Residential/ Nursing home forum Infection Prevention & Control Natalie Foley Infection Prevention & Control Lead

Aims and Objectives Understanding of Infection Prevention & Control Understanding of the Legislation Management of common infections and outbreaks Cleaning and decontamination Water safety

Part 1

Roles & Responsibilities The registered provider Responsible under health and safety legislation for maintaining an environment which is safe for residents, visitors and staff alike. Responsible under the Hygiene Code to ensure that staff receive regular Infection Prevention mandatory updates

The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance/ Hygiene Code The Code sets out what registered providers of health and adult social care services need to do to ensure compliance with the CQC registration requirements for cleanliness and infection control.

10 criteria against which registered providers will be assessed 1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them. 2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections. 3 Provide suitable accurate information on infections to service users and their visitors. 4 Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion. 5 Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people.

10 criteria against which registered providers will be assessed 6 Ensure that all staff are fully involved in the process of preventing and controlling infection. 7 Provide or secure adequate isolation facilities. 8 Secure adequate access to laboratory support as appropriate. 9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections. 10 Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.

Roles & Responsibilities The registered manager Should have access to day to day advice from a qualified infection prevention and control practitioner. Produce an annual statement on the systems in place for the prevention and control of infection and how these are monitored.

Roles & Responsibilities The registered manager Ensure that policies and procedures are readily available to all staff, implemented and monitored. Inform the Health Protection Team if they suspect that there may be an outbreak of an infection or infectious disease

Roles & Responsibilities Staff To read, understand and follow policies and procedures To attend IP& C mandatory training sessions To notify the manager if they suspect an infection/ outbreak

Policies & Procedures Outbreak Management Personal Protective Equipment Hand Hygiene Waste Management Decontamination -cleaning procedures and checklists Safe handling of sharps and Inoculation injury

Why is Infection Prevention important? Additional distress and illness Risk to staff and the community £1 billion each year i.e. antibiotics, hospital stay, staff costs . Approx. 5500 deaths/year.

Healthcare Associated Infections Any infection that arises as a result of healthcare, regardless of the care setting

Common Infections MRSA (Meticilin Resistant Staphylococcus Aureus) Clostridium difficile Norovirus Influenza CPE/CRO (Carbapenam-resistant Organisms)

Recognising an Outbreak Defined as two or more cases of infection occurring around the same time, in residents and/or their carer/s or an increase in the number of cases normally observed Risk assessments Outbreak management plan Route Cause Analysis Documentation Care homes should have a documented outbreak plan appropriate to the services provided, detailing the actions to be taken in the event of an outbreak. The risk assessment is simply a careful examination of what could cause harm to residents in the workplace, including the risk of infection so that an assessment can be made on whether enough precautions have been taken to prevent harm. RCA can be used with groups of staff as an investigative tool and helpful learning exercise to identify why an incident occured, or why there is a series of near-miss incidents and a means of sharing the learning. The analysis is then used to identify areas for change, recommendations and solutions that aim to minimise the recurrence of the incident in the future.

PHE –Health Protection Team Monitor and investigate outbreaks of infection and advise on the control and prevention of infections in the care Not responsible for providing a routine infection prevention and control service directly to care homes.

Occupational Health All staff should have access to occupational health advice. The provider should ensure occupational health advice is available for example through their insurance company, a GP or an occupational health agency

Occupational Health Initial health screening for communicable diseases - confidential health assessment Offer of immunisation (Influenza, Hepatitis B) • Training and compliance with health and safety legislation • Management of exposure to infections -including the local provision for emergency treatment The provider should also ensure that all staff complete a confidential health assessment after a conditional offer of employment and give information about residence overseas, previous current illness, and immunisation against relevant infections, as well as ongoing health surveillance. Prevention of occupational exposure to blood-borne

Repatriations Patients with MRSA Patients with Clostridium difficile Patients with Norovirus Patients with CPE/ CRO

Water Safety Legionella risk Requirement by law Regularly flush unused/ not frequently used water outlets.

Part 2

Causative micro-organism How Infections Spread Causative micro-organism Susceptible host Breaking any link in the chain will assist in preventing the spread of infections Reservoir Portal of entry Portal of exit Mode of transmission

Transmission of Infection Direct Contact Airborne Vehicles Invasive procedures Equipment

How to prevent infections? STANDARD PRECAUTIONS

Standard Precautions Sharps Safety Hand Hygiene Safe Handling and Disposal of Linen Management of body fluid spillages Personal Protective Equipment Standard Precautions Sharps Safety Hand Hygiene Cleaning of the Environment and patient equipment Safe Disposal of Clinical waste Staff Health

Proper technique )))))))))))))))))))0))))))) https://www.youtube.com/watch?v=KusIuq8wu_0 )))))))))))))))))))0)))))))

When do we need to decontaminate our hands?

Supporting residents Promote hygiene - Encourage hand washing - Hand sanitizer/ wipes for residents’ hands - Tailor approaches for residents with cognitive impairment.

Isolation of patients with infections Get advice Rooms should contain hand hygiene facilities En suite/ designated commode Cleaning Psychological well-being Documentation Communication

Key messages for care home managers on winter preparedness Be prepared - Ensure your residents and staff are immunised against flu and have a stockpile of personal protective equipment - Ensure your residents over the age of 65 are immunised against pneumococcal infection. - Ensure your residents who turn 70 or 78 years of age on or after1 April 2018 are immunised against shingles Recognise outbreaks Report outbreaks to the Health Protection Team

Useful Documents Helping Prevent Infection: A quick guide for managers and staff in care homes (NICE 2017). https://www.nice.org.uk/Media/Default/About/NICE-Communities/Social- care/quick-guides/Infection%20prevention.pdf Winter-readiness information for London care homes. (PHE 2018) Prevention and Control of Infection in Care homes (Department of Health, 2013) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachm ent_data/file/214929/Care-home-resource-18-February-2013.pdf Prevention and Control of Infection: Summary for Care home staff (Department of Health, 2013) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachm ent_data/file/214930/Care-Home-Resource-Summary-Feb14-2013.pdf The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachm ent_data/file/449049/Code_of_practice_280715_acc.pdf

Useful Documents Department of Health, 2013. Prevention and Control of Infection in Care homes. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file /214929/Care-home-resource-18-February-2013.pdf Department of Health, 2013. Prevention and Control of Infection: Summary for Care home staff. https://www.gov.uk/government/uploads/system/uploads/attachment _data/file/214930/Care-Home-Resource-Summary-Feb14-2013.pdf Care Home Quality Improvement Audit Tool (Infection Prevention Society, 2013) https://www.ips.uk.net/professional-practice/quality-improvement-tools1/ The Revised Healthcare Cleaning Manual (National Patient Safety Agency 2009) file:///C:/Users/AleMar/Downloads/ind.hc.30.pdf