Introduction
The risk of guests, care staff and visitors acquiring a healthcare associated infection at Leuchie House is minimised
Scope
This policy is for the use of all Leuchie staff, guests and visitors to the house.
Outcome:
- Outcome statement
1.1 It is the policy of Leuchie House to ensure that all necessary standard infection control precautions are in place within the premises, to minimise the risk of a guest, visitor or member of staff acquiring a health care associated infection.
1.2 This policy is intended to provide basic practice guidance in infection control procedures, which will be in accordance with recognised standards of good practice (Health Protection Scotland, National Infection Prevention Control Manual, January 2012).
- Leuchie House environment
2.1 Health and social care settings contain a diverse population of micro-organisms. Areas/items shared by different guests (e.g. toilets, sitting rooms etc) can become contaminated with blood, and body fluids, during the delivery of care and therefore, must be managed appropriately.
2.2 In order to limit such areas/items from becoming potential reservoirs for harmful micro-organisms which, in turn, could lead to the potential contamination/infection of staff, guests, visitors or others, measures must be taken to ensure that the environment is kept clean at all times.
2.3. For the purpose of this policy, the term ‘environment’ refers to:
- Any general horizontal surfaces in the guest’s environment (low- and high-level surfaces must be considered)
- Any frequently touched surfaces in the Leuchie House environment, this also includes rooms such as sluice rooms, treatment rooms, store rooms etc.
- Beds and trolleys, other furniture in the environment, bedside items such as lockers/tables
- Toilets and commodes
- Sinks, basins, baths, showers and the items surrounding these, including, e.g. hand hygiene solution containers
- Floors
- Doors, door handles particularly those in the immediate environment frequently touched by guests, care staff and visitors
- Other paint work and surrounding, e.g. skirting boards, wall, partitions (particularly focusing on those frequently touched)
- Curtains/screens, window blinds
- Light fittings and light switches
- Servery/kitchen areas in the premises, and
- Lift elevator
- Director of Care and Health and Head of Services
3.1 The Director of Care and Health along with the Head of Services is responsible for ensuring that appropriate prevention and control of infection guidance is in place, available, understood and followed by all members of care staff.
3.2 In addition, The Director of Care and Health along with the Head of Services must ensure All staff have had education on the principles of infection prevention and control in the Leuchie House environment
- Appropriate resources are in place in the premises to facilitate a high standard of infection control practices
- Appropriate corrective action or interventions is taken without delay if an incident occurs in relation to infection control
- Staff with any health concerns, or who have become ill due to occupational exposure, are referred to an appropriate agency such as a GP or Occupational Health service, and cleaning schedules for the Leuchie House environment are clearly defined, monitored, documented and available to all members of staff.
- Leuchie House staff
4.1 A designated member of staff should be identified to act as the infection control key worker. This person will receive appropriate training in infection control measures and in turn will advise and support other staff working in Leuchie House to adopt and maintain high standards of infection control.
4.2 All staff working in Leuchie House must be aware of their role in infection control.
4.3 All staff will receive annual training in prevention and control of infection measures.
4.4 New members of staff will receive infection prevention and control training as part of their induction training
4.5 In addition, all staff must ensure that;
- They adopt thorough infection control practices;
- They offer reassurance to all guests, their family members and carers, and visitors;
- They are aware of documented cleaning schedules and how to access them when required and how to use them;
- They take personal responsibility for cleaning schedules in Leuchie House relevant to their position;
- They report to the Head of Care or Head of Services any infection control deficits relating to any areas in the care environment or items of equipment;
- Report any ill health which may be due to occupational exposure in the care environment.
- Visitors to Leuchie House
5.1 Senior staff (Registered Nurses or Management) should make direct contact with visitors to Leuchie House when a guest being visited is at risk, or has an actual or potential infection.
5.2 If a visitor to Leuchie House is unsure of the infection status of the person they are visiting, they should contact the nurse in charge of The Head of Care or the Head of Services before visiting.
6. Standard infection control precautions
6.1 Good basic hygiene practices should be followed at all times. Hand washing is considered the single most important measure in infection prevention and control. Care workers, by the nature of their work, have close contact with guests during toileting, bathing, dressing and assisting in and out of bed with grooming. Micro-organisms are present on all living things so it is possible that with close contact, both guests and care workers may become contaminated with each other’s micro-organisms. For this reason, basic personal hygiene standards should be observed ensuring that:
- A clean uniform is worn daily
- Access to a clean spare uniform is readily available
- Shoes are cleaned regularly
- Pens, watches, scissors are cleaned regularly
- Personal body hygiene is of a high standard at all times
- Long hair is tied back
- Finger nails are short, clean and free of nail varnish, false nails are not worn,
- Jewellery (other than a wedding band or stud earrings) is not worn whist at work, and
- Multiple pairs of worn earrings and/or dangling earrings are not acceptable and should not be worn as they may cause serious injury to the wearer.
