Principles infection control
Principles infection control
Explain employees’ roles and responsibilities in relation to the prevention and control of infection
As an employee the Health and Safety At Work Act 1974 state that I have a duty and responsibility to ensure that I as an employee have a duty to be responsible in showing reasonable care for my own safety. I have the responsibility of my own safety in terms of cleanliness and hygiene observation and practice; I am responsible for cooperating and following the health and safety guidelines and expectations of my employer; I am responsible for maintaining and taking care of all hygiene equipment and materials and to report when there is a faulty; I am responsible for using PPE appropriately and attending the necessary training in health and safety, keeping my skills up to date; I have a responsibility of to monitor the hygiene practices of my staff as a senior care support worker making sure that they observe practices such as wearing appropriate PPE and washing hands appropriately as well as updating their training.
I must be of the attitude that when it comes to infection prevention and control that all individuals (including myself) are high risk and practice my control of hygiene accordingly. This means wearing PPE such as gloves and aprons when assisting a service user to toilet or wash; disposing of the PPE appropriately afterwards and washing my hands thoroughly. It includes using new clean PPE between attending to different service users; making sure pads and soiled linen are bagged and disposed correctly; disinfecting and wiping down areas when necessary;
storing foods to correct temperatures; preparing foods to correct temperatures before serving; using clean food implements and equipment and following the instructions of the use and storage of substances hazardous to health. I must also keep my personal hygiene up to standards at work by wearing appropriate clean clothing and keeping my hair tidy and tied away for my face, no jewellery or dangling parts and sensible foot wear.
Wearing inappropriate clothing such as clothes with tassels can drop into food and cause cross contamination; shoes that will cause imbalance and cause me to topple over would be dangerous especially if carrying food, waste or assisting a person to manoeuvre. Not wearing appropriate PPE would increase the chance of cross contamination as substances such as bodily fluids, chemicals and other foreign particles such as hair etc can be easily transferred to ingest or inhale in some way. Reporting faulty equipment is essential as if a dish washer or washing machine breaks down then this increases the risk of the items they would process to not be processed properly or sit around harbouring bacteria for longer thus increasing the risk to cross contamination. Updating my knowledge in subjects such as health and safety and food safety is vital as it reinforces knowledge and practice and informs me of any legislation and practices that have changed.
If a service user develops an infection then I must record and report this straight away making sure that the home nurse or manager is aware and that it is handed over to the staff team with instructions of how to provide care. The service user must receive medical attention from the home nurse or a GP. These types of infections must also include reporting to necessary bodies such as RIDDOR at the local authority by the GP, especially in circumstances of food poisoning or contagious infections such as Healthcare Associated Infections (e.g. MRSA, MSSA, C. Difficile and E. Coli which are all very contagious bacteria).
If a member of staff has an infection and they pose a risk to others of cross contamination then they should seek medical attention and not come into work advising me by phone call of what the issue is so that I can alert the manager or home nurse and we can check for any risk of cross contamination. This staff member (including myself it affected) should not return to work unless the risk had gone and it is medically safe to do so. A certificate from my (or staffs) GP must be provided in these cases. Continue on a separate page if necessary…
QUESTION- ( 1.2 )
Explain employers’ responsibilities in relation to the prevention and control of infection
Employers have a great duty to ensure that health and safety regulations (HASAWA 1974) are met in the prevention and control of infections because they also have a duty of care to ensure it is prevented and/ or kept under control and terminated. Health and safety legislation states that employers must protect employees from danger and harm as far as reasonably possible so the work premises that they provide for service users to dwell and staff to work in must be safe and free from danger. In terms of infection control, all substances that are hazardous to health including bodily fluids, chemicals and wastes must have provisions so that they can be stored, handled, cleaned, processed and disposed of safely with minimal risk to individuals.
Risk assessments must be carried out in the work place to ensure that any risks are identified, minimised and monitored as a way of limiting and controlling the risk of infection. Risk assessment of stored and used substances including COSHH and biohazard substances and risk assessments of working procedures including risk assessments in serviced users care plans must be carried out and updated.
