Coronavirus (COVID-19): clinical guidance for the management of our clients accessing the care at home service.
This clinical guidance was published by the government on 06 Aug 2020 which expect care packages to continue to be delivered during the coronavirus pandemic. Epitome Home Care will keep the workers up to date with the latest information.
This guide highlights essential practical actions to support good infection control practice during COVID-19, particularly hand and cough hygiene and personal protective equipment (PPE). It signposts to some of the key measures you will need to protect yourself and others when providing care and support for people, including those with suspected or confirmed COVID-19.
Care at Home during the coronavirus (COVID-19) pandemic
Covid-19 is spread directly through close contact with an infected person (within two metres) and indirectly through touching a surface, object, or the hand of an infected person. Infection prevention and control precautions are of critical importance to reduce the spread of the virus and keep ourselves, workers, and the people and the people and families we support safe in their homes.
Standard infection control precautions (SICPs)
SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmission of infectious agents (germs) from both recognised and unrecognised sources of infection.
SICPs should be applied for all individuals at all times in all care settings, whether infection is known or not.
Sources of infection include blood or other body fluids, non-intact skin, mucous membranes, and any equipment in the care environment which could be contaminated.
The 10 SICPs are listed below, and you will get more detail in this resource and in the national guidance identified.
- Patient placement/assessment for risk
- Hand hygiene
- Respiratory and cough hygiene
- Personal protective equipment (PPE)
- Safe management of care equipment
- Safe management of the care environment
- Safe management of linen
- Safe management of blood and body fluid spillages
- Safe disposal of waste (including sharps)
- Occupational safety: prevention and exposure management (including sharps)
Transmission-based precautions (TBPs)
TBPs are applied when SICPs alone are insufficient to prevent cross transmission of an infection.
TBPs are categorised by the route of transmission of the infection.
Droplet precautions are used to prevent and control infection transmission via droplets from the respiratory tract of an infected individual onto the eyes, nose and mouth (mucosal and conjunctivae surfaces) of another non-immune individual. Droplets are greater than five micrometres (μm) in size and droplet precautions are to prevent transmission of infection over short distances (one metre).
Droplet precautions include personal protective equipment (PPE) such as respiratory protective equipment (face masks).
Contact precautions are used to prevent and control infection transmission via direct contact with the patient or indirect contact with the equipment/environment.
Airborne precautions are used to prevent, and control infections spread via aerosols from the respiratory tract of one individual directly onto the eyes, nose, and mouth (mucosal and conjunctivae surfaces) of another individual. Aerosols are smaller than droplets, at less than or equal to 5 micrometres (5μm) in size. As aerosols are airborne, infection can be spread without necessarily having close patient contact. Aerosols penetrate the respiratory system to the alveolar level.
COVID-19 is considered to spread by contact and droplet-type transmission. However airborne transmission is possible through Aerosol Generating Procedures (AGPs).
Symptoms and how COVID-19 is spread.
Common symptoms include a new continuous cough, fever, or loss of/ change in sense of smell or taste.
Older people, very young people, people with underlying health conditions or who are immunocompromised may present with atypical or non-specific symptoms.
COVID-19 is spread through respiratory droplets produced when an infected person coughs or sneezes. This is thought to be the main way the infection is transmitted between people and is most likely to happen when there is close contact (within two metres) with an infected person who is symptomatic. It is likely the risk of infection transmission increases the longer someone is in close contact with an infected person.
There are two routes for COVID-19 to spread.
- Directly: from close contact with an infected person (within two metres) where respiratory secretions can enter the eyes, mouth, nose, or airways. This risk increases the longer someone is in close contact with an infected person who has symptoms.
- Indirectly: by touching a surface, object or the hand of an infected person that has been contaminated with respiratory secretions and then touching your own mouth, nose, or eyes.
Standard Infection Control Precautions:
- Hand Hygiene
Hand hygiene (hand washing) procedures Hand hygiene should be performed for AT LEAST 20 seconds.
Preparation:
- Gather all relevant equipment and ensure that everything which is needed to perform hand hygiene is present.
- Ensure the sink area is CLEAR.
- Ensure wrists and forearms are exposed, jewelry must be removed.
- Ensure nails are short (false nails must not be worn)
PROCEDURE:
- The tap should first be turned on and the temperature of the water checked. Water should be warm.
- Hands should be wet before applying the chosen solution.
- Apply solution provided, manufacturers’ instructions for the solution being used should give guidance as to the volume to be applied (this is usually in the region of 3mls).
- A good lather is required to perform adequate hand hygiene.
- All areas of the hands should be covered.
- The hand washing procedure should take at least 15 seconds.
- Hands should be rinsed well under running water with the hands uppermost so that the water runs off the elbow.
- Taps should be turned off using a ‘hands-free’ technique, e.g., using the elbows, where ‘hands free’ tap systems are not in place, paper towels used first to dry hands can then be used for turning taps off.
