Essential guidance for care providers
Infection prevention and control resources
Resources to help care providers in developing the systems and processes they need to have in place to achieve compliance in infection prevention and control within their work practice.
Audit tools
Care home infection prevention and control resource booklet
Domiciliary care infection prevention and control resource booklet
Royal College of Nursing
Essential practice for infection prevention and control
Care Quality Commission (CQC)
In November 2017 the CQC made infection prevention and control a mandatory Key Line of Enquiry (KLOE).
We work closely with our local CQC inspectors, NHS hospitals, and Clinical Commissioning Group in supporting providers to make improvements in the quality of care delivered to individuals.
Key lines of enquiry for adult social care services
Regulations for service providers and managers
(Registration) Regulations 2009
National Institute for Health and Care Excellence
Infection prevention and control quality standard
Healthcare-associated infections: prevention and control in primary and community care
Department of Health
Prevention and control of infection in care homes
Infection prevention and control in adult social care - Covid-19 supplement
Vaccinations
Staff who have direct contact with residents/service users should make sure they are up to date with their routine vaccinations. This includes:
- Tetanus
- Polio
- Diphtheria
- Influenza
- Measles, Mumps and Rubella (MMR)
- Hepatitis B (if staff have contact with body fluids, provides injections, have a risk of being injured/bitten by service users)
GP mythbuster 37: Immunisation of healthcare staff
From 11 November 2021, anyone working or volunteering in a care home is required by law to have had two doses for the Covid-19 vaccine. This double vaccination status also applies to those attending job interviews, external contractors and students who are required to attend the care home as part of their studies. The government have since updated this legislation and anyone working or volunteering in a care home won't need to be double vaccinated from 15 March 2022. Vaccination against Covid-19 is still strongly recommended to anyone who is working within health and social care.
The Covid-19 booster vaccine is not yet a legal requirement, however, it is highly recommended that people do have their booster vaccine when invited. Find further information about the Covid-19 vaccination programme
Currently, the mandatory vaccination programme does not include those working or volunteering at supported living settings or those providing domiciliary based care. It is highly advised that everyone working within health and social care settings are fully vaccinated against Covid-19.
Managing outbreaks
An outbreak can be defined as two or more cases of infection occurring around the same time, in residents and/or their carers, or an increase in the number of cases normally observed.
It's important to recognise potential outbreaks promptly and to implement control measures as soon as possible to prevent further cases. Staff must be aware of the signs of infection, particularly in the elderly, e.g. fever, diarrhoea or vomiting, unexpected falls and confusion, and report these signs immediately to senior management staff. Learn more about the different types of infections.
Some infectious diseases may spread readily to other residents, members of staff, or relatives, causing outbreaks. 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, such as restricting or closing the care home to visitors.
Guidance for dealing with an outbreak
Influenza-like illness (ILI): managing outbreaks in care homes – Gov.uk
Cleaning and decontamination
The environment
Keeping the environment clean is really important to reduce the risk of infections. Cleaning has two important roles:
- It removes dust, dirt and debris from surfaces. This makes our home and work environments look clean and tidy.
- It removes microscopic particles like bacteria, viruses and spores. Some of these particles can be harmful to our health (particularly those who have long-standing health conditions).
When working within health and social care services, it is essential that good infection prevention and control standards are maintained to protect those using the service. All areas and rooms within the care home environment should be cleaned a minimum of once per day. Environmental cleanliness must be a part of everyday practice and all staff are responsible for ensuring cleaning standards are maintained.
Information on how to keep the care home environment clean:
Safe management of the care environment audit tool for care homes
National standards of healthcare cleanliness Opens new window
The built environment
A building's design can help infection prevention and control by providing an environment that is easy to clean and maintain. It is important that these features are designed into a refurbishment, upgrade or new build from commencement of the project.
When planning to make changes to an existing building e.g. extension, adaption or refurbishment, or are commissioning a new build, it is necessary to refer to current IPC guidance and best practice. The Department of Health has produced a series of Health Building Notes and Health Technical Memorandums that cover all aspects of building work, including fixtures and fitting.
Reusable equipment
There is a variety of reusable equipment used within social care settings.
Communal wheelchairs, hoists and commodes
These items should be cleaned once per day and after each individual use to reduce the risk of transmissible infection from one person to another. Remember, after the cleaning process has taken place, suitable documentation should be completed to provide assurance for the next user.
Commode and commode pan audit tool for care homesLinen
The provision of clean linen is a fundamental requirement of care. Care providers have a duty of care to remove any microbial contaminants from all linen and avoid recontamination. Clean linen should be stored above floor level in a suitable environment dedicated for the storage of clean linen.
A one-way-flow system is recommended within the laundry room to reduce the risk of cross-contamination between clean and dirty linen. An example of this would be moving around the room in a clockwise direction.