Employers must provide the means for staff to access training so that their employees knowledge and skills are up to date; they must provide the means to PPE so that employees can protect themselves and others whilst they work with hazardous substances and they must ensure that regular health and safety checks are carried out so that any issues can be identified and corrected in the building and in the resources. Employers must also provide the necessary infection prevention and control in policies and procedures so that I and my staff team can access the necessary information on how we carry out our work.
The main source of Health Care Associated Infections (HCAIs) are transferred via hand contact therefore it is vital that my employer provides that adequate resources for myself and staff to wash our hands and dry our hands regularly, appropriately and to procedure. The facilities to wash with warm water and use a WC should be clean and safe (not damaged and kept clean) provided with necessary hand wash, disposable hand towels and pedal bins. Such resources are vital to the control and prevention of infections.
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QUESTION- ( 2.1 )
Outline current legislation and regulatory body standards which are relevant to the prevention and control of infection
As well as the Health and Safety At Work Act 1974 that stipulates that each employee and employers have a responsibility of showing reasonable care for ourselves and others and to provide a safe place to work respectively; other acts that state more specifically how the prevention and control of infections must be met in my work place and these include Control of Substances Hazardous to Health (2002) or COSHH and the Reporting of Injuries, Diseases and Dangerous Occurences Regulations 1995 or RIDDOR.
A hazardous substance is any substance or material with the potential to cause illness or injury to the people whom come into contact with it and are likely to come in the forms of liquids, dust, fumes, gases and living organisms. The control of these substances involve the prevention of accidents and ill health and therefore COSHH stipulates that such hazards must be identified; risk assessed; prevent exposure to or control exposure to and staff should be regularly check if they are continuously working with some high risk substances. COSHH also requires that people at work handling substances should follow the instructions or be trained to handle the substances; know what control measures to take and how to take appropriate action in an emergency
In a care home environment the employer must make sure that the storage of any substances is safe and legally adequate i.e. in correct containers, in suitable room, in suitable temperatures, dry area, off of the floor, locked securely… etc; all chemical substances should have their data sheets listing the ingredients; storage rooms sign posted appropriately and have only authorised persons using them… etc. The regulation should also explain of how to deal with spillages safely and this would include the spillage of blood and/or urine; how to dispose of sharps and dispose of soiled materials such as pads.
RIDDOR (1995) covers the recording and reporting of dangerous occurrences and accidents in the workplace. I must ensure that these reports be kept for 3 years and they must be available for inspection by the Health and Safety Executive (HSE) as and when required. Work places should have a system of reporting injuries, diseases and dangerous occurrences as a result of accidents and incidents. An accident is something that happens that results in an injury or death and an incident is something that almost could have happened that might not have caused harm now but could cause an injury, ill health or a fatality in the future. I must report some incidents to the Health and Safety Executive (via RIDDOR) directly and these include:
Death or a major injury – Injury resulting in employees being 3 or more Poisoning days off of work Occupational cancers – Occupational asthma or lung disease Skin condition such as (from asbestos)
skin cancers or dermatitis – Musculo-skeletal disorders including fractures
Under the Health and Social Care Act 2008 a code of practice was established for the prevention and control of Health Care Associated Infections (HCAIs) setting out how the NHS will go about attempting to prevent HCAIs.
Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them.
Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections.
Provide suitable accurate information on infections to service users and their visitors.
Provide suitable accurate information on infections to any person concerned with providing further support or nursing/ medical care in a timely fashion.
Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people.
Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection.
Provide or secure adequate isolation facilities.
Secure adequate access to laboratory support as appropriate.
Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections.
Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.
The Department of Health 2010 ‘The Health and Social Care Act 2008: Code of Practice on the prevention and control of infections and related guidance’.
My employer has to show how it is implementing these codes as best suited to the organisation and assessed and inspected by the Care Quality Commission.
The Public Health Control Of Diseases Act 1984 and the Public Health (infectious Diseases) Regulations provides information about disease which are risks such as Dysentery, cholera, diphtheria and food poisoning… etc . It explains how an outbreak should be handled, recorded and reported and the responsibility of informing the environmental health officer of the outbreak so that an investigation can be carried out.