- Hands should be adequately dried using disposable paper towels.
- Dispose of the paper towels in the appropriate waste bin without re-contaminating your hands e.g., use the foot pedal. Do not touch bin lids with hands.
- Do not use a nailbrush to perform hand hygiene cleaning.
- Bar soap should not be used by staff for hand hygiene.
Hand hygiene using alcohol-based hand rub
These products are useful for performing hand hygiene when sinks are not readily available for hand washing or when hands may be contaminated but are not visibly soiled e.g., entering, or leaving premises. Alcohol-based hand rub can also be used following hand washing to provide a further cleansing and residual effect.
Procedure for alcohol-based hand rub
The amount/volume used to provide adequate coverage of the hands should be indicated in the manufacturers’ instructions, this is normally around 3 ml. The steps to perform hand hygiene using alcohol-based hand rub are the same as when performing hand washing.
Hand hygiene and jewelry
It has been shown that contamination of jewelry, particularly rings with stones and/or jewelry of intricate detail, can occur.
Jewelry must be removed when at work to prevent the spread of micro-organisms by contact with contaminated jewelry.
It is acceptable to wear plain wedding bands however these must be moved or removed when hand hygiene is being performed to reach the bacteria which can collect underneath them.
ANNEX A; HANDWASHING TECHNIQUE USING SOAP AND WATER
ANNEX B; HAND HYGIENE USING ALCHOHOL HAND RUB
Respiratory Hygiene
Respiratory hygiene and cough etiquette should ALWAYS be applied as a standard infection control precaution. The measures include:
- Cover nose and mouth with disposable single use tissues when sneezing, coughing, wiping, and blowing noses.
- Dispose of used tissues into a waste bin.
- Wash hands with soap and water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions.
- Keep contaminated hands away from the mucous membranes of the eyes and nose.
Personal Protective Equipment (PPE)
Protecting yourself and others from the transmission of infection.
Personal protective equipment (PPE) is used to protect you while performing specific tasks that might involve contact with body fluids or blood that may contain infectious agents (germs).
During the COVID-19 pandemic wearing PPE is critical for health and social care workers, carers, and those receiving support and care.
PPE will only protect you and others if you:
- put it on, use it, remove it, and dispose of it in the correct manner.
- practice good hand, cough, and respiratory hygiene.
- follow standard infection prevention and control precautions (SIPCs)
- avoid touching your face.
Not following any of the above can lead to passing germs on.
What does national PPE guidance mean for me?
Your employer will have a policy on PPE including its supply, risk assessment and training in its use. If you have specific questions or concerns around these areas, please discuss them with your employer.
The information in this section is based on Health Protection Scotland’s COVID-19: Guidance for Domiciliary Care (updated 20 August 2020).
We will review the information given here so that it also fully aligns with section 7.5 Personal Protective Equipment in the new Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum (published January 2021).
What PPE should I use?
During COVID-19 common items of PPE social care workers can use when providing care in someone’s home include:
- disposable gloves
- disposable plastic apron or gown
- surgical mask
- eye/face protection.
Please check with your employer who will know which type of gloves you should wear for particular care activities.
How should I put on, remove, and dispose of PPE?
Before Putting on PPE remember to check what the required PPE is for the task/visit and make sure it is the correct size. You will also need to perform hand hygiene.
Infection Control Precautions during Coronavirus (COVID-19 19) pandemic.
- All staff have a responsibility to ensure that they comply with the principles of standard infection control precautions.
- All staff have a responsibility to encourage customers and their families to comply with the principles of standard infection control precautions.
- Report to the homecare manager, any deficits in knowledge or other factors in relation to SICPs,
- Attend induction and mandatory/update infection prevention and control education sessions and complete online infection control training modules as required.
- Report any illness which may be as a result of occupational exposure to the homecare manager.
- Not provide direct customer care while infectious as this could cause harm e.g., Vomiting and Diarrhea Any customer identified by staff as having such symptoms, will be referred to medical professionals and raise awareness with the care manager immediately and record this on the customers care plan daily record.
- Consider the elements of SICPs such as hand hygiene as an objective within staff continuing professional development ensuring continuous updating of knowledge and skills.
- Be aware of national policies, procedures regarding standard infection control precautions.
Personal Protective Equipment
Putting on PPE
PPE should be put on in a safe area either inside the home, such as a porch or a separate room. If there is no available area then the mask can be put on in immediately prior to entering the home, and gloves and apron when in the home.
The order you should put PPE on is:
- apron/gown
- surgical mask
- eye protection (where required)
- gloves.
This is the most practical way although the order for putting on PPE is less critical than the order of removal.
When putting on mask, position the upper straps on the crown of head and the lower strap at the nape of the neck. Mould the metal strap over the bridge of the nose using both hands.
When wearing PPE remember to:
- keep your hands away from your face and the PPE being worn
- change your gloves if are torn or heavily contaminated
- limit the surfaces you touch in the care environment
- always clean your hands after removing your gloves.
