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front cover of booklet.qxd8/28/20039:53 AMPage 1Home HygienePrevention of infection in the homeA training resource for carers and their trainersCommunity InfectionControl Nurses NetworkInternational Scientific Forumon Home Hygienewww.icna.co.ukwww.ifh-homehygiene.org

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Help & informationUseful information about this resourceUsing this resourceInsert the Home Hygiene CD into your computer. If the CD does not automatically run aftera few seconds, browse to the CD contents and find the folder named ‘menu’. Open this folderand find the icon named ‘menu.exe’. Double-click this icon to make the CD run.The CD navigation system, positioned in the bottom right of the screen (including yellowforward and backward buttons) allows you to browse through the slides at your own pace.The green ‘Help’ button will display the Help page on each section. The red ‘Quit’ buttonwill quit your current section. The blue ‘Notes’ button will open Trainer’s notes for the slideyou are currently on. Some slides also have interactive ‘rollover’ elements – rolling the mouseover certain key components of the slide will cause further graphic elements in the slide toappear.Accessing the ‘Trainer’s notes’The Trainer’s notes are stored in a folder called ‘pdf’ on the CD. Trainer’s notes for each slidecan be accessed by clicking the ‘NOTES’ button on any particular slide. A complete PDF isavailable from the ‘Help’ pages on the CD, or from browsing folder named ‘pdf’ on the CDand double-clicking the PDF file named ‘HomeHygiene.pdf’.Resource bookletThis CD is also available in a printed format that includes both Carer and Trainer notes.Individual pages within the booklet can be photocopied and used for training purposes,however for complete reproduction of the entire booklet, written permission should beobtained from the copyright holder.Further information & resourcesFor further information and resources in connection with ‘Home Hygiene’ please visit:www.icna.co.ukwww.ifh-homehygiene.orgHow to orderCopies of the CD-Rom and Resource booklet can be obtained from:www.icna.co.uk Click on ‘Publications’, or mail to Fitwise, Drumcross Hall, Bathgate,EH48 4JT, with your cheque payable to ICNA. Alternatively send a purchase order via mailor email to Lynn @fitwise.co.uk. Please phone 01506 811077 if you have any queries.CD-RomMembers (all categories)Non-membersMembers (all categories)Non-members 5 including postage and packing 10 including postage and packing 5 including postage and packing 10 including postage and packingPrices:Resource BookletPostage other than to UK and Ireland will incur additional charges.TrainerÊs notes Infection Control Nurses Association and International Scientific Forum on Home Hygiene. 2003.Prevention of infection in the home

