Infection Prevention and Control for Nursing & Residential Care - - PowerPoint PPT Presentation

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Coronavirus (COVID-19) Infection Prevention and Control for Nursing & Residential Care Homes

Version 1.3 14th May 2020

What is Coronavirus and COVID-19

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• Coronaviruses are a large family of viruses - they

cause infections ranging from the common cold to Severe Acute Respiratory Syndrome (SARS)

• Sometimes new variants of coronavirus emerge -

such as SARS CoV-2 which causes COVID-19

• SARS CoV-2 has the potential to spread widely

as lack of immunity means everyone in the population is susceptible

What are the symptoms of COVID-19?

• Symptoms start 5 -11 days after exposure
• Illness can be similar to flu
• Most people have fever and dry cough (but

less common in elderly)

• Elderly people may present with confusion,

lethargy, decline in alertness/mobility, diarrhea

• Most people have symptoms for 5 - 6 days
• 20% have more severe illness (from day 7)
•  Shortness of breath
• Lung inflammation
• Pneumonia

Common Symptoms of COVID-19 Fever >37.8oC Dry cough Fatigue Sputum Shortness of breath Muscle/joint pain Sore throat Headache Hoarseness Nasal discharge

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How severe is COVID-19 illness?

• Many people have no obvious

symptoms (30%)

• Of those with symptoms 80%

are mild

• More severe disease in:
• Older people
• Diabetics
• Heart disease
• Chronic respiratory disease
• Immune compromised
• Only 1% of cases fatal
• Highest in high risk groups

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Undetected

Critical

Respiratory/multi-organ failure

Severe

Shortness of breath; Respiration; O2 sats

Mild

Fever, cough

How does COVID-19 spread?

• Exposure to respiratory droplets
• Coughing/sneezing droplets onto

mouth, nose, eyes

• Requires close contact (within 2m)
• Contact with respiratory secretions
• Hands
• Contaminated surfaces, tissues
• Transferred by touching

nose, mouth, eyes with contaminated hands

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Sustained Community Transmission

• This means that COVID-19 is affecting many

people in the community and they may not all have had obvious contact with someone who had symptoms of the infection.

• During this period of sustained community

transmission infection control precautions will need to be taken with all residents not just those with symptoms of COVID-19

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Preventing the spread of COVID-19 Infection Prevention & Control

• 1. Cough etiquette
• 2. Hand hygiene
• 3. Personal protective equipment (PPE)
• 4. Social distancing
• 5. Protecting the vulnerable - shielding
• 6. Isolation of symptomatic residents
• 7. Cleaning

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Personal hygiene to prevent spread

• Cough etiquette
• Cover mouth and nose with a tissue or your sleeve

(not your hands)

• Dispose of tissues directly into bin
• Hand hygiene
• after contact or coughing/sneezing

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Ensure patients have hand wipes

• r alcohol gel

available

Hand Hygiene in care

• f all residents
• Immediately before touching a resident
• Immediately after touching a resident or

their surroundings

• After removing gloves

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Alcohol gel is effective against COVID-19 Soap and water should be used if hands are soiled

Hand hygiene is essential to prevent both staff and residents acquiring COVID-19

Other times when care workers should wash their hands

Before

• leaving home
• food preparation
• eating any food
• eating snacks
• taking a break
• leaving work

After

• arriving at work
• Touching surfaces in

residents’ rooms

• decontaminating equipment
• handling waste
• using the toilet
• after taking a break
• after smoking

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How to hand wash

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• Wash hands AND

forearms after close contact with a resident

• If no elbow taps use a

clean paper towel to turn it off NHS Hand wash video

https://www.nhs.uk/live- well/healthy-body/best-way-to- wash-your-hands/

Patient hand hygiene

• Encourage residents to clean their

hands

• After coughing/sneezing
• Before eating
• After using the toilet
• Hand wipes or alcohol gel need to be

easily available for the resident to use

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Personal Protective Equipment (PPE)

• PPE will only prevent spread of infection if it is:

Used and changed at the right time Accompanied by good hand hygiene Cough etiquette is applied

• Mobile phones should not be used whilst

wearing PPE

• All staff, including cleaners & housekeepers,

must be trained in how to use PPE

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Disposable Gloves

• Wear for any care that involves touching a resident
• Wear within 2 metres of a resident who is coughing
• Remove and wash hands between different tasks

e.g. between helping a resident to the toilet and mouth care

• Always remove gloves and wash hands after

handling body fluids

• Remove gloves and wash hands after each

episode of care

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Be careful not to touch your mouth, nose or eyes while wearing gloves

Disposable Plastic Aprons

• Wear for any care that involves touching a

resident

• Wear when within 2 metres of a resident who is

coughing  Use to protect your uniform or clothes from contamination when providing care  Remove and discard apron after each episode

• f care

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Fluid Resistant Surgical Masks

• Masks protect:
• your nose & mouth from respiratory droplets from residents
• residents and other staff from respiratory droplets from your

mouth and nose (as you might be carrying the infection)

