Infection prevention & control in care homes
This information is written to provide a sign-post for residents, carers and their families about infection prevention and control in care homes. It has been written in response to questions we have been asked by relatives and carers of residents, and staff who work in care homes, including staff who are involved in giving personal care to residents with long-term conditions in their homes.
Guidance has been developed to help care homes and other healthcare providers meet requirements set out in codes of practice for the prevention and control of infections and associated legislation.
Residential care homes providing both personal care and additional nursing care are regulated by the Care Quality Commission in England, Care and Social Services Inspectorate in Wales, and the Care Inspectorate in Scotland, and have a duty to provide clean, safe care. Care homes that provide support for older people and younger adults and children all need to meet the regulators’ requirements to protect residents from the risks of healthcare associated infections. Guidance and support for staff is a top priority for the Departments of Health in the UK and also aims to provide reassurance to residents and their relatives.
Content and frequently asked questions
You can visit a resident who has an infection. However you should ask the staff for advice if someone who has a long-term health problem wants to visit a resident who has MRSA or C.diff. If there is an outbreak of an infectious illness, such as Norovirus, then staff may limit visiting, it depends on their local policy.
If you are unwell you should ask staff for advice about visiting.
You can touch or hug a resident who has an infection, however if you have any cuts or breaks in your skin it is advisable to cover these with a waterproof dressing. If you are fit and well then the risk of infection can be reduced by making sure you wash your hands when you enter the room and after you leave.
Sometimes it is necessary to ask a resident to remain in their own room if they have an infection. This would be for a short time until the risks of spreading the infection have passed. Risks could include diarrhoea and vomiting, symptoms of influenza or open, weeping wounds. Someone who is colonised with MRSA does not usually present a risk to other residents and this is not a reason to isolate a resident and require them to stay in their own room. The care home may have information leaflets they can give you to help you better understand certain infections, and staff won't mind you asking if you are concerned.
The care home will have its own arrangements for laundry and are required to follow strict guidelines for the handling of soiled linen. You should take advice from the staff about taking any laundry home to wash.
If you are doing washing for a resident or caring for someone at home with an infection you may wish to consider a separate wash. You can wash bedding and linen as normal at the hottest temperature suitable for the fabric. You may wish to consider using a using a bleach-based laundry product, however please be mindful of changing laundry powder or detergent if there is likely to be anyone with skin sensitivity in your household, and seek advice from your GP practice or the care home if in doubt.
Wash towels, bedding and underwear separately, taking care not to overload your machine. You can tumble dry or line dry and iron clothes as normal, although not scientifically proven, ironing may help to remove any harmful bacteria.
Remember to carry soiled linen in a sealed bag and to always wash your hands after you have handled soiled linen.
Staff wear gloves and aprons (sometimes referred to as personal protective equipment) for various reasons when caring for residents – one reason is because care staff have a lot of touch-contact with large numbers of residents during their work and this is why precautions such as gloves and aprons are worn – to limit the number of germs that are picked up on their hands – however, it's important that staff clean their hands at certain important moments such as in between touching residents. They will be happy to discuss whether you need to be aware of any infection risk, and will inform you if you need to wear any gloves or aprons when visiting, it's very unusual that you would be asked to do this however. If you have any doubts then it is advisable to ask.
Good hand hygiene at the right moments is one of the most effective ways of preventing infection from spreading. If you feel that staff, visitors or residents who may need help with hand hygiene are not doing this effectively then speak to a member of staff.
Washing hands after visiting the toilet, before preparing food and before eating is important. It is also important for staff or anyone giving care to a resident to clean their hands before and after giving care. Some care homes make hand sanitizers available to help staff quickly and efficiently clean their hands at the right times.
To clean hands effectively use the technique recommended by the National Patient Safety Agency. As a guide using this technique takes about as long as it takes you to recite the alphabet or sing happy birthday twice.
The animation below shows how to wash hands effectively:
- Wet hands
- Apply liquid soap
- Rub hands palm to palm
- Rub right palm over back of left hand
- And left palm over back of right hand
- Palm to palm fingers interlaced
- Back of fingers to opposing palm with fingers interlocked
- Rotational rubbing of right thumb clasped in left palm
- Rotational rubbing of left thumb clasped in right palm
- Rotational rubbing backwards and forwards with clasped fingers in palms (to clean around and under fingernails)
- Dry with paper towels
Minor infections do not usually present a problem to people in relatively good health. However it is always wise to err on the side of caution when caring for frail or elderly residents. The Department of Health have issued new guidance on the prescribing of antibiotics because of the increasing numbers of infections that have become difficult to treat due to some bacteria building up resistance to the antibiotics. Provided staff are aware of your relative's condition then this should be OK.
If your relative is showing any of the symptoms listed below however, then phone the GP for advice if you are not sure how urgent the symptoms are:
- If they develop a severe headache and are sick
- If their skin is very cold or has a strange colour, or they develop an unusual rash
- If they feel confused or have slurred speech or are very drowsy
- If they have difficulty breathing, this includes breathing quickly; turning blue around the lips and the skin below the mouth; the skin between or above the ribs getting sucked or pulled in with every breath.
- If they develop chest pain
- If they have difficulty swallowing or are drooling
- If they cough up blood
- If they are feeling a lot worse
In England the Department of Health guidance "Prevention and control of infection in care homes - an information resource" published 18 February 2013, provides links to resources for managers and staff, including the training and skills that are required for the provision of clean, safe care.
NHS Scotland has developed standards “Infection Control Standards for Adult Care Homes” published 14 March 2005.
NHS Wales has developed guidance “Infection prevention and control guidelines/ resource for care homes in Wales” published 23 Jan 2014
What the guidance covers
The steps taken in care homes to protect residents and staff from infection are an important part of providing care, particularly as some infections can spread where more vulnerable people share eating and living accommodation. It is important to be aware of the possibility of infection in residents and for care workers to be able identify these promptly.
Infections can sometimes be serious and can worsen existing medical conditions and adversely affect recovery. Infections may be caused by germs that are resistant to antibiotics and the reports on TV and in the newspapers may alarm residents, their relatives and carers.
It is important that clear information on the standards of infection prevention and control in care homes is available to allow informed choice and promote confidence in the quality of care provided. Families and carers will want to be assured that the care their relatives and dependants receive is provided in a clean and safe environment.
The guidance aims to provide care home managers, regulators, Public Health England, Public Health Wales and Health Protection Scotland with a common source of information on the prevention and control of infection in care homes. Not all information in the guidance will be relevant to all care homes.
Reference sources and practical guidance on the management and control of healthcare associated infections in care homes
For England - Department of Health guidance "Prevention and control of infection in care homes - an information resource" published 18 February 2013
For Wales - NHS Wales has developed Infection prevention and control guidelines and resources for care homes in Wales (23 Jan 2014) and national minimum standards for care homes in Wales (2004)
For Scotland - NHS Scotland has developed Infection Control Standards for Adult Care Homes (March 2005)
Clostridium difficile infection: Guidance on management and treatment - Public Health England, June 2013- This document supersedes relevant sections of Clostridium difficile infection: How to deal with the problem (below)
Clostridium difficile infection: How to deal with the problem - Department of Health and Health Protection Agency December 2008
National Institute for Health and Care Excellence (NICE) quality standard [QS113]: Healthcare-associated infections - Published date: February 2016 - Information resource added 17 February 2016
National Institute for Health and Care Excellence (NICE) quality standard [QS110]: Pneumonia in adults - Published date: January 2016 - Information resource added 17 February 2016
Page last reviewed: 01/06/2015
Next review due: 01/06/2018
(c) MRSA Action UK 2015