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Section 1: Introduction1. BackgroundOver the past century, deaths from infectious diseases such as cholera, typhoid and diphtheria have declinedsignificantly in the United Kingdom. Despite this however, infectious diseases remain just as significant a cause ofillness in the UK as they do throughout the rest of the world. In the last 20 years, at least 30 new diseases, e.g. HumanImmunodeficiency Virus (HIV), variant Creutzfeldt-Jakob disease (vCJD) have emerged as additional threats whilstdiseases such as tuberculosis, once thought to be under control, have become increasingly prevalent. Globalisation offood supplies, increasing international travel and refugee movements also mean that infections can be rapidly andwidely disseminated to communities who have little or no resistance to them. Escalating treatment costs, the problemof antibiotic resistance and the need to reduce antibiotic prescribing, all indicate a need to place greater emphasis on thecontrol and prevention of infection.The importance of the domestic setting in transmitting infection has been highlighted: Many respiratory and gastrointestinal infections that occur in the home are mild and self-limiting. However, theyrepresent a significant economic and social burden. In particular, gastrointestinal diseases remain at unacceptablyhigh levels. Much of this disease is foodborne, but a significant proportion is the result of person to persontransmission. There is also substantial evidence to show that cold viruses are often transmitted in the home fromone person to another via hands and other surfaces, as well as through the air. Demographic and social changes mean that family members with reduced immunity to infection, such as theelderly, immuno-compromised patients discharged from hospital, patients taking immuno-suppressive drugs andthose using invasive/inhalation systems are increasingly being cared for at home. For these ‘at risk’ groups,infections can be more serious, often requiring hospitalisation with its attendant costs.It is therefore very important that the home, particularly where ‘at risk’ groups live and are cared for, provides aprimary line of defence against infectious diseases. Fortunately, good hygiene can provide this defence, preventingmost of the infections that arise in the home. Better understanding of home hygiene could also be the key to improvedhygiene in hospitals and other community settings.In 1998, as a first step to improving home hygiene standards, the International Scientific Forum on Home Hygiene(IFH) produced a set of ‘Guidelines for prevention of infection and cross-infection in the domestic environment’.These guidelines are based on the concept of risk assessment and risk prevention and include advice on; food hygiene general hygiene personal hygiene (particularly hand hygiene) hygiene in situations where there is more risk.This risk-based approach has come to be known as ‘targeted hygiene’. IFH subsequently produced a set of‘Recommendations for selection of suitable hygiene procedures for use in the domestic environment’.This training resource is based on the IFH guidelines and recommendations and is combined with the practicalknowledge and experience of community-based health professionals. It will enable you to help both professional,informal carers, and others to reduce the risk of infection to those they care for and themselves by clarifying andgiving guidance on where, when and how to prevent infection and cross infection using the ‘targeted hygiene’approach.In recent years, we have seen numerous ‘scare stories’ about whether we are being ‘too clean’ and whether the use ofdisinfectants and antibacterial products could be harmful. Although these allegations require serious consideration, wemust think about the impact that publicising these issues may have on the public's perception of infectious disease risksin the home and the importance of using effective measures to control such risks. This teaching resource includesmaterial that addresses these concerns.TrainerÊs notesReferences1. IFH (1998) Guidelines for prevention of infection and cross infection in the domestic /2pubgu00.htmIFH (2001) Recommendations for selection of suitable hygiene procedures for use in the domestic /2pub04.htm2.Prevention of infection in the home

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Section 1: Introduction2. How to use this resourceThis resource is intended to enable you to train those (professional home carers and familymembers) who are caring for the family in the home. It will also be useful to those working inother disciplines that have a role to play in improving home hygiene. We recognise that you, ‘thetrainer’, may come from a variety of backgrounds. You may work for Social Services and have ahealth education role, or you may be part of the Primary Care Trust, e.g. an Infection ControlNurse, or part of the Community Nursing Team, or other healthcare professional. Whoever youare, provided you have the relevant background, you should find that this resource enables you todeliver a comprehensive training programme for home carers and others.The information in this resource is based on the IFH guidelines and recommendations for homehygiene. It presents the ‘targeted’ approach to home hygiene in a straightforward, easy to followand practical manner and is available in CD-ROM or print.Section 2 gives an overview on how infections are spread in the home and how targeted hygienecan be used to reduce the risks. Section 3 shows how to put targeted hygiene into practice in ourdaily lives. Section 4 gives advice on how to cope in situations where there is a greater risk ofinfection in the home. Section 5 gives information about chemical disinfectants and theirapplications and limitations. Section 6 addresses some of the concerns and misconceptions thatare frequently raised. It includes question and answer sessions that you could use to help checkthe carer’s understanding. Each topic occupies a separate page. The ‘Carer’s notes’ cover theessential practical points and are intended to convey the information to the carer in astraightforward and visual format. The ‘Trainer’s notes’ provide further background information.As a first step to presenting this material to a ‘Carer’, read through the entire pack and make surethat you fully understand the information. You may wish to look up and read through thereference material listed in each Section and in ‘Further Reading’. You should also make sureyour training complies with any local guidelines. If you are unsure of anything, discuss it withthe Community Infection Control Team or Community Nursing Team.The ‘Trainer’s notes’ are not designed to tell you exactly what to say to a carer but they dohighlight the important teaching points and give the background information you will need toanswer any questions. In some cases, it may be appropriate to give the carer a copy of theresource for self-learning. However, try to make sure that they have plenty of time to askquestions and clarify anything they need to. You will not be able to cover all the information inone session, so try to concentrate on one Section or a few specific procedures during each visit.TrainerÊs notesThink about the carer(s) you are working with and pitch the information at the right level. It islikely that they will have varying levels of skill and knowledge, so ideally, the training should bedelivered on a one-to-one basis. However, where you have carers of similar aptitude you maywish to consider talking to them together as a small group.Prevention of infection in the home

