room.Physical and psychological well-beingWhen a decision about isolating a resident is taken, it is important toconsider the likely effects on the resident. Advice should be sought onthe management of individual cases that pose difficulties.InformationVerbal and written information should be given to the resident andvisitors. This should include the details and reason for the isolation,likely duration, precautions required and the ways in which their well being will be met.EnvironmentSingle rooms should contain hand hygiene facilities with a liquid soapdispenser and antimicrobial hand rub. Ideally en-suite facilitiesincluding a toilet. The environment should be as clean and clutter freeas possible.

Safe handling and disposal of sharpsStaff should be trained in the safe handling and disposal of sharps.Venepuncture and injections should only be carried out by trained andcompetent staff. Inoculation, cuts andother injuries.Transmission andexposure of bloodborne viruses (BBVs).Bacterial infections. If an injury occurs thenbleed it, wash it andreport it.Use a waterproofdressing.Complete an incidentform. InjuryRisks Never overfill asharps bin.Correct disposalshould be immediate.Ensure properclosure and completelabels of containers. SafetyDisposal Ensure correctcontainer is available atpoint of use.Located at correctheight in safe position.Available at point ofuse.PositionSharps must not bepassed from hand tohand.Never re-sheath usedneedles.Sharps safety beginswith you. Always assemble andlabel containerscorrectly.Available at point ofuse.Ensure appropriate sizeis used for activity.Container

Linen and laundry The provision of clean linen is a fundamental requirement of care. Incorrect handling and storage of linen can pose an infection hazard. Care homes use a variety of different laundry systems and equipment,therefore it is important to understand the system being used and why. Items should onlybe washed in adedicated laundryroom using thecorrect process. Used linen andclothing mustalways be kept inlaundry bags orbaskets and notloose on the floor.UsedHandlingWashed . Separate Trolleysshould be used forclean, used andsoiled laundry toavois crosscontamination.Trolleys When handlinglaundry you shouldalways wear glovesand an apron andcarry out handhygiene. Clean linen shouldbe stored in a dryarea above floorlevel. It must not be storedwith used linen.Storage It is theresponsibility of theperson handlinglinen to ensure it issegregatedappropriately.Segregate

Decontamination of equipmentDecontamination can be achieved by a number of methods, which fallinto the following three categories.Cleaning Physically removes contamination.Prerequiste to effective disinfection/sterilisation.Most common choice of decontamination in care homes. Reduces the number of viable mircro-organisms.May not inactivate certain viruses and bacterial spores.Disinfection Renders an object free from viable micro-organismsincluding viruses and bacterial spores.SterilisationThe choice of decontamination method depends on the risk of infectionto the person coming into contact with equipment or medical device.Low Risk Items that come into contact with intact skin.Items that do not come into contact with the resident.Items require regular cleaning. Items that come into contact with intact skin & mucousmembranes.Intermediate Items require cleaning followed by disinfection or sterililisation.RiskHigh Risk Items used to penetrate skin, mucous membrane, vascularsystem or sterile spaces.Single use items are preferred but must be sterilised if reusable.

Glucose monitoringRoutine diabetes care involves monitoring blood glucose levels bytaking a sample of capillary blood with a fingerprick lancing device andtesting it with a glucometer.Which Device? Single use unitDisposableUsed once onlyComplete unit to bediscarded after use.Disposable Firing mechanism is separatefrom lancet & endcap. Endcap & lancet are discardedafter each use. Units should be cleaned using amild detergent and disinfectedaccording to manufacturerguidelines.Reusable Wear well fitting and correct sizegloves. Always change gloves betweenresident contact. Ensure hand hygiene before andafter use of gloves. Use standard infectionprevention and controlprecautionsHand hygiene& glove use

moments when health care workers should carry out hand hygiene. This evidence based, field tested, user -centred approach is designed to be easy to learn, logical and applicable in a wide range of settings. This approach recommends health-care workers to clean their hands: 1. before touching a resident , 2. before clean/aseptic procedures,

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