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

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

3. Part 1

4. 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

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. 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

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

12. 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 deaths/year.

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

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

15. 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.

16. 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.

17. 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

18. 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

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

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

21. Part 2

22. 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

23. Transmission of Infection
Direct Contact Airborne
Vehicles Invasive procedures Equipment

24. How to prevent infections?
STANDARD PRECAUTIONS

25. 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

27. Proper technique )))))))))))))))))))0)))))))
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28. When do we need to decontaminate our hands?

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

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

31. 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 are immunised against shingles
Recognise outbreaks
Report outbreaks to the Health Protection Team

32. Useful Documents
Helping Prevent Infection: A quick guide for managers and staff in care homes (NICE 2017). 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) 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) ent_data/file/214930/Care-Home-Resource-Summary-Feb pdf
The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance ent_data/file/449049/Code_of_practice_280715_acc.pdf

33. Useful Documents
Department of Health, Prevention and Control of Infection in Care homes.
/214929/Care-home-resource-18-February-2013.pdf
Department of Health, Prevention and Control of Infection: Summary for Care home staff.
_data/file/214930/Care-Home-Resource-Summary-Feb pdf
Care Home Quality Improvement Audit Tool (Infection Prevention Society, 2013)
The Revised Healthcare Cleaning Manual (National Patient Safety Agency 2009) file:///C:/Users/AleMar/Downloads/ind.hc.30.pdf