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QUESTION- ( 2.2 )
Describe local and organisational policies relevant to the prevention and control of infection
Policies that cover the prevention and control of infection at my work place include those of:
Hand washing technique procedure: To wash hands thoroughly after assisting service users (for example after assisting them to use the toilet, change their pad or even after dressing them or feeding them) it is of paramount importance that I (and my staff team) follow the established method of hand washing. Transference of bacteria via hand to hand contact is the most common way of the spread of infections and pathogens that cause them so it is vital that I carry this out throughout my working practice. My work place has this method displayed in appropriate places (i.e. above hand wash basins) so that it is there to guide me and my staff team. It is a process that should take no more than 15 to 30 seconds and it is a process that is carried out frequently, even if disposable or non disposable gloves are used – hand washing technique is still necessary. The facilities must be available and this includes the basin with hot water, soap and disposable towels.
My work place has policies and procedures outlining what to do in the event of the outbreak of infection. It will outline a procedure of recording and reporting on the necessary forms not only for our records but also for RIDDOR. It will direct me to report and outbreak or the suspicion of an outbreak to the home manager or nurse so that they can report to the Environmental Health authorities. If needed a GP will be called in to tend to the service user and will also advise to or report to the local environmental health inspector for RIDDOR of a notifiable disease such as dysentery, cholera, MRSA, MSSA, C, Difficile or E, Coli (to name a few).
The policy will outline the various circumstances of which to notify the Environmental Health Authorities because even though sickness like diarrhoea and influenza are quite common and most people can overcome them with over the counter medications, for elderly people these can pose more of a threat an cause pneumonia or even death if they are not supported straight away because of their weakened immune system or if they already have a chest condition.
The procedures outline what to do if there is an outbreak in the home depending on what the suspected infection is i.e. best practice in cases of influenza should instruct along the lines of making the conditions present indicate the threat i.e. The signs and symptoms of influenza e.g. Onset of fever, headache, myalgia, cold or runny nose, sore throat… etc; symptoms like these in 2 or more individuals in the home within a 3 day period and the preventative treatment that needs to be put into place as a result.
Policies of storage and use of substances that are hazardous to health also cover chemical products that are used throughout the work place (i.e. detergents, cleaners, disinfectants, aerosols… etc) and the routine and schedule of cleaning areas particularly areas such as bathrooms, wet rooms, toilets and kitchens. Policy and procedure are also provided on how to dispose of items such as sharps and soiled pads; Soiled pads should disposed of in yellow sanitation bags which can be disposed of in the clinical waste bin; needles and other forms of sharps during drug administration or phlebotomy must be disposed of in special sharps containers that are collected and incinerated.
Some service user may have to use certain aids to help them in their day to day lives and these can also require care and attention so as to reduce infection and spread of infection. Such items as catheters need to be cleaned and the service user would need to clean or assistance to clean their most intimate areas so as to prevent infections.
Procedure advice on how to clean and care for the aids and how to protect ourselves with appropriate PPE before tending to them. All new catheter bags will be inside of sterile packaging and we must ensure that these are kept sealed and renew according to care plan. Policy and procedure instructing on care of service users stoma bags would also be another example of such aids where infection prevention and control is of great importance.
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QUESTION- ( 3.1 )
Describe procedures and systems relevant to the prevention and control of infection
My work place also has guidance in the form of policies of when to use Personal Protective Equipment such as gloves, aprons or gowns, masks and eye protection. These are vital as a protective barrier against transference of pathogens from service user to me (or staff) and from me to service user. These must be worn when assisting the service user to toilet, change pads, wash, dress and a fresh set when preparing food. They should also be worn when changing bins or clearing up spillages, especially of hazardous substances. The gloves and aprons must be disposable as this reduces the harbouring of pathogens and cuts down the spread of infections.
