preventing infection workbook - infection … · prevention and control of infections and related...

Guidance for staff providing Care at Home

1

Preventing

Infection

Workbook Guidance for staff providing

Care at Home

Name Job Title


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Contents Page Tick when completed

1. Introduction 4

2. Infection prevention and control 5

3. Standard precautions 10

4. Hand hygiene 11

5. Personal protective equipment 17

6. Sharps management 21

7. Blood and body fluids 25

8. Waste management 28

9. Laundry 30

10. Decontamination of equipment 32

11. Cleaning the environment 36

12. Personal health and hygiene 38

13. Specimen collection 40

14. Urinary catheter care 42

15. Viral gastroenteritis/Norovirus 46

16. Clostridium difficile 50

17. MRSA 55

18. MRGNB 59

19. CPE 61

Commentary 65

Key references 66

Certificate of completion 67

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Preventing Infection Workbook

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1. Introduction We are a community NHS Infection Prevention and Control

(IPC) team based in North Yorkshire. Our aim is to support staff

who provide care at home by ensuring that guidance and best

practice in infection prevention and control is available in this

Workbook. It is evidence-based, includes national guidance and

complements a range of educational infection prevention and

control resources which can be viewed at:

www.infectionpreventioncontrol.co.uk

This Workbook is suitable for a wide range of staff providing

care at home, such as, domiciliary and rehabilitation teams, who

undertake personal care or assist with daily living activities.

Completion helps your organisation demonstrate compliance

with the Health and Social Care Act 2008 and Care Quality

Commission registration requirements in relation to infection

prevention and control training.

By applying the principles within the Workbook you will

demonstrate commitment to high quality care and patient safety.

The Francis Report 2013 states “It is unacceptable for a patient

to be injured by contracting certain types of infection as a result

of the failure to apply methods of hygiene and infection control”.

The Workbook has been designed to be undertaken in stages.

This will allow you to complete the ‘Test your knowledge’

questions before moving on to the next section. On completion,

your manager will check that you have achieved 100%

competency in your infection prevention and control knowledge

and then sign the ‘Certificate of completion’. You should keep

the Workbook as evidence of learning and as an on-going

reference guide to provide you with easily accessible

advice.

Dr Jenny Child

Director of Infection Prevention and Control/

Consultant Microbiologist

Harrogate and District NHS Foundation Trust

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http://www.infectionpreventioncontrol.co.uk


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2. Infection prevention and control The Health and Social Care Act 2008: Code of Practice on the

prevention and control of infections and related guidance

(Department of Health, July 2015), states that, “Good infection

prevention (including cleanliness) is essential to ensure that

people who use health and social care services receive safe and

effective care”.

Infection prevention and control is a key priority for the

Department of Health, reinforced with the standards set out in

the Health and Social Care Act 2008 and the Care Quality

Commission (CQC) registration requirements. Infection

prevention and control spans the five key questions the CQC will

be asking about your service:

Is it safe?

Is it effective?

Is it caring?

Is it responsive to people’s needs?

Is it well-led?

An infection occurs when micro-organisms (germs/bugs) enter

the body and cause damage. These micro-organisms can come

from a variety of sources and often take advantage of a route

into the body provided by a wound or an invasive medical

device, e.g., urinary catheter.

Some infections can reach the bloodstream. When this occurs it

is known as a bacteraemia, which can cause serious or life

threatening infection and can result in death.

Infection prevention and control means doing everything

possible to prevent infection from developing and spreading to

others. Understanding how infections occur and how different

micro-organisms spread, such as bacteria and viruses, is

essential in preventing infection.


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The chain of infection

The spread of harmful micro-

organisms to a person is known as

the ‘chain of infection’ which is made

up of six links. Each link represents

one of the six factors required to

spread infection.

Each link of the chain must be

present for an infection to occur.

Breaking the chain will stop the infection spreading, this

requires the removal of one of the six links. Good infection

prevention and control practice (standard precautions) applied

at all times and in all settings will break a link in the chain.

Bacteria or

virus

Micro-organisms (bacteria, viruses), e.g., Clostridium

difficile, MRSA, Norovirus.

Source Where the micro-organisms are, e.g., people,

animals, food, contaminated equipment or surfaces.

Exit The way in which micro-organisms leave the body,

e.g., coughing, diarrhoea, blood, wound discharge.

Route The way in which micro-organisms are transmitted,

e.g., hands, equipment, airborne, injection, ingestion

(eating).

Entry The way in which micro-organisms enter the body,

e.g., mouth, nose, urinary tract, exposed wounds,

non-intact skin, mucous membranes, needlestick

injury.

People at

risk

A person’s risk to developing an infection is

determined by their age, health, level of immunity,

invasive devices and any medical interventions.