• You can wear a mask for caring for different

residents BUT do not touch the mask

• you could transfer virus to your hands
• Wear the mask on your face – NOT round your neck
• Remove and discard the mask when:
• you take a break or finish your shift
• it is damp, soiled, uncomfortable, difficult to breathe

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Eye Protection

• Wear for direct contact with residents if there is a

risk of respiratory droplets getting into eyes

• e.g. resident who is coughing or vomiting
• Clean after each use using either:
• disinfectant wipe
• detergent and water
• followed by chlorine disinfectant 1000ppm
• check manufacturer’s guidelines

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Watch the video

https://youtu.be/ozY50 PPmsvE

Take PPE off carefully to avoid contaminating yourself

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https://youtu.be/o zY50PPmsvE

Watch the video

Summary of PPE

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Clinical Gloves Plastic Aprons Fluid Resistant Mask Eye protection

Period of use Single use Session of care Direct contact with resident

✔ ✔ ✔

Assess risk

Resident coughing (within 2m)

✔ ✔ ✔

Assess risk

No direct resident contact

✗ ✗ ✔ ✗

Communal areas

✗ ✗

✔

✗

PPE for Aerosol Generating Procedures

Some procedures on patients who have COVID-19 can generate tiny particles from the respiratory tract which might be inhaled by people in the room

• Undertake these procedures in a single room
• Only people involved in procedure should be present
• Wear high level PPE
• Long-sleeved gown
• Eye protection (visor or goggles)
• FFP3 respirator

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Aerosol Generating Procedures*

Airway suctioning (open system) Intubation & extubation High flow nasal oxygen Sputum induction (by physiotherapists) Non-invasive ventilation (BiPAP, CPAP)

* Check www.gov.uk for updates to list

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Putting on & removing PPE for AGP

Social distancing & shielding

• Avoid close contact (2 metres)

between all people in the home

• Ensure elderly/vulnerable

residents are shielded:

• Stay in the home
• Avoid close contact with other

residents/visitors

• Isolate residents with symptoms
• Check residents and staff daily

for symptoms of COVID-19

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Common Symptoms of COVID-19* Fever >37.8oC Dry cough Fatigue Sputum Shortness of breath Muscle/joint pain Sore throat Headache Hoarseness Nasal discharge *In elderly other signs include: confusion/lethargy, mobility/alertness, diarrhoea

What to do if there is an outbreak?

• Isolate those with symptoms in a single bedroom
• Resident should stay in their room (including for meals)
• Isolate for 14 days
• If not en-suite – dedicate nearly bathroom to the resident
• Isolate residents who have been in close contact with

symptomatic residents in a single bedroom

• for 14 days after exposure to a possible case
• Dedicate medical equipment for COVID-19 residents
• eg thermometers, pulse oximeters
• Clean and disinfect before use on another resident
• Do not store PPE in room

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If 2 or more residents develop symptoms of COVID19

Contact your local Health Protection Unit

Arranging for COVID-19 testing

• Testing for all symptomatic residents reported when outbreak notified

with be arranged by Public Health England

• Testing kits will be posted to the home.
• CQC/NHS and local structures will organise:
• Testing of all subsequent residents who develop symptoms.
• Testing of staff/and or symptomatic household contacts
• Liaise with Local Resilience Forum or Local Authority

https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#care-home

Further information: Covid-19 Adult Social Care Action Plan

https://www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action- plan/covid-19-our-action-plan-for-adult-social-care#controlling-the-spread-of-infection-in-care- settings Inform Promote Sustain

Collecting COVID-19 samples

• Equipment required:
• Plastic apron
• Fluid resistant surgical face mask
• Eye protection
• Gloves
• Viral swab
• Swab the back of the throat

(each side), then nose

• Offer a tissue and water

afterwards

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Sending COVID-19 swabs for testing

• Insert swab into transport media
• Snap the stick at the line &

securely close

• Complete label
• name, date of birth and NHS number
• sample type = ‘nose & throat’
• Place sample in 2 bags
• Complete E28 form

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https://www.gov.uk/gover nment/publications/testin g-for-wuhan-novel-cov- 2019-ncov

Break at line

How to take nose and throat swab

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https://youtu.be/9WayjX6vCdk

Managing residents who are ‘walking with a purpose’

• Try to promote cough etiquette
• Try to promote hand cleansing
• offer them hand wipes regularly
• Try to guide the resident back to their room.
• Clean high touch surfaces more frequently
• hand rails, door handles, tables etc

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Managing contact between staff and residents

• Residents
• If extremely vulnerable should be placed in single room

and not share bathroom with other residents

• Symptomatic resident should wear surgical face mask

(if possible) to transfer between rooms

• Staff
• Where possible staff should be allocated to work with

EITHER symptomatic or non-symptomatic residents

• Staff who have previously tested positive for COVID-19

should care for symptomatic residents (still use PPE)

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Waste from rooms of residents with COVID-19

• Waste should be removed at least daily
• Discard as infectious (orange bag) waste stream
• If no infectious waste stream
• store securely for 72hrs and discard as household

waste

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Laundry from rooms of residents with COVID-19