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Section 1: Introduction2. How to use this resource (continued)For each carer, you will need to; identify their knowledge gaps identify the resources/knowledge needed to meet those knowledge gaps develop educational aims and objectives plan and conduct the teaching session/learning experience evaluate the carer’s learning, development and performance.Remember that practical demonstrations and experience can enhance learning more effectivelythan traditional lecture formats. Once you have explained and demonstrated a procedure (e.g.when and how to hygienically clean a food preparation surface) ask the carer to show you how todo it. In this way, you can evaluate and reinforce their learning. After discussing each topic, givethe carer a copy of the ‘Carer’s notes’ so that they can study them in their own time. You mayphotocopy the ‘Carer’s notes’ from your own pack or print them off from the CD-ROM but youshould encourage the carer to purchase their own complete copy. Refer them back to their notesif you notice any errors during subsequent visits or training sessions.Tips Always encourage carers to ask questions so that they can clarify points. Involve the carer in deciding any action plans; don’t dictate. Get the carer to think about a particular procedure that they conduct and the opportunities forspreading germs. Choose a procedure that is not conducted effectively. Get them involved inthinking about how they can reduce the risks of infection. At the end of this Section you will find some useful exercises that you can use to encouragecarers to reduce the risk of infection. You may find it useful to concentrate on improving just one or two specific procedures oneach of your visits, before moving on to think about other procedures. Since good handwashing is the single most important way to reduce the spread of infection, you might start bylooking at this. Discuss hand washing and check that the carer; knows when to wash their hands (e.g. immediately before preparing food and aftertouching high risk raw foods such as chicken) has the appropriate equipment available to wash their hands properly knows the correct hand washing procedure and uses it.If necessary, demonstrate the correct procedures, e.g. how to wash your hands.At the end of each visit, provide the carer with a copy of the ‘Carer’s notes’ relating to thetopics you have discussed. TrainerÊs notesAbove all, keep an open mind and be prepared to learn. Misconceptions about home hygiene arecommon, everyone thinks they are experts on home hygiene and people are often unwilling to letgo of their long-held beliefs.Prevention of infection in the home

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Section 1: Introduction3. You can make a differenceImproving hygiene is the best way of reducing the burden of infectious disease. However, peoples’adherence to simple rules of hygiene behaviour remains poor. This page briefly outlines a simple, yeteffective approach to communicating hygiene.Changing peoples’ behaviour is not easy, even when they know it is in their best interests.Conventional approaches to hygiene education tend to speak from the position of the outsider, theexpert or scientist. ‘Top-down’ approaches to educating consumers have little success because theydo not build on what people know, do, or want. Health and hygiene professionals tend to think thatjust by talking about germs, people will change their behaviour. They have not and will not!We can learn from market research how much (or how little) behaviour change is reasonable toexpect. By combining knowledge gained from successful hygiene promotion campaigns with insightsfrom psychology and marketing theory, we can distil out the principles defining effective hygienepromotion. Experience shows that we can be more successful in influencing behaviour by finding outwhat people already know and do, then what it is they wish to know, and build on this, rather thanacting as an expert who tells them what to do.Here are some ideas about how you can help to teach others about targeted hygiene and, if necessary,change their behaviour.Do;9 make carers believe that their behaviour can make a difference. It is crucial that they feel thatthey have the power to effect change and reduce the risk of infection. Empowerment is the key tosustaining behaviour change9 identify which specific behaviours allow germs to be transmitted. Use your time with carers toidentify risky behaviours. Do this unobtrusively and don’t expect to be told9 identify the risky behaviours for intervention and then target the behaviour you want to change9 identify replacement behaviours that are acceptable and feasible. Be realistic9 keep your advice simple and straightforward. It is vital that carers do not feel overwhelmed bythe information you provide. The risk-based approach used here simplifies this by helping you toidentify specific opportunities for intervention9 be consistent and repetitious. As far as possible, ensure that you repeat the same advice onsuccessive visits9 reward good behaviour. You are a respected and trusted figure. We give great value to positiveremarks from those we respect. Be positive and encouraging when you see good hygienebehaviour. Make the client and his/her carers feel good about their actions and tell them that theyare making a difference9 understand that, in reality home hygiene is quite simple and logical. Encourage carers to discoverthis for themselves by carrying out the exercises on the following page.TrainerÊs notesDon’t; use scare tactics. Fear and anxiety are not motivating. People develop a range of rationalisationsto escape the consequences of your predictions. Moreover, the client and his/her carers maysimply choose to ignore your advice, which will fundamentally undermine your relationship assume people can learn germ theory during your visits. This is sure to lead to informationoverload. A detailed understanding of germs/microbiology is helpful but not necessary to goodhygiene behaviour. Lack of knowledge about disease is rarely the factor limiting behaviourchange.Prevention of infection in the home