Bacteria or virus

Route

Source

Entry

Peo

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risk

Exi

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Chain of infection


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3. Standard precautions All care staff in all situations involving the care of service

users or contact with their environment must use infection

prevention and control ‘standard precautions’.

There are seven control measures known as standard

precautions (see table below). These underpin routine safe

practice and break the chain of infection which in turn protects

service users, visitors and staff. There is often no way of

knowing who is infected, so by applying standard precautions

to all people and at all times, best practice becomes second

nature and the risks of infection are minimised.

In most cases, without a laboratory test, it is impossible to

tell who has or is carrying an infection. Since every person

is a potential infection risk, it is essential that all staff apply

safe systems of working at every opportunity.

Safe working practices take the guesswork out of

protecting yourself and others as you provide care.

Standard precautions

Hand hygiene

Personal protective equipment

Sharps management

Blood and body fluids

Waste management

Laundry

Decontamination of equipment 7


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There are two categories of micro-organisms present on

the skin of the hands

Transient bacteria are found on the surface of the skin.

They are called ‘transient’ as they do not routinely live on the

hands. They are transferred to hands after contact with

people or the environment and are easily removed by routine

handwashing with liquid soap and warm running water.

Resident bacteria are found on the hands in the deep layers

and crevices and live on the skin of all people. They play an

important role in protecting the skin from harmful bacteria

and are not easily removed by routine handwashing with

liquid soap and warm running water.

4. Hand hygiene Hand hygiene is the process of physically removing dirt,

blood or body fluids and the removal of micro-organisms from

the hands.

Evidence and national guidance identifies that effective hand

hygiene results in significant reduction in the carriage of

harmful micro-organisms on the hands. Effective hand

hygiene reduces the number of healthcare associated

infections (HCAIs) leading to a reduction in morbidity

(disease) and mortality (death) of service users.

Hand hygiene is the single most important way to prevent the

spread of infection. Hands may look visibly clean, but micro-

organisms are always present, some harmful, some not.

Hands may become contaminated by direct contact with a

service user, handling equipment and contact with the

general environment.

Removal of transient micro-organisms is the most important

factor in preventing them from being transferred to others.

Removal of resident micro-organisms is only required before

surgery and invasive procedures, it is not required by carers.

Tra

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Test your knowledge Please tick the correct answer True False

1. Alcohol handrub can be applied to gloved

hands.

2. A new disposable apron should be worn

for each new task.

3. Before putting on and after removing

gloves, hands must be washed.

4. Gloves should be removed before an

apron.

Remember

Alcohol handrub should not be applied to gloves as it may

affect the integrity of the gloves.

Protect yourself and service users by wearing the correct

personal protective equipment.

Note

To minimise the risk of cross/self-contamination, gloves,

which are potentially the most contaminated item, should

always be removed first, followed by the apron and then

eye protection and mask.

Gloves are not a substitute for handwashing.

All PPE should be disposed of as soon as the activity is

completed and as per local policy.

Gloves are not required to be worn when serving plated

food, but remember, good hand hygiene is essential.


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In the event of a sharps or inoculation injury

1. Encourage bleeding of the wound

by squeezing under running water,

this will help to remove any

viruses. Do not suck the wound.

2. Wash the wound with liquid soap

and warm running water and dry.

3. Cover the wound with a

waterproof dressing.

4. Report the injury to your manager

immediately.

5. Immediately contact your GP.

During ‘out of normal office hours’, attend the nearest

Accident and Emergency (A&E) department.

6. If you have had a needlestick/sharps injury from a sharp

instrument which has been used on a service user

(source), the GP in charge of their care may take a blood

sample from the service user to test for hepatitis B, C and

HIV (following counselling and agreement of the service

user).

7. At the A&E department or GP surgery:

a blood sample will be taken from you to check your

hepatitis B vaccination/antibody levels and you will be

offered immunoglobulin if they are low. The blood

sample will be stored until results are available from the

service user’s blood sample, if taken

if the person (source) is known or suspected to be HIV

positive, you will be offered Post Exposure HIV

Prophylaxis (PEP) treatment. This should ideally

commence within 1 hour of the injury, but can be

given up to 2 weeks following the injury

PEP treatment is only available from A&E departments.


27 7.

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Note *Chlorine-based disinfectants, such as household bleach,

should not be used on soft furnishings, untreated wood and

carpets as it will cause ‘whitening/bleaching’. Therefore,

only detergent and warm water, a carpet shampoo

machine or steam cleaner should be used.

Splashes of blood or body fluids to the eyes or mouth must

be treated as potential exposure to a blood-borne virus.

Rinse eyes or mouth with copious amounts of water and

then follow steps 4 to 7 on page 23.