6.2 Hands should always be washed:
- At the start and finish of each work period
- Before each guest contact
- Before and after any clinical procedure
- Before and after removal of protective gloves
- Before and after any medicines administration
- Following any actual or potential contact with body fluids
- Before eating, drinking or handling any foodstuffs, and after using the toilet.
6.3 Liquid soap and paper towels will be available at all times for all care staff to use for hand washing purposes.
6.4 Alcohol hand gel will be available to supplement hand hygiene but is only to be used on visibly clean hands. This is located at Reception and is mainly for use by visitors to the house.
6.5 Hands should be washed in running water using liquid soap.
6.6 No bar soap is to be used for hand washing.
6.7 After washing, hands should be dried using paper towels only.
6.8 No linen towels are to be used for drying staffs’ hands within the premises as this presents as a potential spread of infection.
6.9 Linen towels for guests’ use should be easily identifiable and washed daily or more often if they become heavily contaminated.
6.10 Guest who personally request to use linen facecloths are requested to bring their own which are kept in their own rooms.
6.11 Disposable gloves should be worn for any activity where hands may come into contact with blood, body fluids, mucous membranes or guests’ broken skin.
6.12 Disposable latex gloves should not be used.
6.13 Intact skin is an effective barrier to micro-organisms entering the body. Therefore, any members of staff who have skin cuts, abrasions or other skin lesions or disorders, should ensure that the affected areas of skin are covered with an appropriate dressing whilst engaging with guests.
6.14 All spillages of blood or body fluids must be dealt with immediately they occur using appropriate cleaning materials whilst wearing disposable gloves (non-latex). The waste spillage should be disposed of into a clinical waste bag.
- Personal protective equipment (PPE)
7.1 A stock of personal protective equipment (PPE) will be available in Leuchie House each day.
7.2 Personal protective equipment includes;
- Disposable gloves
- Disposable plastic aprons
- Protective eye goggles
- Disposable shoe covers, and
- Face masks.
- Visors
Please note that the above list of PPE is NOT exhaustive.
7.3 PPE should be appropriate, fit for purpose and suitable for the person using/wearing it, with supplies located close to the point of use.
7.4 All staff must never perform hand washing while wearing gloves and never use products such as alcohol hand products to clean gloves
7.5 Disposable gloves used for procedures where exposure to blood/other body fluids may occur are single use, and should be removed and replaced following each use, with hand washing performed in between times
7.6 PPE should not be a source of further contamination, e.g. by being left on environmental surfaces following removal, or by being removed inappropriately by wearers and as such contaminating hands unnecessarily.
7.7 The use of PPE such as gloves does not negate the need for hand hygiene.
7.8 Stocks of PPE should be stored off the floor e.g. on appropriate shelving in a designated, clean and dry storage area to ensure that they are not potentially contaminated prior to use.
7.9 Single use items should be used where appropriate/possible and never reused (packaging of such items clearly states if they are single use). Manufacturers’ instructions should always be followed.
- Disposal of sharps/care of sharp items
8.1 Approved sharps’ waste containers will be available for use within Leuchie House.
8.2 Each sharps’ container must be clearly labelled and dated when commenced for use and labelled and dated again when closed prior to uplift. This is for traceability purposes.
8.3 Before commencing an activity involving a sharp item, an appropriate approved sharps’ bin should be readily available.
8.4 Sharps containers should be stored/positioned safely for use and as close to the point of use as possible.
8.5 Sharps’ containers should never be placed on the floor in case they are accidentally kicked, resulting in them toppling over and the contents spilling out.
8.6 Sharps containers should be assembled correctly and should never be over-filled, i.e. above the manufactures’ fill line.
8.7 All needles and syringes must be discarded immediately after use into the sharps’ bin.
8.8 Needles should be re-sheathed after use.
8.9 Items should never be removed from sharps’ containers. The temporary closure mechanism on sharps’ containers should be used in between use for safety
8.10 Sharps’ containers should be safely and appropriately sealed in accordance with manufacturers’ instructions and should be disposed of once full.
8.11 Any sharps exposure incidents e.g. needle stick injuries, that occur in Leuchie House must be reported to the nurse in charge or Head of Care and managed appropriately.