The procedures cover how to don and remove such items as carrying out such methods in sequence cuts down the risk of the spread of infections and transference of pathogens e.g. it may outline a process such as:
Carry out hand hygiene immediately before and after donning and removing PPE. Don a gown
Don a mask (if used)
Don eye wear (if used)
Such donning of protection must be carried out in this order as to put gloves on firstly would make it difficult to tie and adjust other garments; also if hands are gloved it may encourage the user to touch things that may carry infection and then they would transfer when donning other PPE. Donning a mask or eye wear firstly would also be impractical as they would get in the way when donning other items.
It is best to don the gown firstly as this has to be done up at the back and then the others (where applicable) and gloves lastly. The procedure will also outline how to don each item of PPE e.g. for donning gloves it may say to don them lastly by inserting hands into gloves and then making sure that the gloves also cover the wrists; and also how to (and in what order to) remove each item of PPE in order to cuts down the risk of the spread of infections and transference of pathogens.
Cleaning of certain rooms and facilities in the care home require regular cleaning and decontaminating, disinfecting and sterilisation. Toilets, bathrooms, commodes, equipment such as hoists, bath chairs and handle rails all need to be cleansed in line with the procedure of the home.
For example procedure in my care home stipulates that the commodes must be generally cleaned and decontaminated and disinfected after each use, as well as the resident’s toilets. Soiling may not be visible to the eye however the bacteria still persists so this must be cleaned and disinfected immediately. Similarly bathrooms and wet rooms must be cleaned and disinfected after each use as residue from the service users body would be left behind causing bacteria to build up, especially in a damp place.
According to procedure I ensure that staffs or myself frequently check the resident’s toilets (hourly). A checking schedule is placed in the toilet where we tick off that it has been checked. In addition to this when we assist the service user to use the toilets after their use we used disinfecting wipes to clean down the seat area and a spate wipe to clean the flushing handle whilst applying disinfectant to the toilet bowl. If debris is in the toilet bowl, this must be scrubbed away using the toilet brush. Many service users need our assistance to use the toilet however some are able to use the toilet themselves and may not remember or be able to disinfect the toilet appropriately after use so we check the toilet hourly for this purpose.
After we finish assisting the service user, making sure that they wash their hands and they are made comfortable outside of toilet we change gloves to clean gloves (as to not cross contaminate from assisting them to other surfaces) and use cleaning materials that are stored in a secure cupboard in the toilet firstly applying toilet bowl disinfectant to the bowl and scrub bowl with toilet brush (if required); use a disinfecting wipe to clean top of bowl, a fresh one for the seat and another last wipe during the flush. We clean the flushing handle lastly using the wipe so as to not risk contamination after touching anywhere else.
Where wipes are not used or have run out we use colour coded disposable cleaning cloths and liquid detergents (to remove physical debris) then liquid disinfectant to disinfect the surfaces. These are readily made up to the correct solutions (according to manufactures specifications) and are bottled in colour coded plastic bottles and labelled. For cleaning supplies used in toilets the spray bottles containing the detergent and disinfectants, cleaning cloths, mops and mop-buckets are all red. This gives a clear indication that these are the materials and equipment to be used in the toilet areas only and ensures that these are not used elsewhere in the home providing a procedural barrier against cross contamination.
When using the liquid cleaners/disinfectants and cloths we clean and disinfect the flush handle firstly and then work our way down to the bowl to spread of infection from toilet bowl to flush handle. If there is a spillage of urine on the floor then we use water and detergent with a designated mop and mop-bucket (colour coded red) to clean away the spillage. After the physical debris has been removed then we use disinfectant to disinfect the area, ensuring that hazard warning signs are put in place whilst cleaning is taking place so as to warn others of slippery floor surfaces. We open the window so as to encourage quicker drying of the floor and monitor it for safety and remove signage when drying is complete.
After cleaning these areas and supplies are securely pit away, we discard of our PPE in a specific manner which also acts as a procedural preventative barrier against the spread of infection: gloves (turned inside out), apron and then hand hygiene.