Section 1: IntroductionParticipatory exercises to develop carers understanding of homehygieneExercise 1Work with the carer to select a typical contaminated source in the home. This could be a Salmonellacontaminated chicken, a person with an infection such as a cold or diarrhoea and vomiting, or a kittenwith Campylobacter. Ask the carer to work out for themselves how the germs are most likely tospread from the specified source and cause infection to someone in the home. Next, get them to thinkcritically about whether their current practices are likely to prevent that spread, which actions are themost important, and whether and how they could do better.Exercise 2Check understanding by asking carers to consider a specific procedure such as hand washing orhygienically cleaning a chopping board. Ask them to tell you and/or demonstrate; when/in what situations the procedure is necessary where the germs are likely to have come from in that situation what sort of germs are most likely to be present what hygienic cleaning process should be chosen in that situation and why how to do it properly what factors could cause the procedure to fail what will happen to the germs during the hygiene process.TrainerÊs notesExercise 3One of the problems you face as a trainer is persuading people that when it comes to preventingtransmission of infection what is ‘visibly clean’ is not necessarily ‘hygienically clean’. Many trainersfind it useful to obtain an ultra-violet (UV) training aid to help them visualise the spread of invisiblegerms. You can coat an object with powder or paint that glows under UV light and then ask the carerto handle the object in the normal way. You can then pass the UV light over the object and itsenvironment to see which other objects and sites have become contaminated during handling.Another exercise involves coating a surface or object with the powder or paint and asking the carer toclean the item in the normal way. The UV light can be used to see how well the surface or object wascleaned. The UV training aid can also be used to test the effectiveness of hand washing.Prevention of infection in the home

Section 1: IntroductionApplication of the National Vocational Qualifications Standards:Infection control is integral to the practice of many carers working in, care agencies anddomiciliary care services. Within your role as a carer, you will come into contact with manyservice users, whilst undertaking a variety of caring activities. These include: Intimate personal care (toileting / hygiene needs) Clinical care (dealing with incontinence, Stomas, PEG feeds & dressings) Domiciliary care (cleaning, laundry and food preparation) Social care (promoting independence, etc) Advisory nature (caring for children, providing social support)All of these carry the risk of infection for both care workers and service user alike. Adopting theuse of hygiene precautions to prevent infection is at the core of this training pack. If you arefollowing the NVQ framework to obtain qualifications relating to Health & Social Care, you canuse the information contained in this publication to provide some underpinning knowledge for anumber of units. To assist you and your assessor in achieving this, the relevant units have beenwritten below:NVQ Level 3 Promoting Independence:Mandatory Unit CU1,Option A Group Y4, Y5Option B Group X13, X15.NVQ Level 3 Care:Mandatory Unit CU1Option A Group CU2, X13, Z12Option B Group W7, B3, B4, X8, X15 Y5, Z15, Z16NVQ Level 2 Care:Mandatory Unit CU1,Option A Group Z9, Z11Option B Group CU3, NC13NVQ Diagnostic & Therapeutics:Mandatory Unit CU1Option A Group CU2, X4, X8, X14, X17, X18, X20Option B Units B4, NC7, NC8, X11, X12, X13, X19Training & Development AwardsManagement AwardsHealth & Safety AwardsTrainerÊs notesThis training pack can be cross-referenced to other fields or educational courses to provideknowledge evidence, such as: Prevention of infection in the home

