Even under normal circumstances, it’s essential for managers and care staff to know how to prevent the spread of infections and maintain a hygienic and safe environment for their residents, staff and visitors.

But these are anything but normal times. Due to the coronavirus that causes COVID-19, infection control has become even more vital. On inspections, the CQC seeks evidence to show that a service is clean and hygienic, and that staff understand their training and policies and put these in practice. Infection control is part of the Key Lines of Enquiry (KLOE) within the Safe area and comes under Regulation 12 of the Health and Social Care Act. Care and nursing homes are also expected to follow guidance from other bodies, like the Department of Health. During an inspection, the CQC will typically observe the cleanliness and ask staff about their knowledge. This includes the manager, the care and nursing staff, and also housekeepers. The CQC expects that staff are trained to handle food safely and they can describe how they do so.

Infection Control Compliance

The best way you can make sure your home and staff are compliant is to:

• have up to date policies
• train staff so that they know about and understand these policies in practice
• audit regularly
• follow up on any actions promptly
• ensure you can and so put the evidence of your actions in front of the inspectors

It’s important to check your home regularly and frequently to see that staff practices are correct. Are they employing good hand washing? Are they using personal protective equipment (PPE) correctly? You should check cleanliness and how well the staff understand the procedures. Look at the laundry and kitchens, as well as residents’ rooms to see if staff are missing anything. Always make notes on these checks and add any actions to your plan. Take prompt action to remedy any issues and then return to recheck at a later date.

During the current pandemic, some care homes have really struggled to obtain PPE and to manage services with staff who may not be familiar with their home. Currently, the CQC has suspended normal inspections, so if infection control was an issue at your last inspection, you will have a little more time than usual to get this right and achieve compliance. For now, your focus should be on preventing the virus from entering your care home or making sure the spread of COVID-19 infection is reduced.

Basic Infection Control Actions During the COVID-19 Pandemic

Keep an eye on the CQC and Department of Health websites for news and updates. If you haven’t’ received a pack of PPE, you should follow the guidelines on the NH Supply Chain website, here The National Supply Disruption Response.

The key tips for care home staff to follow are:

1. Clinical Handwashing

Follow guides and make sure all staff have access to handwashing facilities and give them hand sanitisers to carry for when they are not near facilities. Ensure staff wash hands based on the World Health Organization’s 5 Moments:

1. Before a new contact
2. After contact with a person
3. After exposure to bodily fluids
4. After contact with surfaces
5. Before going to do anything else

2. Moisturising

Due to all this washing, hands can become dry, chapped and sore. Not only is this uncomfortable, but damaged and cracked skin can also harbour the virus more easily. So moisturise at least three times a day.

3. Cleaning

Clean surfaces more often. It’s not yet known exactly how long the coronavirus that cause COVID-19 can last on surfaces. But other, similar viruses can last on surfaces for many hours or days. So it’s important to regularly clean bed rails, hand rails, door knobs and other commonly touched surfaces.

4. Soaps and towels

Don’t use communal towels or bars of soap. Instead, use liquid soaps and paper towels and dispose of the towels in the same place that hands are washed.

5. Nails and jewellery

Long, painted nails and jewellery can increase the risk of contamination. Ask your staff to keep their nails short and unpainted and to remove jewellery, where possible.

Correct Use of PPE

If you have PPE, try not to waste your supply. When PPE must be worn, communicate as best you can to people why it is needed. PPE use should be risk-assessed and put on and taken off in a certain order:

Donning / putting on PPE

1. Wash hands
2. Put on apron or gown
3. Put on face mask
4. Put on eye protection
5. Put on gloves

Doffing / taking off PPE

1. Remove gloves
2. Remove apron
3. Remove eye protection
4. Remove face mask
5. Wash hands

PPE is not needed if someone is free of signs of any illness and so are the staff (and the staff’s family) attending to that person. It’s also not required where the risk of bodily fluid splash is minimal.

Gloves and aprons are needed where the risk of slashing of bodily fluid is high, but no known infection is present. If infection is present, full gloves, waterproof gowns/aprons, surgical face mask and eye protection are required. This should all be removed before leaving the area.

Disposal of PPE and other items must be done safely. Double bagging in the normal colour bags for that waste is required when dealing with PPE and other waste after attending someone with suspected or confirmed infection. This must be kept and set aside for 72 hours before normal disposal. Cleaning and laundry should be increased, with particular attention paid to separating dirty and clean items. Staff should avoid shaking laundry.

In the very sad event of someone dying of suspected or confirmed infection, all their items must be double bagged and set aside for at least 72 hours before being stored elsewhere for later collection by family. Their room should be deep cleaned and left after that for 72 hours before anyone new enters the room.

Everyone understands the massive challenges care homes are facing during this time. We know you want to protect your residents and your hard-working staff, so do your best, follow the guidance and be as creative as possible to keep up spirits for yourself and your staff, as well as your residents and their families.

If you need advice on putting the guidance into practice or finding further information, please get in touch.