11.12 Infection Prevention and Control

1. Introduction

Good infection prevention and control (IPC) measures are essential to ensure that adults who are living in their own homes and whose care and support needs are met by service providers and visited at by adult social care (ASC) staff, receive safe and effective care. Infection prevention and control must be embedded into everyday practice, with the same high standards applied by all staff.

This chapter outlines the different areas in which action must be taken to keep adults and staff safe.

2. Processes

2.1 Training and information

All relevant ASC staff should complete IPC training as part of their induction and regular update training should also be provided. Additional training may be required in response to an incident or particular circumstances, such as the covid pandemic.

2.2 Audit

Audit process should be in place to ensure that all necessary IPC processes are adhered to. This should include a review of care and support practices to ensure that principles and guidance covered in training are being fully implemented.

It will be the responsibility of the ASC IPC lead to ensure that any corrective actions identified because of an audit are implemented within the agreed timescales.

3. Infection Prevention and Control Risk assessments

Staff should ensure that risk assessments in relation to IPC risks for adults who receive care and support at home, are carried out:

• during the first contact with the adult; and
• reviewed at agreed intervals or sooner if changes occur.

The risk assessment should be recorded and should identify any steps required to eliminate, reduce or control risks from infection.

Where required, and together with health practitioners, the IPC lead should monitor the risks of infection to determine whether further steps are needed to reduce or control infection.

3.1 Infection risk assessment

Assessing a person’s risk of catching or spreading an infection and providing them with information about infection is essential for the adult’s safety.

Where there is a medical history or risk of infection, this should be included in the adult’s assessment, care and support plan and considered when the plan is reviewed. The assessment should determine whether any extra IPC precautions are needed, including whether staff need to wear additional personal protective equipment (PPE). It should include all factors which may mean the person is at higher risk of catching or spreading infection including:

• symptoms:
  • history of current diarrhoea or vomiting;
  • unexplained rash;
  • fever or temperature;
  • respiratory symptoms, such as coughing or sneezing;
• contact:
  • previous infection with a multi-drug resistant pathogen (where known);
  • recent travel outside the UK where there are known risks of infection;
  • contact with people with a known infection;
• person risk factors:
  • vaccination status which will assist assessment of their susceptibility to infection and allow protective actions to be taken when necessary;
  • wounds or breaks in the skin;
  • invasive devices such as urinary catheters;
  • conditions or medicines that weaken the immune system;

• environmental risk factors, such as poor ventilation in the home (Infection Prevention and Control: Resource for Adult Social Care (Department of Health and Social Care).

4. Reducing the Risk of Spreading Infection

4.1 Actions

Staff who are suspected or have contracted an infectious disease should be placed on sick leave and contact / visit their GP or other medical services for assessment and treatment as necessary.

Specialist health and safety advice may also be required to provide further guidance. ASC staff should work with health professionals, the adult and their family in order to provide continuing care and support to the adult and reduce the risk of further spread of infection.

Staff should wear any additional PPE as required.

4.2 Control principles

There are a number of control principles for care staff as outlined in Infection Prevention and Control: Resource for Adult Social Care (Department of Health and Social Care):

• Reducing the hazard: Public health measures such as vaccination, testing and isolation help to reduce the risk of infection. Vaccination against respiratory illnesses such as flu and COVID-19 is an important measure in reducing the risk of severe disease. Measures such as not coming to work when ill, advising people to isolate while infectious and recognising and reporting infections promptly, all help to prevent infections spreading at work.
• Changing what we do: When faced with a particular risk, such as an outbreak, we may need to change what we do. This might include reducing communal activities, limiting visiting, or adding disinfection into a more frequent cleaning schedule, for example.
• Changing where we work: We may not be able to change where we work but the work environment can be made as safe as possible. For example, by improving ventilation, ensuring fixtures and fittings are in good repair and can be easily cleaned and following water safety guidelines, we reduce opportunities for pathogens to survive in the environment.
• Changing how we work: Changing the way we organise work can reduce risk. Examples include reducing the number of people in a space at any one time and minimising the movement of staff between different settings. Administrative controls such as risk assessments, training, audit, and providing clear signage and instructions also help to reduce the risk of infection at work.’

4.3 Standard infection control precautions

See Infection Prevention and Control: Resource for Adult Social Care, Preventing Infection section (Department of Health and Social Care for a full current list of infection control precautions.

5. Responding to Infections

5.1 Medical intervention

At the first sign of any transmissible illness, the adult’s relatives should be informed. With the adult’s permission (or their carer if the adult does not have the mental capacity to consent – see Mental Capacity chapter), their GP should be contacted and a visit requested.

Where the illness is more urgent the ambulance service should be contacted and visit the adult to conduct an assessment. If it is suspected that hospital or Accident and Emergency admission will be necessary, the hospital should first be contacted for advice, as it may not be advisable to take an adult with an infectious illness to an area where there are other people.

The adult’s GP should arrange any relevant testing required for diagnosis, treatment and management of the illness. Staff should ensure that the adult receives any treatment as prescribed by the doctor.

5.2 Obtaining advice

ASC staff or the manager should obtain advice from relevant health practitioners whenever required.

6. Cleaning

6.1 Cleaning

See also Section 4.3, Standard infection control precautions

When working with adults in their own homes, levels of tidiness and cleanliness will vary, but staff should always adhere to the same principles of IPC whatever the circumstances in which they are working.

Where there is equipment in the adult’s home for use during the provision of care and support, for example hoists, beds and commodes, they should be cleaned and disinfected as required.

Staff should ensure there is adequate and suitable hand washing facilities and anti-microbial hand washes where required. This may include being issued with pocket sized bottles to use if there are no adequate facilities in the adult’s home.

7. Information

7.1 Information to adults and their visitors

Information on the general principles of infection prevention and control should be available to all adults, their relatives, friends and any other visitors to the adult’s home. This is particularly important if an adult as a medical history of, or is at risk of, infection. This should include:

• general principles on the prevention and control of infection;
• supporting adults’ awareness and involvement in relation to IPC;
• the role of adults (where appropriate), carers, relatives and advocates in IPC;
• the importance of hand hygiene measures;
• reporting any concerns about hygiene or cleanliness;
• providing explanations of incidents / outbreaks.

Where staff have any concerns, they should report them to their manager. The manager may need to consult a specialist IPC advisor, the outcome of which should be shared with the adult’s and their family as appropriate.