Surrey Skills Academy with Support from Health Education Kent Surrey Sussex

Surrey Skills Academy with support from Health Education Kent Surrey Sussex

The Care Certificate Framework For Adult Social Care Workers & Healthcare Support Workers

Name of Learner: Click here to enter text.

Role: Click here to enter text.

Organisation: Click here to enter text.

Mentor: Click here to enter text.

Assessor: Click here to enter text.

Date started: Click here to enter a date.

of 20 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

The Care Certificate Framework

Infection prevention and control

Standard 15 Main areas:

 I will prevent the spread of infection

Links:

Compassion in Practice (6 C’s):

2 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

Care, Compassion, Competence, Communication, Courage and Commitment Standard 15

This standard is about the spread of infection and identifies the main routes by which infection can get into the body and how your own health or hygiene might pose a risk to the individuals you support. It then looks at common types of personal protective clothing, equipment and procedures, including hand- washing and the principle of handling infected / soiled linen and clinical waste.

An infection can be defined as, the invasion and multiplication of micro-organisms such as bacteria, viruses, fungi and parasites that are not normally present within the body. An infection may cause no symptoms and be subclinical, or it may cause symptoms and be clinically apparent. An infection may remain localised, or it may spread through the blood or lymphatic vessels to become systemic (body-wide).

The mode of transmission is the method by which an infectious agent passes from one person or place to another, and it is important to be aware of this, when we explore later how to implement the measures required to prevent it. The different modes of transmission include: -  Direct contact This is person to person spread of infection through physical contact between people.  Indirect contact This occurs when someone comes into contact with a contaminated object.  Insects (vector transmission) This is where insects can for example bite someone, e.g. mosquitoes and malaria.  Droplet This occurs when people sneeze, cough or talk and they expel droplets of respiratory secretions and saliva. These droplets will travel about one metre from the person expelling them and may contain agents responsible for respiratory infections such as flu or tuberculosis.  Airborne Airborne also involves droplets or particles containing infectious agents, but on a small enough scale that the particles can remain suspended in the Page 3 of 20 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

air for long periods of times, and this may include such infections as measles or chicken-pox.  Parental This occurs when blood or other body fluids containing infectious agents come into contact with mucous membranes or exposed tissue.  Faecal-oral This is the route of much of the gastrointestinal illnesses and water and food-borne disease.

Based on the above the common entry points for infection include:  Gastrointestinal tract (through the mouth or anus – affecting stomach to the bowels)  Upper Respiratory tract (through the nose and mouth - affecting the lungs)  Urogenital tract (affecting the urinary tract)  Broken / Injured skin  Blood  Mucous membranes (through eyes)

It is important to consider the chain of infection, when looking at how infections are spread:

Fig 1 – The Chain of Infection 4 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

The stages of the chain of infection: -  Infectious agent – An organism with the ability to cause disease. The greater the organism's ability to grow and multiply, ability to enter tissue and ability to cause disease, the greater the possibility that the organism will cause an infection. Infectious agents are bacteria, virus, fungi, and parasites.  Reservoir - A place within which micro-organisms can thrive and reproduce. For example, micro-organisms thrive in human beings, animals, and inanimate objects such as water, table tops, and doorknobs.  Portal of exit - A place of exit providing a way for a micro-organism to leave the reservoir. For example, the micro-organism may leave the reservoir through the nose or mouth when someone sneezes or coughs. Micro-organisms, carried away from the body by faeces, may also leave the reservoir of an infected bowel.  Mode of transmission - Method of transfer by which the organism moves or is carried from one place to another. The hands of the health care worker may carry bacteria from one person to another.  Portal of entry - An opening allowing the micro-organism to enter the host. Portals include body orifices, mucus membranes, or breaks in the skin. Portals also result from tubes placed in body cavities, such as urinary catheters, or from punctures produced by invasive procedures such as intravenous fluid replacement.  Susceptible host - A person who cannot resist a micro-organism invading the body, multiplying, and resulting in infection. The host is susceptible to the disease, lacking immunity or physical resistance to overcome the invasion by the pathogenic microorganism.

Infections will spread if all stages of this chain are complete, preventing infection means breaking the links in the chain so that an infection cannot spread.

Clients receiving health and social care are at risk of developing infection as a result of their compromised state of health, underlying medical conditions, or as a result of contact with health care interventions. In addition, health or social care settings can provide ideal conditions for micro-organisms to be transmitted between those who Page 5 of 20 Surrey Skills Academy with support from Health Education Kent Surrey Sussex receive and give care. The close proximity and contact between each party and the continuous contact in a shared working and living environment all contribute to transmission. Micro-organisms by their very nature are opportunistic, exploiting chances to grow or enter the body, which may result in infection.