At the end of a residency and once the room has been voided and all belongings have been removed it is the procedure of our workplace that it should be cleaned and decontaminated, disinfected and sterilised. To do this we have a void team who remove any leftover items to throw away at a local authority refuse centre and get ready to refurbish the room. Wearing PPE we clean, disinfect and use a steam steriliser to sterilise the bed frame and commode (a new mattress is always ordered at the beginning of new residencies) and move these temporarily into a storage room. We also strip the windows of curtains and drapes to launder. The void team then remove the lino and sterilise the room walls and ceiling, skirting door and door frame and handles; repaint and lay new lino to flooring. We then replace the window dressings, bed frame and commode.
Many other procedures are particular to our home some of which include:
Daily, weekly and monthly cleaning of the kitchen and its contents. The storage and maintenance of products and equipment e.g. cleaning chemicals and the required documentation, food stores and the stock rotation, health aids particular to each service user (such as catheters, stoma bags, dressings and pads), hoists, commodes, stand and twists, transfer boards, PPE… etc. Disposal of clinical wastes.
Safe handling and disposal of sharps.
Managing spillages of blood and bodily fluids products.
How to report and record and manage occurrences or suspicions of an outbreak.
How to report and record accidents and incidents.
Best practice of hand hygiene.
Handling and laundering of soiled clothes and linen.
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QUESTION- ( 3.2 )
Explain the potential impact of an outbreak of infection on the individual and the organisation
The potential impact of an outbreak of infection on the individual can be devastating because it not only means that they have to be cared for in isolation to limit the risk of infection to other service users but it also means that the infection poses great risk to the individual’s life as their immune system is usually compromised and an infection poses a greater threat to their life. The symptoms of having an infection can be very uncomfortable for them in the mean time as their body is trying to fight the infection they can suffer symptoms such as fever and weakened muscle pain. If their skin is fragile and they are bed bound extra care must be taken to make sure that they are cleaned well and turned often to limit the onset of bedsores that can lead to even more complications.
In cases of their treatment using some antibiotics (particularly stronger antibiotics that can give risk to the onset of other bacterial infections such as C. Diff because these antibiotics can have the effect of killing the initial infection in the digestive tract but can also kill beneficial, naturally occurring bacteria essential to the health of the digestive system. The resultant imbalance can give rise to C. Diff (which also naturally occurs in the system) to multiply causing an imbalance by over population that is toxic to their system. The resulting symptoms include can give the side effect of diarrhoea and vomiting which in turn create aerosols and risk of airborne transmission.
The isolation that follows when the individual needs to be cared for and treated separately from others so as to reduce the risk of spread of infections to others can also affect the individual’s emotional/ mental wellbeing as they may feel more lonely and depressed during this time and this can affect their self esteem. It is therefore essential that myself and members of staff visit the individual often to maintain social contact with them and ensure support of their mental health. Visits to the individual from friends and relatives must be stopped until the outbreak has cleared so as limit the risk of cross contamination to the visitors and also protect the resident from bacteria the visitors may unwittingly bring with them. The potential difficulties that follow an infection outbreak for the individual are complex and life threatening.
The impact of an infection out break on the organisation can also be devastating as it can be costly for the treatment that has to be implemented and the organisations reputation can suffer as if poor practice or negligence was discovered after an investigation of the outbreak then it is within the rights of the HSE to prosecute individuals and this can lead to a fine or imprisonment.
QUESTION- ( 4.1 )
Define the term risk
A risk within a care setting applies to a number of possibilities that can involve the risk posed from use of equipments, the use of substances or the danger of a service user to themselves and others.
In terms of infection prevention and control the term risk applies to the level of risk posed from biological hazards or biohazards to people (including service users, staff and visitors). Some biological hazards are those substances that come from living organisms such as people and they can be found in bodily fluids such as blood, vomit, waste matter, saliva… etc. Organisms that exist in bodily fluids include HIV, MRSA, influenza, MSSA, C. Difficile, E. Coli and many others.
Once a biohazard in my workplace has been identified then I must be able to identify the level of risk that it poses to all people which means at what rate and by what means can the organism spread? Is it likely to spread without precautions put in place? What level of harm is posed to others if precautions are not implemented? I would need to rate the level of risk to these factors as low, medium or high.