• Linen and clothing can be decontaminated by

usual washing process

• Treat as infectious waste
• Place directly into alginate (dissolvable) bag
• Place this into an outer plastic bag outside the room
• Can be laundered immediately
• Bring laundry hamper close to room
• Do not take in the room
• Do not shake or sort linen
• Do not put used linen on floor or other surfaces

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Staff uniform and safety at home

Personal hygiene

• Wash hands and forearms

before leaving the home

• Wash hands again when arrive

home

• Virus easily removed by soap

and water and alcohol gel

• Personal items do not need to

be decontaminated

• These are not in contact with

respiratory secretions from patients

Uniforms

• Use dedicated work clothing if no

uniform

• Protect from contamination during day

with plastic aprons

• Change out of uniform before leaving

the home (take home in a plastic bag)

• Wash uniforms separately to other

household linen

• Avoid overloading - dilution important

for removing dirt & contamination

• Can be tumble dried and ironed with

household laundry.

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Minimising environmental contamination in the home

• Regular cleaning throughout the home prevents surfaces

becoming contaminated with virus

• Open windows to allow fresh air to circulate
• Use detergent/disinfectant solution for cleaning hard surfaces:
• Preferably 1000ppm chlorine disinfectant
• If another disinfectant (check efficacy with manufacturer)
• Ensure disinfectants marked EN24776 Virucidal properties
• Use detergent to clean soft furnishing (if likely to be damaged by

chlorine disinfectant) or consider steam cleaning

• Discard items heavily contaminated by body fluids if not washable
• Use disposable cloths
• Launder mop heads (daily last in the last wash) or use disposable

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Cleaning staff

Clinical Gloves Plastic Aprons Fluid Resistant Mask Eye protection Period of use Single use Session of care Cleaning

✔ ✔ ✔

Assess risk

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• Ensure they know what PPE they should wear and

have received training

• Clean all surfaces in resident rooms
• especially high touch areas e.g bedrails, bathrooms
• Discard cleaning solution at a disposal point
• Clean mop handle & bucket
• Remove waste and linen

Additional procedures for cleaning rooms of residents with COVID-19

• Clean rooms of residents with COVID-19 last
• Use disposable cloths
• Use disposable mop head
• Discard cleaning solution at a disposal point
• Clean mop handle & bucket
• Remove waste and linen

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Cleaning room of resident with COVID-19 who has died

• Clean all surfaces
• high level windows, ledges and sills, curtain rails
• lower level windows, ledges and sills
• furniture, fixtures and fittings, en-suite rooms
• door handles, light switches, soap & towel dispensers
• Clean all surfaces of mattress and bed
• Unzip mattress – check foam for strike through – replace if soiled
• Mop hard floor surfaces
• Shampoo carpet and fabric chairs or use a steam cleaner
• Discard waste (as clinical waste)
• Place laundry in dissolvable bag and return to laundry

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Staff with COVID-19

• If you develop symptoms of a flu-like illness then DO NOT come

into work and inform you manager:

• fever of more than 37.8oC and new persistent cough
• other symptoms of respiratory infection
• Self-isolate at home for 7 days from onset of symptoms
• Arrange to take a COVID-19 test
• within 3-4 days of start of symptoms
• if you are better and the test is negative your can return to work
• If your symptoms worsen contact NHS 111
• If a member of your family develops symptoms
• Arrange for them to have a COVID-19 test (if possible)
• If this is negative you can return to work
• If no test or test is positive then self-isolate for 14 days
• Staff at high risk of complications from COVID-19
• risk-assessment to manage if and where they can work

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Facilitating visits by relatives for residents with COVID-19 receiving end of life care

• A visit by a one or two close relatives to a resident who is

dying should be facilitated if possible

• They should be given a clear description of what to expect
• It is reasonable to consider the visits as ‘essential travel’

under the principles of social distancing

• The visitor does not need to wear gloves to hold their loved
• ne hand – but advised not to touch their mouth, nose or eyes

and wash their hands when leaving the room

• Visitors will need to be shown how to put on and take off a

face mask and apron

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Useful resources

Public Health England Coronavirus (COVID-19) guidance

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/881329/ COVID-19_How_to_work_safely_in_care_homes.pdf https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880274/ Admission_and_Care_of_Residents_during_COVID-19_Incident_in_a_Care_Home.pdf https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

Public Health England Campaign Resources

https://campaignresources.phe.gov.uk/resources/campaigns/101-coronavirus-

NHS website

https://www.nhs.uk/conditions/coronavirus-covid-19/

Infection Prevention Society

https://www.ips.uk.net/professional-practice/resources1/covid-19-advice-and-guidance/#.XqVO5hd7mV4 IPS/BACN Compassionate end of life care: https://www.ips.uk.net/files/5415/8713/0634/Joint_IPS_BACCN_Position_Paper__- _COVID19_Visiting_at_the_End_of_Life_Final.pdf

World Health Organization

https://www.who.int/emergencies/diseases/novel-coronavirus-2019 Inform Promote Sustain

IPS Training Resource

• Developed by:
• Jennie Wilson, IPS Vice-President
• Lisa Renshaw (Chair, Care Home Special Interest Group)
• Hannah BySouth, Royal National Orthopaedic NHS Trust
• Available from:

https://www.ips.uk.net/

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