CrossroadsCarePrevention and control of infection guidance for staff

D.01c

Infection prevention and control guidance for staff

1.0 SCOPE

1.1 This guidancesets out Crossroads Care’s approach to the prevention and control of infection for the following groups:

  • Crossroads Care staff
  • service users of all ages, including parents, carers, adults, children and young people with care needs.

1.2 Its aim is to protect you and the people you care for against acquiringinfections from work activities.

1.3As a care worker you are at risk of acquiringor spreading infection, especially if you come into contact with blood or body fluids such as urine, faeces, vomit or sputum. These may contain pathogensthat can spread from person to person if you don’t take the necessary precautions.

1.4You also need to read Crossroads Care’s guidance for staff on:

  • control of substances hazardous to health (F.10c)
  • hepatitis (D.02c)
  • HIV and AIDS (D.03c)
  • MRSA (D.04c)
  • tuberculosis (D.05c)
  • food handling and basic hygiene control (D.06c)
  • safe use and disposal of clinical sharps (D.07c)
  • accident, incident and near miss reporting, recording and investigation (F.09).

2.0 INTRODUCTION

2.1We aim to make sure you know:

  • how to prevent the spread of infection within your work environment
  • the safe way to handle any potentially infectious materials you might come into contact with at work
  • aboutclinical waste and how to dispose of it safely
  • how to prepare, cook, serve, store and transport food safely.

2.2 Read this guidance carefully and put it into practice. If you don’t understand anything in it or have any questions, or if you are worried about your own health and safety, speak to your line manager straight away.

2.3 Appendix 1 at the end of this document gives definitions of:

  • infectious disease
  • infection control
  • pathogens
  • cross infection
  • immunodeficiency.

2.4 Appendix 1 also gives you information about:

  • how infection enters the body
  • how infections spread.

3.0 Universal precautions

3.1There is a risk that any blood or bodily fluids you deal with are infectious. Never presume to know who has and who does not have an infectious disease. Always use ‘universal precautions’ when caring for anyone, whatever their age or condition.

3.2 Universal precautions are infection control guidelines designed to protect you and others from infectious diseases by preventing contact with blood and body fluids. These are set out below and a summary of them is given in Appendix 3at the end of this document.

3.3 Hand hygiene

3.3.1The most effective precaution you can take against the spread of infection is thorough hand hygiene.Full details of how to wash your hands properly are set out in Appendix 2 at the end of this document.

3.3.2 Wash and dry your hands:

  • when you arrive at and before you leave a service user’s home
  • between going from one person to another where direct contact is involved
  • before and after you provide personal care
  • between different care activities for the same person
  • after handling any body fluids (including specimens) or soiled items such as laundry, nappies or pads
  • after you have done any cleaning
  • after blowing your nose or covering a sneeze or cough
  • after touching your mouth, face or hair
  • after using the toilet
  • before you eat, drinkor handle food
  • after handling raw foods (for example meat or eggs)
  • after you handle rubbish or waste
  • whenever your hands are obviously dirty.

3.3.3Just because you are wearing disposable gloves it does not mean you don’t need to wash your hands. It is important that you wash your hands both before and after you use gloves.

3.4 Nails

3.4.1Keep your nails short and clean. Do not wear nail varnish or artificial nails.

  • Long nails may puncture disposable gloves.
  • Bacteria can harbour under long / artificial nails.
  • Nail varnish may chip off and fall into food.

3.5 Jewellery

3.5.1 Keep jewellery worn to a minimum. Do not wear rings, necklaces, earrings or watches

that may snag on clothing, gloves or skin as this may cause injury and increase the risk of cross-infection.

3.6Skin

3.6.1Skin that is in good condition and intact (without cuts, grazes or sores) is a natural defence against infection. Cover any cuts and grazes with a water-resistant plaster or dressing.

3.6.2 If a person’s blood or body fluids splash onto your skin or into your eyes, nose or mouth, the action you need to take is set out in the safe use and disposal of sharps guidance for care workers (D.07c, Appendix 3).

3.6.3 If bathing a person with care needs, always wash and dry their skin carefully so that they are not put at risk ofdiscomfort or infection due to inadequate cleansing. Take particular care where skin meets skin, for example between fingers and toes, under breasts and in the groin. This can help protect against fungal infections and breakdown of skin.

3.7Personal protective equipment (PPE)

3.7.1 Disposable(non-latex, such as vinyl or nitrile)gloves and disposable aprons.

  • Wear disposable gloves and aprons at all times when handling body fluids, carrying out personal care tasks and when cleaning.
  • Only use disposable gloves and aprons once.
  • Make sure you change your gloves and apron between different tasks including different personal care activities for the same person.
  • Do not go from a cleaning task (such as cleaning up a spillage) to a personal care task (such as emptying a catheter bag) or vice versa without changing your gloves and apron as this may spread infection.
  • Always change your gloves and apron between caring for different people.
  • Dispose of gloves and aprons immediately after use into an appropriate waste disposal bag (see 3.9 below).
  • Never try to wash and/or reuse disposable gloves or aprons.
  • Always carry an extra supply of disposable gloves and aprons in case of emergency.