8.12 In the event of a sharps’ injury, bleeding should be encouraged and the area of the skin washing in hot, soapy water. A waterproof dressing should be applied and the incident recorded in the Accident/Incident Book. Depending on the nature of sharps’ injury, the accident/incident may be RIDDOR reportable following the carrying out of a risk assessment by the nurse in charge.
8.13 Other produced sharp items of a non-clinical nature such as broken glass or crockery, must be discarded into a separate sharp’s container. This container should be identified and labelled for traceability purposes.
- Cleaning schedules
9.1 Written cleaning schedules will be available and in all internal areas of Leuchie House.
9.2 Cleaning schedules will highlight areas and frequency of cleaning and which department staff will clean.
9.3 Cleaning schedules will highlight methods of cleaning such as washing, wiping, damp dusting, vacuuming, laundering or other techniques.
9.4 All cleaning schedules must be signed as required by the member of staff carrying out the cleaning task. The signing of cleaning schedules will be monitored by the Housekeeper.
- Housekeeping and cleaning arrangements
10.1 All internal areas of Leuchie House should be washed regularly. This includes all surfaces, sinks, baths, showers, toilets, taps, floors, skirting areas, desk areas, telephones, seats, tables, door handles, light switches and shelving.
10.2 All domestic waste bins should be emptied regularly, at least once per day.
10.3 All clinical waste bins should be emptied at the end of each shift by nursing staff. Clinical waste bags should not be overfilled. When two thirds full, the bag must be replaced.
10.4 Sharps’ bins should not be allowed to be more than two thirds (2/3) full. The sharps’ bin should then be replaced by nursing staff.
10.5 Following any clinical procedure, thorough cleaning of the treatment room area and/or guest’s bedroom area must be carried out by nursing staff and all used equipment disposed of safely and correctly.
10.6 Waste bins for domestic waste will be of a foot pedal operated design, should be functional at all times and in good working order.
10.7 Waste bins for healthcare or clinical waste will be of a foot pedal operated design, should be functional at all times and in satisfactory condition.
10.8 All general areas within Leuchie House should be maintained in a tidy state at all times.
- Disposal of waste
11.1 All waste soiled or contaminated with blood or body fluids, should be regarded as healthcare waste and disposed of safely in a dedicated healthcare waste bag, which should not be overfilled. When the bag is two thirds full, it must be replaced.
11.2 Waste should never be disposed of in an already full waste bin.
11.3 Waste bags should not be more than two thirds full.
11.4 Waste should be disposed of immediately, as close to the point of use as possible into the appropriate receptacle provided in the sluice rooms.
11.5 All waste bins in Leuchie House should be kept clean.
11.6 Waste bins should be hands free, pedal operated lids so that hands do not become contaminated during waste disposal.
11.7 The outside waste storage area must be kept clean, tidy and secure at all times to prevent unauthorised access.
12. Care equipment
12.1 All care equipment should be checked on a daily basis or after use, for cleanliness, breakages, breakdowns, contamination and state of repair.
12.2 Items such as supplies, must always be stored off the floor.
12.3 Equipment used for storage such as shelves, units, lockers etc. should have easy-to-clean, smooth impervious surfaces and be water-resistant.
12.4 Any care equipment in need of repair should be attended to without delay and/or reported to an appropriate person and written records kept of repair progress.
12.5 A clinical healthcare waste bin must be available for use at identified areas in the premises.
12.6 All standing hoists and lifting hoists should be cleaned daily, or more often depending on use and guests’ circumstances. Particular attention must be paid to the underside areas of hoists and aids as these areas may become soiled and not be readily visible.
12.7 All bathing aids should be cleaned after use and stored clean.
12.8 All guests’ commodes should be cleaned after each use. Particular attention must be paid to the underside areas of commodes as these areas may become soiled and not be readily visible.
12.9 All guests’ wheelchairs should be cleaned twice weekly, or more often depending on use and guests’ circumstance. Particular attention must be paid to the underside areas of wheelchairs as these areas may become soiled and not readily visible.
12.10 Items which are not intact, for example surfaces or armchairs, sofas, bedrail protectors etc., should be removed, repaired or replaced and reported to the maintenance staff.
12.11 Where there is concern about risk of infection due to damaged equipment, a written record should be made for reference.
- Storage of sterile products
13.1 Sterile products will be stored within the designated clean cupboards and/or shelves in the Treatment Room.
13.2 All sterile items will be stored in their original manufacturer’s packaging until ready to be used.
13.3 All sterile items will be stored off the floor.
- Specialist infection control advice
14.1 Expert advice on infection control issues will be obtained on an as required basis depending on clinical circumstances within Leuchie House.
