Coronavirus (COVID-19) Infection Prevention and Control ... · for Nursing & Residential Care Homes Version 1.3 14th May 2020. What is Coronavirus and COVID-19 Inform Promote Sustain

Inform Promote Sustain

Coronavirus (COVID-19)

Infection Prevention and Control

for Nursing & Residential Care Homes

Version 1.3 14th May 2020

What is Coronavirus and COVID-19


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


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


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


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


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


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


Ensure patients

have hand wipes

or alcohol gel

available

Hand Hygiene in care

of all residents

Immediately before touching a resident

Immediately after touching a resident or

their surroundings

After removing gloves


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


How to hand

wash


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/

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


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


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


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

of care


Fluid Resistant

Surgical Masks Masks protect:

o your nose & mouth from respiratory droplets from residents

o 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

o you could transfer virus to your hands

Wear the mask on your face – NOT round your neck

Remove and discard the mask when:

o you take a break or finish your shift

o it is damp, soiled, uncomfortable, difficult to breathe


Eye Protection

Wear for direct contact with residents if there is a

risk of respiratory droplets getting into eyes

o 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



Watch the video https://youtu.be/ozY50

PPmsvE

https://youtu.be/ozY50PPmsvE


Take PPE off

carefully to

avoid

contaminating

yourself


https://youtu.be/o

zY50PPmsvE

Watch the video



Summary of PPE


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


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

http://www.gov.uk


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


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


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













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













































Collecting COVID-19 samples

Equipment required:

o Plastic apron

o Fluid resistant surgical face mask

o Eye protection

o Gloves

o Viral swab

Swab the back of the throat

(each side), then nose

Offer a tissue and water

afterwards


Sending COVID-19 swabs for testing

Insert swab into transport media

Snap the stick at the line &

securely close

Complete label

o name, date of birth and NHS number

o sample type = ‘nose & throat’

Place sample in 2 bags

Complete E28 form


https://www.gov.uk/gover

nment/publications/testin

g-for-wuhan-novel-cov-

2019-ncov

Break at line

https://www.gov.uk/government/publications/testing-for-wuhan-novel-cov-2019-ncov















How to take nose and throat swab


https://youtu.be/9WayjX6vCdk

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


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)


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

o store securely for 72hrs and discard as household

waste


Laundry from rooms of

residents with COVID-19

Linen and clothing can be decontaminated by

usual washing process

Treat as infectious waste

o Place directly into alginate (dissolvable) bag

o Place this into an outer plastic bag outside the room

o 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


Staff uniform and safety at home

Personal hygiene

Wash hands and forearms

before leaving the home

Wash hands again when arrive

home

o Virus easily removed by soap

and water and alcohol gel

Personal items do not need to

be decontaminated

o 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.


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:

o Preferably 1000ppm chlorine disinfectant

o If another disinfectant (check efficacy with manufacturer)

o 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


Cleaning staff

Clinical

Gloves

Plastic

Aprons

Fluid Resistant

Mask

Eye

protection

Period of use Single use Session of care

Cleaning ✔ ✔ ✔ Assess

risk


Ensure they know what PPE they should wear and

have received training

Clean all surfaces in resident rooms

o especially high touch areas e.g bedrails, bathrooms

Discard cleaning solution at a disposal point

o 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


Cleaning room of resident with

COVID-19 who has died Clean all surfaces

o high level windows, ledges and sills, curtain rails

o lower level windows, ledges and sills

o furniture, fixtures and fittings, en-suite rooms

o door handles, light switches, soap & towel dispensers

Clean all surfaces of mattress and bed

o 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


Staff with COVID-19

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

into work and inform you manager:

o fever of more than 37.8oC and new persistent cough

o other symptoms of respiratory infection

Self-isolate at home for 7 days from onset of symptoms

o 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

o If your symptoms worsen contact NHS 111

If a member of your family develops symptoms

o Arrange for them to have a COVID-19 test (if possible)

o If this is negative you can return to work

o If no test or test is positive then self-isolate for 14 days

Staff at high risk of complications from COVID-19

o risk-assessment to manage if and where they can work


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

one 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


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


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










https://www.ips.uk.net/professional-practice/resources1/covid-19-advice-and-guidance/.XqVO5hd7mV4











https://www.ips.uk.net/files/5415/8713/0634/Joint_IPS_BACCN_Position_Paper__-_COVID19_Visiting_at_the_End_of_Life_Final.pdf



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





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/


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

Documents

Coronavirus (COVID-19) Infection Prevention and Control ... · for Nursing & Residential Care Homes Version 1.3 14th May 2020. What is Coronavirus and COVID-19 Inform Promote Sustain