IPC guidance


Demonstrating compliance The CQC eight-point audit scheme: n Visitor controls: communication, professional or family, guidance, procedures, etc.


n Residents’ awareness: minimise proximity, basic hygiene measures, external visits, the need for isolation, etc.


n Safe admission of residents: assessment, awareness, controls, isolation, etc.


n PPE awareness and use: communication, special needs, procedures, stock management.


n Positive test procedures: residents, staff, isolation, administering medication.


n Operating the premises hygienically: layout, cleaning, walkways/routes, fire safety, etc.


n IPC staff training: permanent and agency, previous outbreaks, wellbeing, staff support.


n IPC practices: awareness, audit, non- conformances, and corrections.


The root causes of infection are manifold and, while clinical in essence, the vectors for their transmission are physical and all procedures where cross-contamination may occur must be risk-assessed and correctly managed. Best practices have, of course, been implicit for years, and whenever an influenza, norovirus, or other such outbreak has occurred, the necessary containment procedures have been practised. None so critically and severely, however, as when the COVID 19 pandemic kicked in, albeit with much confusion, crossed wires, and the potential for blame. Much has been learnt over the last few years but are we really prepared and ready to implement the required procedures the next time it happens?


The pandemic and beyond Antimicrobial resistance is a global problem that makes infections harder to treat with existing medicines. High standards of IPC reduce the opportunities for infections to spread and for resistance to develop, so that is why this new guidance has been developed. Day-in, day-out, responsibility for the health and wellbeing of many of the most vulnerable elderly members of society is entrusted to 5,500 different provider- organisations across the UK’s £16bn care home sector, operating 11,000-plus care homes, with more than 400,000 residents. Historically, residential care settings have always presented significant challenges


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The root causes of infection are manifold and, while clinical in essence, the vectors for their transmission are physical and all procedures where cross-contamination may occur must be risk-assessed and correctly managed.


to those in charge of establishing and implementing appropriate protocols and good-practice in on-site risk-management, safety culture, cleanliness, hygiene- management, and IPC. And then came COVID!


By autumn 2020, Public Health England


(now the UK Health Security Agency) reported that more than 43,000 care home residents had tested positive for COVID. Throughout 2021 and moving into 2022, care homes faced an unprecedented set of logistical, legal, workforce, and operational challenges to the safe and successful management of their businesses. Now, as we move into the so-called ‘post- pandemic’ age, we cannot be complacent; the care home sector must reflect on the experience and refocus, implementing those new and urgent measures as standard procedures. The whole culture is ripe and ready for change. The impact of COVID on the care


home sector was widely published, albeit sometimes inaccurately, and there is no doubting the massive and tragic loss of life, but to some degree it happened everywhere else, too. We must all learn from the experience, and what better incentive than loss of life and the crumbling economy to focus attention?


Time for a major upgrade


The IPC guidance should not just be for care homes.


All aspects of IPC - physical, clinical and


behavioural - both in design and practice, should be up there with all the other current headliners such as energy efficiency, net zero strategy, fire safety, air and noise pollution, and so on, to realise safe, healthy, and sustainable buildings – not just for the ‘new build’ regulations, but as a requirement for all existing premises and work environments. Industry, transport, hospitality, and leisure must all embrace the culture of IPC and impose the relevant measures as a norm. In June, the National Engineering Policy Centre (NEPC) published its report Infection resilient environments: time for a major upgrade.3


for improving the health of indoor environments, including: n The development of a clear baseline of what best practice in infection resilience looks like.


n The establishment by local authorities of in-use regulations to maintain standards of safe and healthy building performance over a building’s lifetime.


n That the Department for business, energy and industrial strategy, the Department for transport, and the Department for levelling up, housing and communities ensure major retrofit programmes address infection resilience in order to seize the opportunity created by the net zero strategy to make UK infrastructure safe, healthy, and sustainable.


n The creation of joined-up policy-making that will align infection resilient environments with net zero, safety, equality, and accessibility goals – key to which is the government identifying a lead department.


In addition to these, regular cleaning plays an essential role – for the building infrastructure (where ventilation is so important), washrooms, office and work equipment, floors, and, of course, our own personal hygiene and consideration for others. Hand washing techniques and practices


have been highlighted at intervals over the last 40+ years, but despite the original discovery of its importance in 1847 and even with World Hand Hygiene Day being celebrated on 5 May this year, how many of us really do it properly? Public washrooms and facilities are


generally inadequate – Semmelweis, Lister and Pasteur would no doubt turn in their graves.


The wearing of face coverings is commonplace, but the general public often do not really understand why, or which type to use; once again, the information is confusing, as are the principles of testing, staying apart, and isolation.


Conclusion The report made recommendations


In summary, arrangements for IPC compliance should include:


www.thecarehomeenvironment.com September 2022


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