3.7.2 When you are wearing gloves and aprons it is possible to become lax, as you feel protected. Remember,anything you touch with contaminated gloves will itself become contaminated. PPE is provided just as much for the protection of the service user as for your own safety.

3.7.3 It is your responsibility to use, maintain, replace and dispose of all personal protective equipment (PPE) properly.

3.7.4Your footwear needs to be sturdy, non-slip, have flat heels, enclosed back or strap and enclosed toes. One of the reasons for this is to reduce the risk of injury from sharps and potential exposure to body fluids - see safe use and disposal of sharps guidance (D.07c) for details.

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3.8Cleaning spillages

3.8.1 Treat every spillage of body fluids or body waste as potentially infectious and deal with it as quickly as possible.

  • Put on disposable gloves and apron.
  • Clear up wetness with paper towels and place in the appropriate waste disposal bag (see 3.9 below).
  • Always use fresh cloths and towels in each area where there is a spillage.
  • If it won’t cause damage to the soiled surface, use a solution of 10% bleach in water to wipe the area clean.
  • On other surfaces (such as carpets) allow remaining spillage to dry, and use a standard cleaning product or hot soapy water to clean.
  • Remove gloves and aprons and dispose.
  • Wash hands.

3.8.2 When handling heavily contaminated laundry (such as sheets, towels, clothing, flannels and other cloths):

  • put on disposable gloves and apron
  • wipe away any solids with paper towels and dispose of in appropriate waste disposal bag (see 3.9 below).
  • sluice off the laundry as much as possible and then place in the washing machine
  • close the washing machine door without contaminating it (you can use your knee or elbow or close it after removing PPE and washing hands)
  • remove gloves and aprons and dispose
  • wash hands
  • wash the laundry with detergent at the hottest setting for the fabric concerned with normal washing powder.

3.9Safe disposal of waste

3.9.1 Household waste

Unless otherwise directed by your line manager, waste containing bodily fluids (for examplesanitary towels, nappies, incontinence pads, soiled disposable gloves and aprons) can be disposed of in ordinary household waste. Bag such items separately. Do not put into them into dustbins loose.

3.9.2 Clinical waste

In some circumstances however items containing bodily fluids (for example nappies, pads) need to be disposed of as clinical waste rather than household waste (see 3.9.1 above). This will usually be if the service user has a medical condition such as HIV/AIDS, hepatitis or MRSA.

3.9.3The care plan will document whether waste needs to be treated as clinical waste. If it does:

  • dispose of all flushable material such as urine, faeces and vomit down the toilet
  • dispose of other clinical waste containing bodily fluids (for example sanitary towels, nappies, incontinence pads, soiled disposable gloves and aprons)into the clinical waste disposal bagsprovided - these are usually yellow and will be collected separately by an authorised agency
  • seal and safely store clinical waste disposal bags when they no more than three quarters full, ready for collection - if overfull, the bags are more likely to split.

3.9.4Make sure you never leave anything within the service user’s home in a soiled condition. This includes any surfaces that may have come into contact with waste. If this means you need extra time to clean up, contact your line manager and let them know. Never rush a job at the expense of hygiene or cleanliness.

3.10Personal hygiene

3.10.1 As a care worker you are likelyto come into close contact with service users so you need to maintain a high standard of personal hygiene. Make sure the clothes you wear to work are always clean and pay particular attention to body odour.

3.10.2 If your clothing gets significantly dirty in the course of your work, particularly if it becomes soiled with blood or bodily fluids, contact your line manager / the person on call to discuss what action you need to take.

3.11Avoid unnecessary contact

  • Do not breathe into the face of or carelessly touch the nose, mouth or wound area of a service user.
  • Take steps at all times to prevent contact with blood and body fluids by wearing the personal protective equipment provided.

3.12Look after your own health

3.12.1Take advantage of any health checks you are offered. According to current national recommendations health-care personnel who care for people at risk are encouraged to receive influenza vaccinations. The recommended time to have the vaccine is in October or November, but even later is still useful, as the season can last from October until May.

3.12.2It is recommended that you inform your line manager if any of the following apply:

  • you have psoriasis, eczema or dermatitis on your face, hands or lower arms
  • you are pregnant or planning on becoming pregnant
  • you are immuno-deficient
  • you are undergoing treatment for cancer or on steroid therapy
  • you have an infectious disease , for example MRSA, hepatitis, TB or HIV / AIDS.