- Management of cases and outbreaks of diarrhoea and vomiting
15.1 Diarrhoea in older people is common and does not always have an infectious origin. Infectious diarrhoea in an older person can cause increased morbidity and mortality, and spreads easily.
15.2 All cases must be presumed to be infectious until advised otherwise.
15.3 Guests’ general practitioners (GPs) and/or GP’s local to Leuchie House should be notified. If infection is suspected, the GP may advise faecal specimens to be sent to a laboratory.
15.4 If more than two cases which are known or suspected to be infectious occur, the following agencies/individuals must be notified;
- The guests’ GP
- The consultant in Communicable Disease Control at Name of Hospital TBC
- The Care Inspectorate (Musselburgh office) tell: 0131 653 4100
- Environmental Health, East Lothian – tell: 01620 827365 (Out of hours tel: 01875 612818)
- The guest’s relatives
Contact with the above agencies/individuals must be documented in the guest’s care plan with the date and time of contact, the name of the person/s spoken to and confirmation of the name of the member of Leuchie House staff reporting the outbreak.
15.5 If admission to hospital is required, a nursing transfer letter will be completed and sent with the guest to hospital. The ambulance crew will be notified of the transfer letter.
15.6 Care staff must wear disposable gloves and aprons to handle soiled linen which should be placed in a water-soluble alginate bag and placed in a laundry bag, preferably water soluble and leak proof, then washed in a washing machine on a hot wash of at least 60o celcius. Delicate clothing should be washed separately on a normal wash cycle. After placing the items of clothing in the washing machine, care staff should remove gloves and apron and wash their hands.
15.7 Cleaning of hard surfaces, toilets and wash had basins including door handles and taps must be carried out at least daily using a dilute solution of hypochlorite/bleach (1,000ppm).
15.8 If possible allocate the same staff to either symptomatic guests or asymptomatic guests. All staff who may have direct contact with symptomatic guests must be fully informed and follow the precautions listed below:
15.9 All symptomatic guests should be cared for in their room until asymptomatic for 48 hours.
15.10 If diarrhoea is prolonged it may be unreasonable to keep the guest isolated for an extended period and individual circumstances may need to be considered, or advice sought. If possible, isolate symptomatic guests in a room not shared with another guest. If this involves moving the guest to another room, consent must be gained from the other guest and/or relatives where appropriate.
15.11 Single use disposable aprons and gloves must be used by all care staff delivering care to symptomatic guests. Aprons and gloves should be disposed of into a clinical waste bag immediately after each use. Staff should then wash their hands.
15.12 Liquid soap dispensers and disposable hand towels must be used in each of the symptomatic guests’ rooms and in all communal guest toilets.
15.3 Emptying and cleaning of commodes and bed pans from symptomatic guests.
Sluice facilities available
When disposing of excreta, disposable gloves and aprons must be worn. Cover the bed pan/commode pan and remove to the sluice area immediately. If excreta are disposed of manually take care to avoid splashing. The bed pan should then be placed in the sluice machine for washing and sterilising. If the bed pan/commode pan must be cleaned manually it should be washed in hot water and general-purpose detergent and then disinfected in a hypochlorite/bleach solution (1000ppm). After cleaning the bedpan/commode has been carried out, return the bed pan/commode pan to the guests’ room.
Sluice facilities not available
Designate an area for the disposal of excreta and cleaning of bed pans/commode pans. This area should be reserved for this use only and should consist of a toilet and sink as minimum requirements. Disposal of the faeces should be into the toilet and cleaning/disinfection of the bed pan/commode pan should be carried out in the sink. The sink should be cleaning with hot water and general-purpose detergent and disinfected with a hypochlorite/bleach solution (1000ppm). Staff must wear disposable gloves and aprons whilst dealing with excreta and cleaning the bed pan/commode pan. Hand washing must be thorough and should not take place in the sink in which the bed pan/commode pan has been cleaned.
15.4 Care staff
Care staff with diarrhoea or vomiting should be off work until they have been free of symptoms (diarrhoea or vomiting) for 48 hours. Staff should not cross over from care duties to catering duties during a shift.
15.5 Outbreaks
An outbreak of diarrhoea and/or vomiting is defined as two or more cases of guests with similar symptoms.