Decontamination arrangements for linen within health and social care Opens new window
Management of soiled/infected linen
Incorrect handling of soiled/infected linen can increase the risk of transmission of harmful microorganisms. Soiled/infected linen should be segregated, transported and processed separately to standard laundry items. Soiled/infected linen should be placed directly inside a water-soluble bag before being placed into an outer disposable plastic bag. The water-soluble bag should be placed directly into the washing machine and not opened beforehand.
Mattresses
Mattresses should be cleaned in accordance with the manufacturer's instructions and fully cleaned in between each resident. Mattresses that have zips should have the internal structure checked to be sure of their integrity.
Mattress and mattress cover audit tool for care homes
Single-use items
Some items are not designed to be cleaned and have been designated as single-use. These items should be disposed of after use, in line with the manufacturer's instructions. If these items are cleaned and reused, there could be an increased risk of infection transmission and the individual could then take on any legal liability.
Single-use medical devices leaflet Opens new window
Personal Protective Equipment (PPE)
Employers have a legal responsibility to provide staff with suitable PPE that will protect them from exposure to harmful microorganisms. PPE can also prevent the transmission of harmful microorganisms to other staff and residents within the care environment. PPE can include items like disposable gloves, plastic aprons, face masks and eye protection which are often designated as single-use items and should be removed, disposed of, and changed in between individual residents and particular tasks.
Personal protective equipment audit tool for care homes
Covid-19 supplement to the infection prevention and control resource for adult social care
Single patient multiple use items
Some items have been designated for multiple use on one resident and staff should follow the cleaning process advised by the manufacturer. These items are usually advised to be disposed of once they are no longer required, but always review the instructions for further guidance. Items that fall into this category would be hoist slings, slide sheets, nebuliser masks, etc.
Hand hygiene
Effective hand hygiene is the easiest and cheapest way to reduce the spread of infection. Hand hygiene should be performed throughout the day, but particularly following the World Health Organisation's 5 moments of hand hygiene:
Your 5 moments for hand hygiene at the point of care Opens new window
The best way to clean your hands is by using liquid soap and water. Hands should be washed for a minimum of 30 seconds, paying particular attention to the fingers and wrists. Hand sanitiser (alcohol gel) can be used if hands are not visibly soiled. Hand sanitiser does have limitations and is not effective against bacteria and viruses that affect the bowel/gut (Norovirus, C-diff). Ideally, hand sanitiser should only be used if soap and water is not readily available.
Best practice on how to hand wash - step by step images Opens new window
Best practice on how to hand rub - step by step images Opens new window
Management of waste and sharps
Waste that is generated within care facilities should be segregated and disposed of through the most suitable waste stream. Disposing of items incorrectly could cause avoidable harm to those working within waste collection services.
General/domestic waste
This is non-hazardous waste that will usually go to landfill. Black or transparent plastic bags are used to dispose of this waste. Items that can be safely disposed of through this stream are paper towels, food packaging, newspapers etc.
Care providers who don’t currently have access to offensive or clinical waste streams can dispose of hazardous waste through the general waste, but this should be double bagged and securely tied.
Hazardous/offensive waste
This is any waste item contaminated with urine, faeces, vomit or wound dressing.
A yellow bag with a black stripe (commonly known as a "tiger bag") is used to dispose of this waste stream. This waste is incinerated or placed into a suitably registered landfill site.
Clinical waste
This is any waste item contaminated with urine, faeces, vomit, wound dressing, blood or used PPE from someone who is suspected or confirmed as an infection risk. An orange bag is used to dispose of these items and then incinerated at a licenced facility.
Safe handling and disposal of medical sharps
It is vital to handle any sharp objects and items in a safe way, to avoid serious injury or illness. Medical sharps are devices used to cut or puncture the skin (needles, lancets, scalpels, scissors etc.).
If a medical sharp is contaminated with a residents blood, there is a higher risk of transmitting disease or blood-borne viruses (hepatitis B, C or HIV).
To avoid unnecessary risks, medical sharps should only be used if needed. Needles should not be re-sheathed after use.
All medical sharps should be disposed of within a plastic sharps bin that conforms to UN 3291 (1997) and/or BS 7320 (1990) standards. These special bins, should be assembled in line with the manufacturer’ instructions and clearly labelled with the location and date of assembly/closure documented on the label. It is important not to overfill the bin.
Find out more about handling sharps in social care
In the event of a sharps injury (staff or residents), immediate action should be taken:
- Encourage the wound to bleed
- Wash the wound using soap and water
- Don't scrub the wound
- Don't attempt to suck the wound
- Cover the wound with a dressing
- Seek urgent medical advice (NHS 111, Walk-in centre, A&E)
- Report the incident through your employer
- Inbed local sharps injury SOP 2017
Find out more about sharps injuries.
Cleaning blood and body fluid spillages
Blood and body fluids can contain a high concentration of harmful organisms. All spillages should be made safe immediately, cleaned and decontaminated using an appropriate method.