Removing and disposing of PPE
PPE should be removed before you leave the home and should not be worn outside or to the next visit. Remove PPE somewhere away from the main care area, for example the hall, and place in a waste bag (following the information about disposal below).
Hand hygiene must be carried out immediately after removing PPE.
If the person has COVID-19 PPE waste should be double bagged and held in the home and for 72 hours before disposal into the normal household waste stream for collection. The bag should be marked for storage for 72 hours (add date and time to the bag). If the person does not have COVID-19 PPE should be bagged as normal.
If the household/ individual has a special waste uplift for personal care items, PPE should be bagged and placed in this receptacle.
Do not go back into the care area or within two metres of the person receiving care.
To minimise cross-contamination you should apply the order below to remove PPE, even if you have not used all the items listed.
Removing gloves
- Grasp the outside of one glove with the opposite gloved hand and peel it off.
- Hold the removed glove in your gloved hand.
- Slide the fingers of your un-gloved hand under the remaining glove at your wrist.
- Peel this glove off and dispose both appropriately.
Removing an apron or gown
- Unfasten or break the ties.
- Pull the apron/gown away from your neck and shoulders, touching the inside of the apron/gown only.
- Turn the apron/gown inside out, fold or roll into a bundle and dispose of it appropriately.
Removing eye protection
- Handle by the headband or earpieces and dispose of them appropriately.
Removing a fluid resistant surgical facemask
You should remove your mask in the following order after leaving the care area.
- Untie or break bottom ties, followed by top ties or elastic.
- Remove by handling the ties only (as front of mask may be contaminated).
- For face masks with elastic, stretch both the elastic ear loops wide to remove and lean forward slightly.
- Dispose of mask appropriately.
- Perform hand hygiene immediately after removing all PPE.
Staying safe and well – you need care too.
You are likely to be under increased pressure over this period and you will need appropriate support.
It is crucial that we are all able to talk openly and honestly about our mental health and wellbeing, and that we have access to the right help and support when we need it. Looking after our mental health is just as important as our physical health.
Epitome Home Care will apply the principles of Standard Infection Control
The use of Personal Protective Equipment (PPE) is essential for health and safety.
For the purposes of this policy, the PPE described will be:
- Gloves.
- Aprons
When to wear gloves
Gloves must be worn for any procedure where contact with the customer in a personal care situation occurs i.e., washing, dressing, food prep etc.
PROCEEDURE
- Gloves should be donned by holding the wrist end of the glove open with one hand to allow the other hand to enter easily (do not wear jewelry other than a wedding band under gloves.
- Gloves must be worn as single use items. They are put on immediately before an instance of customer personal care and removed as soon as the activity is completed.
- Gloves are changed between different care or treatment activities for the customer.
- Never perform hand washing whilst wearing gloves, and never use products such as alcohol-based hand rub to clean gloves.
- Gloves are not a substitute for employing good hand hygiene, and this should be performed before donning gloves, immediately after the removal and disposal of gloves, and between every change of gloves. Therefore, compliance with hand hygiene measures is essential.
How to remove and dispose of gloves
- Gloves should be removed promptly after use and before touching non-contaminated/clean areas/items, environmental surfaces, or other persons (including the person wearing them).
- Gloves which have been worn for a procedure/activity should not be worn to handle or write on charts or to touch any other communal, clean surface.
- Care should be taken when removing used gloves to avoid contamination of hands and clothing.
- The wrist end of the glove should be handled, and the glove should be pulled down gently over the hand, turning the outer contaminated surface inward while doing so, i.e. the gloves are then disposed of inside out, preferably with the second glove also pulled over the first while removing it so that they are wrapped together.
- Used gloves should never be placed on environmental surfaces but disposed of safely and immediately following use.
- Hand hygiene should be performed immediately after the removal and disposal of gloves.
Aprons
Must be worn when in close contact with the customer and when there is a risk that clothing may be
contaminated with pathogenic micro-organisms or blood, body fluids, secretions, or excretions, except
for perspiration.
Aprons will be appropriate for use, fit for purpose and will avoid any interference during procedures. Never reuse or wash single-use disposable aprons.
When to change an apron and how to remove and dispose of it;
- Aprons should be changed between customer care procedures.
- It may be necessary to change aprons between tasks on the customer to prevent unnecessary cross-contamination.
- Remove aprons immediately once a task is finished.
- Torn or otherwise damaged aprons should not be used and should be removed immediately (safety permitting) if this occurs during a procedure.
- Remove aprons carefully to avoid contact with the most likely contaminated areas (e.g. the front surface), and prevent contamination of clothes under them. The outer contaminated side of the apron/gown should be turned inward, rolled into a ball and then the item should be discarded.
- Never place used aprons on environmental surfaces.
Management of Care Equipment
- Care equipment will be cleaned following use.
- Equipment should also be checked for cleanliness prior to use.
- Covers for items should be used where appropriate