Infection control
surfaces can all harbour microbes. Keeping the environment clean reduces the number of pathogens that can potentially infect residents. Most micro-organisms are found in dust or dirt, so cleaning or vacuuming alone can cause significant reductions in pathogens.
NHS guidelines recommend limiting the number of products to avoid inappropriate use. Warm water and pH-neutral detergents are suitable for many cleaning activities. Disinfectants are not required for routine cleaning but should be used on equipment and areas occupied by a resident with a known or suspected infection. It is vital to use the correct proportions of disinfectant to water. Spillage kits should be used for disinfecting surfaces contaminated by blood or body fluids.
Some pathogens, such as C. difficile, are a particular challenge in care homes. C. difficile is a bacterium that can cause a gastrointestinal infection that can lead to serious illness or even life-threatening complications, including perforated bowel or sepsis. Being elderly, unwell, or living in a communal care setting are risk factors. Up to three per cent of adults carry the bacterium asymptomatically. A single patient can discharge millions of spores in their faeces, which can live on surfaces for up to six months. These spores can also withstand dehydration and resist many common disinfectants, including alcohol-based sanitisers. On surfaces, chlorine bleach at the appropriate dilution is the most effective disinfectant against C. difficile. Antibiotics can treat the illness effectively. However, antibiotic treatment can also destroy ‘good’ bacteria in the gut. In a significant number of cases, this leads to repeated, debilitating infections in a patient, and increases the risk of infection spreading. Hard-to-control illnesses, like those
caused by C. difficile, make the need for transparent, robust IPC policies and practices apparent. Staff need to know procedures, how to spot symptoms, and their responsibilities and roles in IPC. To be really effective, care homes need IPC policies that incorporate best practice, national guidelines, and the importance of effective communication between all involved, including visitors and patients.
Effective cleaning plans NHS Community IPC guidelines recommend a cleaning plan for every care home. This sets out standards, who is responsible for what, who is in overall
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To be really effective, care homes need policies that incorporate best practice, national guidelines, and the importance of effective communication between all involved
charge, and other elements. The guidelines also recommend care homes conduct weekly audits to assess standards of cleanliness, and NHS Infection Control provides a downloadable audit toolkit.
Knowing the chain of infection Understanding how infection can be spread is crucial for staff to conduct effective IPC. There are six links in the circular chain of infection. Every link provides an opportunity to break the infection. The links are as follows: the pathogen that causes the illness, the reservoir (where the pathogen lives, e.g. on a person, in the environment, or food), the portal of exit (how the pathogen leaves the reservoir, e.g., through coughing, sneezing, diarrhoea), the means of transmission (how the pathogen moves from one person to another e.g. via touching a contaminated object or skin-to- skin contact), the portal of entry (how the pathogen gets into another person e.g. via the mouth or a wound), and the susceptible host (a person who is vulnerable to infection, due to age or an underlying health condition). According to health advice, the more links in the chain that are broken, the greater the protection. Examples of ‘breaking the chain’ include regular cleaning of the environment or decontamination to eliminate reservoirs, keeping away from others when infectious, covering mouths and noses when sneezing to block the portals of exit, and vaccinations for those susceptible.
Assessing vulnerable residents The government recommends care homes assess individual residents’ risk of catching or spreading an infection before they start using the service. This can then be kept under review for as long as they use the service. Assessments should contribute to planning a person’s care and whether extra IPC precautions are needed. Assessments include relevant factors such as symptoms (for example, a history of diarrhoea/ vomiting, coughing, unexplained rashes), travel history, or previous infections with multi-drug-resistant pathogens.
Isolating patients for safety Residents with an infection or suspected infection should be isolated and staff should
understand when and how to use personal protective equipment (PPE) to reduce the chances of spread.
Many care homes and staff rose to the “massive challenge” of protecting residents and displayed a great deal of “professionalism and compassion” during the COVID-19 pandemic, according to CQC inspectors. A holistic IPC approach can protect residents from other infections and needs to involve all concerned: residents, friends, and family, too. With a comprehensive set of infection
prevention measures in place, staff can focus on providing a safe, nurturing environment, and residents can focus on enjoying their lives and time with their loved ones. Effective and transparent policies that
acknowledge the inter-connectedness of IPC can successfully reduce infection, nip potential outbreaks in the bud, and help maintain a good balance between prevention and residents’ quality of life. n
Damien Hancox
Damien Hancox is the CEO of SpectrumX, a UK-based healthcare and pharmaceutical company focused on providing safe, effective products - including its Spectricept line of broad- spectrum, alcohol-free, non-skin-irritant disinfectants - using patent-pending formulations of stabilised HOCL, a substance naturally occurring in white blood cells and a key contributor in immune response to infection.
www.thecarehomeenvironment.com February 2023
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