Compound issues of staffing, inspections, compliance and efficiency challenge almost every care operator in the country. The same issues also impact whether the high standards of care and safeguarding demanded by the sector are met. The prospect of a CQC inspection is constantly looming and, while many factors affect the outcome, infection control and prevention must always be treated as a priority.
Health Service Journal (HSJ) recently reported that 30% of Infection Prevention Society members had seen a reduction in the infection prevention and control services where they work. This is concerning given that cases of E coli, which can be easily transferred via human faeces, have risen by 30% since 2012.
While Government says that continuing professional development funds for infection control will increase, experts argue these are thinly spread across the workforce and don’t make up for previous cuts. According to HSJ, ‘The 17% increase in the national budget for continuing professional development…does not come near to replacing the 60% cuts between 2015 and 2017.’
Considering the financial and resource pressures of running a care home or delivering community services, it is easy for hygiene to unintentionally slip down the priority list. Staff clearly understand the vital importance of infection prevention but delivering on this effectively is another matter entirely.
A well-documented and effectively communicated infection control plan is one way to ensure that policies and procedures are clearly adhered to. This covers everything that care providers must do to ensure hygienic standards, prevent the spread of infection and keep clients, staff and visitors safe.
The plan provides an essential ‘rulebook’ for managers, staff and visitors. Even committed care teams can struggle to control infection if they don’t have clear and consistent guidelines. This is where a documented infection control plan really helps.
Plans and policies will differ from one care environment to another, based on things like size and the type of care provided. However, there are a number of factors and regulations that matter in all situations.
It may seem like the most obvious thing in the world, but good hand hygiene is easy to overlook. This is the case even when staff know it should be done and is the single biggest trigger for infection spreading. Reports say that standards drop hugely without strict compliance monitoring.
One Australian study discovered that staff overlook hand hygiene when they think no-one is checking. University of New South Wales’ medical researchers found hand hygiene rates fell from above 90%, to just 30% when human auditors were replaced by automated surveillance.
There are no hard and fast rules but the NHS’ Infection Prevention and Control website provides some useful guidelines for care homes and home care providers. Make sure your policies define the processes that should be followed and when, for example after ‘hands-on’ contact with a resident.
Infection control plans should also define how, if and when staff should be using personal protective equipment, including disposable gloves and aprons. These are commonly required in acute care and nursing environments, due to the likely increased contact with bodily fluids.
Care providers should carefully consider all activities and instances where personal protection measures need to be taken and define equipment and usage processes. For instance, an employee may need to use gloves and an apron when handling soiled clothing. They should then remove these and dispose of them safely before handling clean equipment or touching patients.
Easy accessibility to personal protective equipment (PPE) is vital, and procedures should be integrated with hand hygiene too. In a home care environment, PPE should be carried separately to other cleaning equipment if it cannot be immediately disposed of. Hand washing and handling of soiled PPE must also happen in the right order.
The Department of Health and Social Care and the World Health Organisation both recommend My 5 moments for hand hygiene – the key points when healthcare workers should carry out hand hygiene – as the below:
- Before touching a resident.
- Before clean/aseptic procedure.
- After body fluid exposure risk.
- After touching a resident.
- After touching a resident’s environment.
Effective decontamination and waste disposal
It’s inevitable that care providers will deal with waste and potentially infectious substances, and it’s vital that soiled items are always effectively decontaminated. The Department of Health and Social care provides some useful best practice guidelines in its Decontamination of linen in health and social care document.
Laundry facilities should be equipped with commercial machines that are capable of turning over large volumes of dirty washing as quickly as possible and to a safe standard, minimising the chances of soiled clothing, towels or bedding piling-up and potentially spreading infection. Once each washing cycle has finished, it’s also important that care is taken to prevent cross-contamination.
Any potentially contaminated waste, such as dressings and disposable clothing, should be put immediately into the correct coloured storage bag or container, labelled and stored. Clients and their visitors should also be made aware of these procedures, especially if they are also involved in their care.
There are many policies and regulations impacting care providers and several that relate to infection control. It’s vital to ensure these are being followed and met across different operations, and the infection control plan is an effective way of ensuring processes comply.
Good sources of information on this include the websites of the Department of Health and Social Care, The National Institute for Health and Care Excellence, the Care Quality Commission (CQC) and the Infection Prevention Society.
Linen decontamination is an area where regulation really matters. For example, NHS infection control guidelines state the required duration and temperature of washes as either:
- 10 minutes at 65ºC or over.
- Three minutes at 75ºC or over.
- One minute at 85ºC or over.
Washing machines used in care environments also need to be compliant with the Water Regulatory Advisory Scheme (WRAS) category 5 to prevent the mains water supply becoming contaminated from potentially hazardous or infectious waste.
High quality and rigorous infection control procedures should go a long way to ensuring that this area of future CQC inspection has a positive outcome. However, it’s also worth doing some scenario planning, such as where infection control issues have led to poor or failed inspection outcomes in the past.
When it comes to quality standards and inspection outcomes, laundry procedures are one area that can be a gap in a care provider’s armour. The challenge is that there is no definitive set of guidelines showing how a home’s laundry is assessed. This may apply to other areas of assessment too.
Recent CQC inspection reports provide useful insights into the situations where laundry-related infection control issues have negatively impacted inspection outcomes. These show the types of incident that must clearly be avoided.
One Midlands care home inspection report found a failure to protect people’s safety because the laundry room was disorganised, meaning the risk of cross-contamination was high. This shows that inspections review how well-organised and documented a home’s processes are and how rigorously they are followed by staff.
At another care home, inspectors were told by staff that wet and soiled laundry were washed together, as well as with peoples’ clothes. Having measures to separate soiled and potentially infected laundry throughout washing and drying is a must. This should include water soluble laundry bags and, for extra certainty, potentially barrier washers and using commercial laundry equipment that kills infection through sustained high temperature cycles.
One collection-to-clean process
A group of nursing homes was put into special measures partly due to the fact that collection of soiled laundry from bedrooms did not adhere to suitable cleanliness standards. This shows the risks of hand-collecting laundry without protective equipment, rather than putting it straight into a sealed container such as a bag or bin in the bedroom where it should remain until being washed. It also demonstrates that a holistic approach to compliance needs to be taken across the home environment.
Ensuring effective equipment is available
One case highlighted equipment and process issues leading to improvements being required for infection control. These included a lack of access to Personal Protective Equipment (PPE) and handwashing facilities in the laundry, increasing the chances of staff becoming infected or carrying infections out of the laundry to the rest of the home. This again highlights the importance of having easily accessible and appropriate PPE at all key points throughout the home.
Infection control and prevention is something care providers know they need to focus on. However, it is a complex area that requires effective delivery of policies and education, and policing. Otherwise, there is every chance that hygiene standards could drop, leading to a poor inspection outcome or individual illness, or at worst, a major infection outbreak.
How do you ensure your processes are compliant? Have your CQC inspection reports been impacted by the quality of infection control at your service? Share your thoughts and feedback on this article below.