Health care associated infections (HCAIs) may be caused by a large number of different micro-organisms, a significant proportion of which are avoidable if sustainable and robust systems are in place to manage risks associated with infection. HCAIs are not confined to hospitals, and health care / social care workers who practice in community settings (including GP surgeries, clients own homes and care homes) all have the same responsibilities to prevent opportunities for infection to occur.

Hand washing is the single most important measure in reducing cross-infection but studies have shown that it is rarely carried out in a satisfactory manner. The areas of the hands which are often missed are the wrist creases, thumbs, finger tips and under the finger nails. Under jewellery is also an area where germs multiple and are not clean satisfactory during hand-washing. This is the reason jewellery should, be kept to an absolute minimum (e.g. wedding band only), and removed while washing hands. Hands should be washed:  Before you handle food  Before giving out any medicines  Before handling any wounds  Before and after each work shift or work break  Before and after physical contact with each client  After you have used the lavatory  After assisting others to use the lavatory  After you cough, sneeze or use a tissue/hankie  After handling any dressings or wounds  After making beds  After handling rubbish  After handling raw food

 After handling dirty or soiled laundry  After handling contaminated items such as bedpans, urinals, and urine drainage bags  Whenever hands become visibly soiled  After performing any personal grooming (e.g. touching your hair, nose, ears, arm-pits, etc)

This can be summarised, by linking to the 5 moments of Hand Hygiene issued by the World Health Organisation (WHO), see below:

Fig 2 – 5 moments of Hand Hygiene from WHO guidance

Hand washing should be performed as follows:

Fig 3 – Hand-washing technique – Health Protection Agency

Individuals you care for and support may have low immunity due to illness, side effects of medication or poor nutrition. Therefore these individuals are at a higher risk (vulnerability) of catching an infection or communicable disease. The most common risk is through direct contact with an infectious person, or via an un-clean / infected / used piece of equipment such as commodes, wheelchairs, and hoists. A high standard of personal hygiene will need to be applied, as well as ensuring all equipment is properly cleaned before use.

Your own personal and general hygiene therefore plays an important part in infection control.  Your nails – should be kept short and free from dirt. You may need to give serious consideration to this if you usually have long or false nails, as these can contribute to the risk of cross infection  Your hair – should be clean, and tied up / away from the face if it is long. Hair can come into contact with infectious agents (e.g. bodily fluids) and / or be an infectious agent if not attended to properly  Your personal jewellery – should be removed apart from a wedding band. Infection can be found under the jewellery or within stones. It can damage skin surfaces during moving and assisting, or by accident.  Your clothing – regularly laundered and footwear kept clean, (if moving and assisting is part of your role, you will need to ensure that your shoes fully cover your toes, support the whole foot including the ankle, and is of a material that provides adequate support and protection) 8 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

You should inform your line manager if you are in contact with contagious diseases outside of work; as you could be carrying the infection to other people, and putting others at risk. Diarrhoea and / or vomiting can be very serious for older adults and very young children and can cause them to lose a large percentage of their body fluid supply. You should therefore report to your line manager any episodes of diarrhoea and / or vomiting and not attend work.

The use of personal protective clothing and equipment may vary slightly, according to the setting that you are working in, but can include:-  Uniforms Reasons – they are worn within some organisations to reduce the risk of pathogenic organisms being transferred from the outside environment on the care workers clothing to the client and also to prevent pathogenic organisms from the client being transferred outside the care environment. See individual organisations policy on this  Gloves Reasons – according to the World Health Organisation (2009), gloves are worn for 2 main reasons: 1. To reduce the risk of contamination of health-care workers hands with blood and other body fluids. 2. To reduce the risk of germ dissemination to the environment and of transmission from the health-care worker to the patient and vice versa, as well as from one patient to another. Gloves are therefore only required when there is a need to deal with infected materials, such as bed pans, drainage bags, wound care and dressings, or when dealing with blood, bodily fluids, mucous membranes or broken skin. Gloves should not be worn when dealing with some aspects of personal care e.g. dressing; unless it is in the care / support plan. Sterile gloves, packed as a pair are used for clinical procedures.  Aprons Reason – like gloves, an apron provides a physical barrier between the care worker and other surfaces. Different colour aprons are used, depending on task being completed, see individual organisational policy on this, but can include white, blue, red and green. Page 9 of 20 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

 Masks Reasons – are used to protect healthcare workers from blood or body fluids where there is a risk of airborne or droplet route infections being transmitted. At times, they can also be used when the client is particularly susceptible to infections, i.e. if they are immunosuppressed.  Goggles Reasons – are worn to try and prevent blood or body fluids being splashed into the eyes.  Hats Reasons – they are not commonly used outside of the operating theatre, although it is best practice for the chefs to wear catering style hats to ensure that their hair does not fall into the food.  Shoes It is important that shoes are not open toed because this will reduce the risk of infection if blood or body fluids are spilt. In some specific clinical areas, it is important that the footwear is not worn outside that specific, area; otherwise there is a risk of organisms being carried into that environment.