You are not obliged to provide this information but your manager will be better able to protect you (for example by amending your duties) and give you support if you do.

3.13 Staff sickness

3.13.1 If you get an infection that can be passed on to other people (for example a cold or sore throat), inform your linemanager so that they can adjust your rota if necessary. Some service users who have lowered immune systems may not be able to shrug off these infections as easily as you and could go on to develop a serious illness.

Examples of people who may have lowered immune systems include:

  • frail older people
  • babies, infants and children
  • service users with certain diseases such as HIV / AIDS or hepatitis
  • service users who are taking certain medications such as steroids or medication for the treatment of cancer.

3.13.2 If you develop nausea, vomiting, diarrhoea or stomach cramps you will need to stay off work and are not allowed to not return until 48 hours after the symptoms have disappeared. If you develop these symptoms whilst you are at work, inform your line manager / the person on call straight away.

3.14Safe use and disposal of sharps

3.14.1 The safe way to use and dispose of sharps is fully documented in the safe use and disposal of sharps guidance for care workers (D.07c).

3.15Sharing

6.16.1 Never share items such as towels, flannels, razor blades or toothbrushes with anyone else as these may that may be contaminated with blood or bodily fluids

3.16Environmental cleaning

3.16.1 Dust and dirt are a potential source of healthcare related infection. It is important to leave the service user’s home clean and tidy, for their sake and for the sake of the carer and other staff who follow you.

3.16.2 Make sure your working environment is clean and tidy.

  • Placeused crockery, cutlery and kitchen utensilsin the dishwasheror wash in hot water and detergent.
  • Clean any equipment you use (such as commodes) with detergent and hot water.
  • Clean work surfaces with detergent, rinse with a damp cloth and leave to dry.
  • Use separate cloths and mopsfor the kitchen, bathroom, toilet and other areas to avoid cross-contamination.

3.17Food preparation

3.17.1 Follow theCrossroads Care’sfood handling and hygiene guidancefor staff (D.06c) in order to ensure that food in service users’ homes is prepared, cooked, stored and presented in accordance with the high standards required by law.

4.0 working with diagnosed infection

4.1 We expect you to work with people who have a diagnosed infection without prejudice or discrimination and will treat any unreasonable refusal to do so as a serious matter.

4.2 We do recognise however that there may be legitimate clinical reasons why it is not safe for you to work with some service users. If this is the case, let your line manager know.

4.3 We also recognise that some staff can feel afraid they will catch an infection or might just not know enough about a particular condition. If so, let your line manager know and they will sort out extra training for you.

4.4If you still have concerns after extra training, you will be given the opportunity to discuss them with your line manager. However if you then continue to display discriminatory and prejudicial attitudes, this may result in disciplinary action.

5.0 confidentiality

5.1 Crossroads Care expect its staff to treat people who are ill or disabled(for whatever reason)

with dignity and kindness. Everyone has a right to expect their culture, faith and lifestyle to be respected. They also have a right to expect you will treat their situation with confidentiality in accordance with Crossroads Care’s confidentiality and disclosure guidance for staff (D.11c).

5.2 Only discuss work-related matters with your line manager on a need to know basis or in supervision for advice and support. Any breach of confidentiality is a serious matter and may lead to disciplinary action.

5.3 Confidentiality of any diagnosis has to be respected at all times and written permission is required before any third party is informed. Any breach may be treated as a disciplinary matter under the confidentiality and disclosure policy.

6.0 REPORTING

6.1 If you get one of the notifiable diseases listed below as a result of exposure at work, tell your line manager as soon as you can, as it has to be reported to the Health and Safety Executive.

6.2 Notifiable diseases include: cholera, food poisoning, smallpox, typhus, dysentery, measles, meningitis, mumps, rabies, rubella, tetanus, typhoid fever, viral haemorrhagic fever, hepatitis, HIV / AIDS, whooping cough, leptospirosis, tuberculosis and yellow fever. Full details are available on the HSE website:

6.3 Report any accidents, incidents or near misses (however minor) linked to work activities to your line manager / the person on call straight away.

7.0 LEARNING AND DEVELOPMENT

7.1You will find general learning and development requirements relevant to this guidance in the learning and development guidance (E.13c).

8.0 ACCEPTANCE

8.1 You are required to sign to indicate that you have received, read and understood the content this guidance as directed by your line manager and on completion of training, it is your personal responsibility to follow it. Failure to do so may result in disciplinary proceedings.

APPENDIX 1

1.0 definitionS

Infectious disease

Some diseases are infectious which means they can be passed from one person to another. Examples of infectious diseases include MRSA, hepatitis, TB and HIV / AIDS (the list is not exhaustive).

Infection control

‘Infection control’ refers to a wide range of procedures and techniques intended to prevent the spread of infectious diseases.