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Section 2: Breaking the chain of infection usingtargeted hygiene1. The chain of infectionIn order for a person to become infected, several factors (links) are needed. These links must all bepresent for an infection to be transmitted.Source of causative microbes (source of germs)There have to be microbes present that can cause disease (known as pathogens/germs) either in or onsomeone or a pet that has the infection, on a contaminated item, in or on contaminated food or water, or inthe air. You cannot get infected unless germs are present.ExamplesThe gut, skin and respiratory tract of humans and animals contain many types of microbes which caninclude bacteria, viruses, fungi and parasites. These can contaminate hands, equipment, surfaces, cleaningcloths, food or water. Some bacteria, viruses and fungi such as moulds, can also be present in the air.Method of exit (way out)Secretions, discharges or skin scales from an infected person or animal, and particles from food, containmicrobes that can contaminate the environment or a person who has contact with them.ExamplesDroplets from the mouth and nose, faeces, vomit, skin scales, hairs and wound fluid can contaminate hands,surfaces, fabrics, food and the air. Germs in particles and moisture from food can contaminate food storageand preparation surfaces and hands.Method of spread (spread of germs)How microbes from one person, animal or food can reach another person.ExamplesCarried on contaminated hands (that touch other people, surfaces and food); by direct contact between aninfected and healthy person (e.g. by kissing, touching or sharing a bed); by contact with soiled equipment,surfaces, cleaning cloths, linen and dressings and by serving contaminated food. Some microbes such asfungal spores or bacteria attached to skin scales are carried in the air. Some viruses are carried inaerosolised droplets produced by coughing, sneezing or vomiting.Method of entry (way in)Microbes need to enter the body for an infection to take place.ExamplesBreathed in, swallowed, through a break in the skin (cuts and wounds), through mucous membranes(including the surface of the eye); via tubes entering body openings and blood vessels, e.g. catheters.TrainerÊs notesSusceptible person (person at risk)Everyone is susceptible to infection but certain factors can make a person more likely to succumb toinfection (i.e. a person at extra risk).ExamplesSusceptibility to infection is increased; by extremes of age (immune system either immature or wearing out) because the person has not been previously exposed to a particular pathogen (germ) or has notreceived the relevant immunisations to build their immunity by tubes and invasive devices entering body openings/cavities and blood vessels by drug treatment or diseases affecting the immune system.Further information about ‘at risk’ groups is given in Section 4.Prevention of infection in the home