QUESTION- ( 4.2 )
Outline potential risks of infection within the workplace
In a care home setting the potential for the risk of infection greatly increases because the service users are more vulnerable to getting infection then most people. Their susceptibility to infection is increased by a great many factors that affect their immune system, such as their age. Very old people’s immune systems are weaker due to their age and therefore are more susceptible to getting infection. Service user’s may also be suffering from certain terminal illnesses and this may compromise their immune system or they may be receiving medication or treatment for a terminal illness and this may compromise their immune system e.g. chemotherapy for cancer weakens the immune system. When people are ill or are elderly and suffer from degenerative diseases such as dementia their diets can change and they can begin to eat less or not feel like eating at all. For instances if they undergo a major operation like a hip replacement or have part of their digestive tract removed and acquire a stoma then they may have lost their appetite or find it difficult to change their diet risking them of becoming malnourished.
Their nutritional status becomes poor as a result hence compromising their immune system. If they have had surgery and have wounds, stitches or some kind of skin trauma as a result, this greatly increases the risk to infection as the skin has been breached and this is the body’s greatest defence barrier against infection. These areas of the skin are undergoing healing and must be kept cleansed regularly to reduce bacteria. Stomas for the exit of excrement via the bowl or urine, catheters for the drainage of urine from the bladder via the urethra and cannulas inserted into the service user’s arm for the administration of intravenously all give a way to entry directly into the body.
This increases the risk to the service user of infection not only as a direct passage but also if the bags, needles or tubing are not sterile when used or if they become blocked and bacteria can then quickly build up. As mentioned before the use of some drugs can increase a service user’s risk to infection e.g. strong antibiotics changing the levels of natural bacteria in the body and causing an imbalance creating C. Diff infection or chemotherapy drugs weakening the immune system exposing the service user to risk of infection.
The service user in a weakened state also becomes at greater risk of carrying infections and can spread pathogens themselves. There are highly contagious blood borne diseases such as Hepatitis B, HIV or MRSA that can be transferred to others who have to interact with them such as myself and staff who are providing care. Friends and relatives and other visitors can also be exposed to these infections. Aerosols from air borne pathogens such as the norovirus or influenza can transfer to others from the carriers vomit. The same is true of outside visitors bringing in such pathogens and risking infection to the service users who have weakened immune systems and who would find it more difficult to fight off such pathogens and sometimes fatal.
People coming into the care home environment from outside also include myself and the staff team. We must be aware of our own personal hygiene and health as we can also be carriers of air borne viruses such as colds, flu, diarrhoea and vomiting. As care workers staff and myself need to be even more vigilant about our personal hygiene, state of health and our infection control practice. We must be extra vigilant when working within the care home as we are tending to different service users so it is vital that we practice a high standard of infection control procedure and adhere the requirements as set out in our organisations procedures so as to prevent cross contamination and the spread of infections between potentially contagious and vulnerable service users.
We must ensure that we are clean and tidy for work and that our personal hygiene and attire does not pose a risk of infection to the service users and we must be responsible for our health and monitor this as if we do have a cold or flu it is best that we do not enter the work place as these illnesses can be detrimental to our service users. It is therefore vital that we follow our organisations procedure on our fitness for work and take the appropriate action and inform our manager of our state of health as this could save a person’s life. It is therefore essential that I and my staff treat all individuals as high risk in the light of potential risk factors of infection in a care home environment.
The equipment that we use with the service users often come into contact with the service users. Equipment such as hoists, stand and turns, banana boards, commodes, walking frames, profiling beds all come into contact with service users who may be carrying infections or pathogens that will cause infections. In addition areas such as toilets, bathrooms, doors and door handles and stand rails are also areas where bacteria and pathogens can sit and survive. Some pathogens are very resistant and can survive in a dormant state until the conditions in their surroundings becomes right then they can multiply e.g. the spores of C. Diff. It is therefore essential that regular cleaning to the schedule is carried out thoroughly as to limit the opportunity for pathogens to harbour.