5 Ways to Control Infection in Nursing and Care Homes

Nursing and care homes provide an invaluable service, offering safety, compassion and professional assistance to those who cannot continue to look after themselves at their own residence.

Endeavoring to feel akin to a home-away-from-home, as opposed to a hospital facility, residential care allows many elderly and unwell people to live with peace of mind; their day-to-day needs are supported 24/7 by in-house carers, with nursing homes also employing qualified medical staff.

Although focusing on home comforts, professional standards of hygiene and infection control are a high priority.

Nursing and care home residents are commonly in high-risk groups for catching healthcare acquired infections (HCAIs), often due to their age and existing health conditions. For this reason, infection control procedures must always be of an extremely high standard and will come under scrutiny during regular CQC inspections.

Here are 5 ways to provide adequate infection control in your care home, ensuring that residents and clinicians are kept safe from dangerous pathogens and the illnesses they spread.

1. Wash hands thoroughly, and at the right time

Every caregiver will understand the importance of hand hygiene; however, in order for this to be effective, hands must be washed at the right time, and in the right way.

To reduce the potential for contamination, clinicians should keep arms bare below the elbow, with hands free of jewellery (although some facilities may allow a plain, flat wedding band). Fingernails should always be short and clean, without polish or false nails; meanwhile, any cuts or grazes should be covered by a waterproof dressing.

In most cases, hands can be cleaned by a decontaminating handrub, but there are two moments during practical care when one should immediately wash hands with soap and water:

• When hands are visibly dirty, or have been exposed to bodily fluids
• When care has been provided to residents with vomiting or diarrhoea, even if the clinician wore suitable gloves for the task.
  
  

2. Use the correct PPE

There are plenty of interactions with residents which don’t require protective equipment. When providing personal care, however, clinicians should always wear suitable gloves, as well as a disposable apron when required.

The most essential rules are:

• Only use PPE once, before removing for disposal
• When using gloves, be sure to put them on immediately before care is provided and remove immediately after
• Be sure to change gloves between each task – even if these tasks are provided for the same person
• Always change gloves between caring for different residents
• Dispose of used PPE promptly and in the correct bin for its waste type.

3. Manage linen appropriately

Residents will require their clothes and bed linen to be changed regularly, just like anyone else; however, there may be occasions where items are soiled.

To prevent cross-contamination, these will need to be removed from the service user’s living quarters in a hygienic way, before they are thoroughly cleaned.

Care givers should:

• Wear appropriate PPE, such as gloves and aprons
• Put dirty linen directly into bags or containers, segregated by category, before being taken to the laundry area
• Arrange for items to be put straight into the relevant machine, without further sorting and unnecessary exposure
• Wash hands immediately after the task.

4. Educate visitors

Nursing and care homes receive a lot of external footfall, often from those who are visiting residents. To help prevent the inadvertent spread of germs by guests, appropriate advisory signage and introduction to available facilities should be maintained. For example:

• Stress the importance of clean hands, as well as where, how and when the handwash facilities should be used
• Provide hand sanitising gel at stations throughout the premises
• Clearly label the washroom facilities where hands can be safely cleaned without cross-contamination
• Make sure the appropriate way to handle, store and dispose of waste is understood
• Advise guests of when it is safe to visit, i.e. not during outbreaks of infection, or when the guest is ill themselves/has unwell members of the family at home.

5. Dispose of human waste appropriately

Many residents in nursing and care homes will experience continence issues, due to age or illness. Similarly, some may require assistance with toileting if they struggle with general mobility.

When this kind of care is required, residents may need to use an array of products for comfort, convenience and dignity. This could include disposable items such as pulp bedpans and urinals, or items that need cleaning between uses, such as commode pots.

Every nursing and care home should have a robust policy in regard to how these tasks are performed, and how waste should be safely disposed of in the sluice room.

As a guide:

• Clinicians should be clear as to whether the items used for toileting are single-use disposable, or reusable and in need of disinfection
• Used bedpans (or similar waste collection products) should be covered and immediately taken to the sluice room for disposal
• Whether a pulp macerator or bedpan washer disinfector is used, they must be used in conjunction with the relevant kind of bedpan, i.e. single-use or reusable
• Hands are to be washed immediately before and after sluice room tasks, even when gloves are worn.

Nursing and care homes should avoid washing bedpans and commode pots by hand, wherever possible.

Not only is it very difficult to determine if the item has been thoroughly disinfected (generally only by a visual check), but bacteria can easily be spread through the air by uncontained water jets, as well as aerosolization in steam from hot water.

Similarly, where pulp products are used, facilities should avoid the use of yellow/tiger stripe bags for disposal. These bags can not only rip and spill contents on the floor, but also expose the atmosphere to bacteria when they are opened by a clinician to insert another item.

In addition, the constant touching of bins and bags can made it very difficult to determine that the outside of these containers are actually clean. If they have become dirty through touch (and much of this could be invisible), the bag will cross-contaminate every area it touches; and inevitably, bags will need to be carried through the facility to a collection point, further increasing the risk of infection.

In reality, the only safe way to dispose of pulp products is with a macerator; meanwhile, reusable bedpans can only be reliably cleaned by a washer disinfector.