Faecal specimens should be obtained from all symptomatic guests or staff. Laboratory request forms marked “OUTBREAK” ensuring the name of Leuchie House is clearly shown. An ongoing record should be kept of all cases including the guest’s/member of staff’s name, date of birth, date of onset, symptoms and if a specimen has been obtained. Any investigation will require a list of all guests and staff, and these should be prepared in advance as possible.
One or more toilets must be designated for the sole use of symptomatic guests.
If food poisoning is suspected, Environmental Health Officers may wish to obtain a food history from guests and staff. Diet sheets and menus will be required. Events, functions and parties serving food and drink to outside visitors should be cancelled or postponed until clearance is given by the Consultant in Communicable Disease Control.
Admissions to, or transfers from, Leuchie House should be suspended until all cases have been asymptomatic (no diarrhoea or vomiting) for 48 hours. This may be varied following discussion with the guests’ GP’s, the Care Inspectorate and the Consultant in Communicable Disease Control.
Consideration should be given to the safety of visitors of guests with infections, particularly the elderly and very young visitors. In addition to verbal advice, consider the provision of written advice on the nature of the infection and how to prevent cross infection for relatives of affected guests.
Incidents of vomiting or incontinence in a communal area should be cleaned up immediately and the area well ventilated to reduce possible airborne spread of viruses. If carpeted areas are contaminated the affected area should be cleaned, shampooed and if available, a steam cleaner should be used.
- Management of COVID 19 and potential outbreak
16.1 COVID 19 is spread when respiratory secretions from an infected person enters the mouth, nose or eyes of another.
16.2 To prevent the spread these points should be remembered:
- No staff or visitors should enter Leuchie if they have symptoms
- Practice social distancing in the workplace and minimise contact where possible
- Avoid touching the eyes, nose or mouth unless hands are washed immediately beforehand
- Catch coughs or sneezes in a tissue or the crook of the elbow
16.3 Hand hygiene
- Ensure bare below the elbows (do not wear long sleeved clothing)
- Carry out HH using soap and water (essential if visibly soiled) or alcohol-based hand rub (ABHR)
- Undertake HH; before and after touching an individual/their environment, after body-fluid exposure risk, before an aseptic procedure
- Extend HH to exposed forearms if contaminated
16.4 Isolation
- Ensure suspected and confirmed individuals are isolated in a single room for 14 days from symptom onset
- Wherever possible, keep the door to the isolation room/area closed
- If no single rooms available, you may cohort confirmed individuals together or suspected individuals together provided they have no other known/suspected infections
- Dedicated equipment where needed
- Staff should be dedicated to COVID-19 areas
16.5 PPE
When providing care within 2m of an individual who is shielding or who may be suspected or known to have COVID-19
- Fluid Resistant Surgical Mask (sessional) – can go between individuals in same item of PPE
- Eye/face protection (sessional) – can go between individuals in same item of PPE
- Apron (should always be single use only) – remove after individual care or cleaning
- Gloves (should always be single use only) – remove after individual care or cleaning
- Always perform Hand Hygiene after removing your PPE
- See COVID-19 care home guidance for additional PPE required for aerosol generating procedures
16.6 Cleaning
Decontaminate equipment and the environment at least TWICE daily with
- General purpose detergent followed by or combined with a chlorine releasing agent at least 1000ppm av Chlorine
- Ensure at least TWICE DAILY cleaning of frequently touched surfaces (e.g communal toilets, door handles, bed rails, tables)
- Ensure COVID-19 areas are cleaned after non COVID-19 areas
16.7 Waste
Dispose of COVID-19 waste in clinical waste bags at point of use
If you do not have a clinical waste stream, COVID-19 waste can be disposed of in the domestic waste stream. Once full, the bag should be placed in a second bag and tied. These bags should then be stored in a secure location for 72 hours before being put out for collection.
Special purple lidded cytotoxic waste bins should be used for cytotoxic waste
16.8 Linen
- Manage all COVID-19 linen as ‘infectious’
- Wear PPE when handling linen and do so within the individual’s room
- Do not shake linen
- Transport securely to laundry facility in linen receptacle
- Change in and out of uniform at work and transport home in a bag to launder
16.9 Visitors
- See separate visiting guidance
- References
Regulation: 4 (1) (d) – Welfare of users
The Social Care and Social Work Improvement Scotland (Requirements for Care Services)
Regulations 2011
In the event of an outbreak or suspected outbreak, or a guest being diagnosed as contagious please ensure that the SMT (Senior Management Team) are informed and kept up to date. The SMT includes the CEO and Director of Care and Health
Signature Date
Mark Bevan, Chief Executive, Leuchie House