Personal protective equipment should always

be worn when dealing with blood and/or body

fluid spillages.

Always add household bleach to cold water. If

hot water is used, it breaks down the active

ingredient of bleach, making the solution

ineffective (meaning the bleach does not work).


1. It is not necessary to wear personal

protective equipment when dealing with

blood spillages.

2. The area should be ventilated when using

a chlorine-based disinfectant solution.

3. A chlorine-based disinfectant solution can

be placed directly on urine.

4. Splashes of body fluids to the eyes should

be rinsed with copious amounts of water.


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8. Waste management All staff are responsible for the safe management and

disposal of waste. Waste is potentially hazardous and, if not

disposed of correctly, can result in injury or infection.

Any waste that is generated during the care of a service user,

e.g., catheter bags, continence pads, personal protective

equipment (PPE), should be disposed of as per local policy.

Waste will usually be disposed of as household waste, unless

alternative arrangements are in place with the Local Authority.

Disposal of waste

Appropriate personal protective

equipment should be worn when

handling waste.

All waste bags should be 2/3 full or

less, this allows enough space for the

bag to be tied securely.

Avoid expelling air from a waste bag

while leaning over it as harmful micro-organisms may be

released into the air.

Make sure all waste bags are securely tied using a suitable

plastic tie or secure knot, as pictured.

Waste should be securely bagged and disposed of as

household waste.

When handling tied waste bags, only hold by the neck of

Good waste management is important to ensure:

Reduction of health and safety risks from waste.

Protection of the environment.

Compliance with environmental legislation.


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1. Wash

hands thoroughly with liquid soap and warm running water.

2. Put on

disposable apron.

3. Put on

disposable gloves.

4. Starting

from the top, clean the back rest and arms (remember to clean under the arms).

5. Remove

the lid and clean the lid of the commode, topside first then underside.

6. Remove

the seat, if the design allows, and clean the top then underside.

7. Clean the

seat frame, legs, and then foot pedals and wheels if there are any.

8. Remove

gloves (these should be removed before your apron) and dispose of.

9. Remove

apron and dispose of.

10. Wash

hands thoroughly with liquid soap and warm running water.

Cleaning a commode

Always use disposable cleaning cloths.


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11. Cleaning the environment Cleaning and disinfecting are different:

cleaning with detergent and warm water removes dirt and

reduces the number of germs to a safe level

cleaning must be carried out before disinfection if

disinfection needs to be performed

disinfecting destroys most, but not all bacteria and also

depends on the type of disinfectant used.

What you need for cleaning

Wear appropriate personal protective equipment.

A general purpose detergent, e.g., washing up liquid, is

suitable for cleaning most surfaces.

Wash and leave mops and cloths to air dry after each use.

Do not leave mops or cloths soaking overnight.

Use separate cloths for cleaning kitchens and toilets/

bathrooms.

Staff should wash their hands before putting on gloves.

Re-usable domestic gloves should be worn for routine

household duties, disposable gloves for cleaning toilets.

Domestic gloves can be worn by other staff providing skin

is intact and hands are washed before wearing them.

Always wash domestic gloves before taking them off and

then wash hands with liquid soap and warm running water.

What you need for disinfecting

The routine use of disinfectants for general home cleaning is

unnecessary. A disinfectant such as household bleach may

be required in some circumstances. For example, equipment

soiled with body fluids, the area must first be cleaned and

then be disinfected using 1,000 parts per million (ppm)

household bleach (dilution of 1 in 100, e.g., 10ml of

household bleach in 1 litre of cold water).


44 14

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When detaching the used bag from the catheter, do not

touch the end of the catheter. This will help prevent

contamination and infection.

When removing the protective cap from the new catheter

bag tube, do not touch the end of the tube. This will help

prevent contamination and infection.

Place the used catheter bag in a plastic bag, tie the bag

and dispose of as household waste.

Remove disposable gloves and apron and wash hands.

Always record the date when the catheter bag is

changed.

Overnight drainage bags

If a person has a leg bag during the

day, an additional larger linked

drainage bag (night bag) should be

used for overnight use. The night

bag should be attached to the leg

bag to keep the original system

intact.

Standard precautions must be applied.

When attaching a night bag, always wash hands and

wear disposable gloves and apron.

Attach the night bag to a stand to ensure that the

drainage tap is not touching the floor, to prevent

contamination of the tap.

When removing the protective cap from the new night bag

tube, to prevent contamination and infection, do not touch

the end before attaching it to the drainage tap on the leg

bag.

Remove disposable gloves and apron and wash hands.


46

15. Viral gastroenteritis/Norovirus Norovirus is the most common cause of viral gastroenteritis

and between 600,000 and 1 million people in the UK are

affected every year. Many people refer to it as gastric flu or

winter vomiting. Viral gastroenteritis is highly infectious and

can spread easily from person-to-person, therefore, it is

important to use infection prevention and control precautions.