Gloves need to be applied and removed as follows: -

Fig 4 – Application and removal of disposable gloves (Gloves Use Information Leaflet, WHO, 2009)

When handling infected or soiled linen and clinical waste, the procedure you follow, will depend on your working environment. Waste can be defined as “any substance or object the holder discards, intends to discard or is required to discard” European Parliament, 2008. Waste material produced in either health or social care may carry a risk of infection to people who are not directly involved in providing healthcare but who are involved in the transport or disposal of that waste.

It is therefore important to ensure that waste is disposed of appropriately and in line with your organisational policy on this.

Where organisations have clinical waste collections, a colour coding scheme is in use: - Colour Waste

Yellow Waste which requires disposal by incineration Yellow sharps box Needles, syringes or other sharp instruments Orange Waste which may be “treated” Yellow / black Offensive waste Purple Cytotoxic waste Black Domestic waste

Fig 5 – Examples of colours of waste disposal

Clinical waste means any waste which consists wholly or partly of:  Human or animal tissue – usually applies to hospital and / or research environments  Blood or body fluids  Excretions  Incontinence pads  Swabs or dressings  Syringes, needles or other sharp instruments – yellow sharps box

However, at times when working in the community, there is no provision for clinical waste collections in which case, clinical waste is double bagged and placed in the normal household rubbish – so it is imperative you check your organisations policy on this.

Infection can be transferred between contaminated and uncontaminated items of clothing, laundry and the environments in which they are stored. You need to be vigilant when dealing with heavily soiled linen / washing, which should be washed immediately. Your working environment may make use of dissolvable red sacks for such items of linen / washing; again, check your policy for more information on this.

Spillages should be cleaned up as quickly as possible adhering to the Infection Control Policy and Procedures, again the location of your work will determine the guidelines you adhere to here, so check your organisations policy on this.

of 20 Surrey Skills Academy with support from Health Education Kent Surrey Sussex Standard 15 Workbook

Links:

Compassion in Practice (6 C’s) Care, Compassion, Competence, Communication, Courage and Commitment Standard 15.1 – Prevent the spread of infection

15.1a Describe the main ways that infection can enter the body

1. Click here to enter text.

15.1a Describe the main methods of transmission that would enable infection to be passed on 1. Click here to enter text.

15.1c Describe how your own health or hygiene might pose a risk to the individuals you support or work with Click here to enter text.

15.1d List the common types of personal protective clothing, equipment and procedures you may use and explain how and when to use them Type When to use How to use 1. Click here to enter text. Click here to enter text. Click here to enter text.

2. Click here to enter text. Click here to enter text. Click here to enter text.

15.1e Explain how you handle infected or soiled linen and clinical waste within your organisation. If you come into contact with different types of clinical waste, then specify each one 1. Infected or soiled linen Click here to enter text.

2. Clinical waste Click here to enter text.

Standard 15

of 20 Surrey Skills Academy with support from Health Education Kent Surrey Sussex Observation

Links:

Compassion in Practice (6 C’s) Care, Compassion, Competence, Communication, Courage and Commitment Standard Observation Signature & Date of observation 15.1b Demonstrate Click here to enter text. Click here to effective hand enter text. hygiene Click here to enter a date. 18 Surrey Skills Academy with support from Health Education Kent Surrey Sussex

Standard 15

Outcome To meet this standard Assessment Evidence Date Provided signed off Prevent the 15.1a Describe the main Assessed by any of the Choose Click spread of ways an infection can get following methods: an item. here to infection into the body - 1:1 discussion enter a - Group work date. - Written 15.1b Demonstrate effective The assessment must Choose Click hand hygiene be observed in the an item. here to workplace as part of enter a the normal work duties date. 15.1c Explain how their own Assessed by any of the Choose Click health or hygiene might following methods: an item. here to pose a risk to the individuals - 1:1 discussion enter a they support or work with - Group work date. - Written 15.1d List common types of Assessed by any of the Choose Click personal protective clothing, following methods: an item. here to equipment and procedures - 1:1 discussion enter a and how and when to use - Group work date. them - Written 15.1e Explain the principles Assessed by any of the Choose Click of safe handling of infected following methods: an item. here to or soiled linen and clinical - 1:1 discussion enter a waste - Group work date. - Written

I am satisfied with the evidence of learning that it meets all the required standards.

Assessor’s Name: Assessor’s Position: Click here to enter text. Click here to enter text. Signature: Date: Click here to enter text. Click here to enter a date. Learner’s Signature: Date: Click here to enter text. Click here to enter a date.