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Section 2: Breaking the chain of infection usingtargeted hygiene2. Breaking the chainHow to remove a linkSource of causative microbe (source of germs) Isolate the source - For certain infections, particularly those transmitted through the air (via droplets)isolate the person to one room in the house/home, and exclude them from school, nursery, day centres,clubs, etc. Contain the source - Place contaminated items (nappies, pads, dressings) and raw food waste, straightinto a bin or plastic bag. Store raw meat in a covered container.Eliminate the source - Prevent mould growth with good ventilation to reduce humidity levels. Method of exit (way out) Reduce contamination of items and surfaces with body fluids - Cover mouth with a tissue whencoughing and sneezing. Cover discharging wounds. Use incontinence pads/nappies. Protect surfaceswith disposable paper when managing messy dressings or changing nappies. Use a separate choppingboard to prepare raw meat and poultry.Method of spread (spread of germs) Use the targeted hygiene approach to home hygiene to prevent the spread of germs. The principles oftargeted hygiene are described later in this Section. Section 3 shows you how to put targeted hygieneinto practice.Method of entry (way in) Reduce the chance of microbes entering the body through the skin by covering cuts. Check that foodhas been handled and cooked correctly and that drinking water is from a safe source. Use hygienicpractices when handling catheters, drainage tubes and wounds.Susceptible person (person at risk)Protect everyone by; giving appropriate immunisations encouraging a healthy diet and life style following any medical advice.This is particularly important for people at extra risk. Additionally, for those at extra risk, it is vital to, forexample; ensure that their food, drinks and feeds are not a source of infection make sure hands are clean and gloves are used, to reduce the risk of contamination, when caringfor wounds or handling any tubes entering the body, e.g. urinary catheterskeep them away from people known to be infectious and crowds. Infection may be passed from person to person or animal to person (direct spread) or by contact withequipment, surfaces or unwashed hands (indirect spread). Infection can also be caused by swallowingcontaminated food and water. People with infection pose a greater risk in the home.There will always be germs around, contaminating people, pets, food and surfaces and there will always bepeople more susceptible than others to infection. To a certain extent, we can limit the exit of germs and theentry of germs from and into the body, but the one link that we have most control over is the method ofspread. Preventing the spread of infection is achieved by good hygiene. This includes personal hygiene(hand washing), environmental hygiene and cleanliness (targeted cleaning regimes, prompt clearing ofspills of body fluids, adequate laundering) and food hygiene. The following notes in this Section andSection 3 give details of how good hygiene can reduce the spread of infection through adopting a targetedhygiene approach.TrainerÊs notesFurther information and guidance on ‘at risk’ groups and groups which pose a greater risk in the homebecause they are infected is given in Section 4.Prevention of infection in the home

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Section 2: Breaking the chain of infection usingtargeted hygiene3. What is good hygiene practice?Good hygiene practice means reducing the risks of germs spreading in the home.What are germs?lnfectious diseases are caused by germs that may be bacterial, viral, fungal or protozoal. The term, germ, isfrequently used by the public to refer to all microbes. Strictly speaking (and in this teaching resource) itapplies only to those microbes that cause disease.Microbes that cause disease (i.e. germs)Brewing and baking yeastsMicrobes that do not cause disease inhumansMost species normally found on the skin.Those found in yoghurts and cheesesCandida albicans (thrush), Aspergillus, Tinea(ringworm)BacteriaFungiPlant virusesSalmonella, Campylobacter,E. coli, Staphylococcus aureus, methicillinresistant Staphylococcus aureus (MRSA),LegionellaVirusesNorovirus (Norwalk virus or ‘wintervomiting’) and rotavirus (diarrhoea).Cold and flu, measles and mumps virusesCryptosporidiaProtozoaWhat are the risks?Microbes are found everywhere in the home, often in large numbers at sites where there is sufficient water.The residual water in the u-bend of the sink is likely to contain at least 1 million microbes per millilitre ofwater. A used dishcloth may contain up to 100 million bacteria per square centimetre. The surface of achicken may contain over 25,000 Salmonella or Campylobacter. The human skin is colonised by 100 1000 or more bacteria per square centimetre. The floor is likely to contain 100 or more bacteria per 25square centimetres. In each of these places, there will be different types of microbes present, includingseveral species of bacteria and fungi. Most microbes in the home are not harmful, but harmful microbes(i.e. germs) are always present somewhere.However rigorously we clean and disinfect we cannot rid the home of germs and other microbes. There iseven some evidence to suggest that lack of exposure to microbes could be harmful (see Section 6).What we can do through good hygiene practice is to reduce the risk of coming into contact with thosemicrobes that are harmful (i.e. germs). We know that germs originate from a limited range of sources, e.g.food, people and pets. By knowing what these sources are and how and when germs are spread, we can usehygiene to reduce the risk of them spreading. Reducing the risk of spread of germs through hygieniccleaning is not about trying to rid the whole house of germs, it is about getting rid of as many germs aspossible from sites and surfaces, where and when there is a risk. This is known as targeted hygiene.TrainerÊs notesBut keep in mind that reducing microbial risks through hyg

These guidelines are based on the concept of risk as sessment and risk prevention and include advice on; food hygiene general hygiene personal hygiene (particularly hand hygiene) hygiene in situations where there is more risk. This risk-based approach has come to be known as 'targeted hygiene'. IFH subsequently produced a set of

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