What does viral gastroenteritis cause?

Signs of viral gastroenteritis include:

sudden onset of diarrhoea* and/or vomiting

vomiting - can be projectile (forceful)

nausea

abdominal/stomach cramps

headache and/or low-grade fever.

Symptoms usually begin around 12-48 hours after being

infected with the virus. (*Refer to page 53 for the definition of

diarrhoea.)

Illness is usually of a short duration and most people are

better within 48 hours with no long-term effects. However,

some people, especially the elderly and those with existing

long-term illness, may have symptoms that last longer.

Why does viral gastroenteritis cause outbreaks?

Viral gastroenteritis often causes outbreaks

because it is easily spread from person-to-

person and without effective cleaning, the

virus is able to survive in the environment for

many days. Outbreaks tend to affect people

in hospitals, schools, care homes, sheltered

housing or where there is a large group of

people.

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Standard precautions must be applied.

Disposable gloves and apron should be worn when caring

for a service user until they are symptom free for 48 hours

and passed a formed stool. Gloves and apron should be

changed after each activity is completed and hands

washed with liquid soap and warm water after removal.

Encourage the service user to drink fluids and ensure their

fluid balance is monitored to prevent dehydration.

Thorough handwashing is essential for staff using liquid

soap and warm running water. Alcohol handrub does

not kill spores and must not be used.

Encourage service users to wash their hands after using

the toilet and before meals. If unable to access hand

washing facilities, moist hand wipes can be used.

After an episode of diarrhoea, encourage service users to

close the toilet seat lid before flushing the toilet to reduce

possible spread and disinfect with household bleach.

The service user should use a separate towel to dry their

hands and this should not be used by other people. The

towel should be washed daily.

Alcohol wipes should not be used for cleaning and

disinfection of equipment as they do not kill spores.

Clean surfaces in toilets and bathrooms at least daily, with

a household bleach, see page 36.

Items such as hoists, frames and frequently used surfaces,

e.g., tables, should be cleaned daily as above.

Wash soiled clothing or bedding separately as soon as

possible at the highest temperature advised on the label.

The service user should have a shower or bath daily, as

C. difficile spores may be on other areas of their body.

Staff are not usually at risk of acquiring C. difficile infection.


57 17

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Service user’s in their own home can socialise in and

outside of their home without restrictions. Any visitors to

their home should be advised to wash their hands on

leaving.

If a service user has MRSA in a wound, it should be kept

covered with a dressing.

Linen and clothing should be washed in the service user’s

or communual washing machine at the highest

temperature stated on the washing label.

No special precautions are required for washing crockery

or cutlery and they should be dealt with in the normal way,

e.g., by washing with washing up liquid and warm water.

When cleaning, e.g., surfaces in a service user’s home,

detergent and warm water are sufficient.

Are staff at risk of MRSA?

By applying standard precautions at all times the risk of

spreading MRSA is reduced.

MRSA is not usually a risk to healthy people including

children and pregnant women. Research has shown that

staff who do become colonised have usually acquired the

bacteria through their work, but it is usually present for a

short time only.

Staff should ensure cuts and grazes are covered with a

waterproof plaster.

Report any skin conditions to your manager.

Note

Studies show MRSA colonisation may affect approximately

20% of service users in care home establishments.


64 19

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Note

There are a number of local initiatives

across the country where service users

found to be positive for CPE either

colonised or infected, should have been given advice

about CPE and a CPE card. The card should be shown to

healthcare providers involved in their care. For further

details visit www.infectionpreventioncontrol.co.uk.

Remember

Using standard precautions will minimise the spread of

CPE and should be rigorously implemented, but no

additional infection control precautions are required.

Further advice will be given by your local Community

Infection Prevention and Control (IPC) or Public Health

England (PHE) team.


1. There are very few antibiotics for the

treatment of CPE infections.

2. Hand washing is not necessary when

dealing with a service user with CPE.

3. Colonisation with CPE is more common

than infection.

4. Toilets should be cleaned with household

bleach if a service user has diarrhoea.

Linen and clothing should be washed in the service user’s

or communual washing machine at the highest

temperature stated on the washing label.

Keep toilet and bathroom areas clean.

http://www.infectionpreventioncontrol.co.uk/


68

Written and produced by Community Infection Prevention and Control

Harrogate and District NHS Foundation Trust

Tel: 01423 557340

www.infectionpreventioncontrol.co.uk

March 2016

© Harrogate and District NHS Foundation Trust, Community Infection Prevention and Control 2016

http://www.infectionpreventioncontrol.co.uk

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