COVID-19 and infection control procedures in care settings during a pandemic

Topics covered: care homes, COVID-19, CQC, infection control

As providers will know, CQC tend to inspect infection control under Regulations 12 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 12 states that care and treatment must be provided in a safe way for service users and providers are responsible for ‘assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are health care associated’. Regulation 15 states that all premises and equipment used by the service provider must be clean and providers must maintain standards of hygiene appropriate for the purposes for which they are being used’.

In this article I consider the latest guidance in relation to infection control measures during the COVID-19 crisis.

Infection control and COVID-19

The Department of Health and Social Care, Public Health England and other public health authorities for Wales, Northern Ireland and Scotland have issued joint guidance titled, “COVID-19: Guidance for infection prevention and control in healthcare settings”. A copy of the guidance can be accessed here

The guidance discusses the importance of limiting transmission of COVID-19 in healthcare settings through the use of various infection prevention and control measures for example, maintaining separation in space and/or time between suspected and confirmed COVID-19 patients.

It is acknowledged in the guidance that it is impossible for healthcare settings to carry on with a ‘business as usual’ approach during the COVID-19 pandemic. Instead, the guidance recommends that providers should assess their facilities’ current capabilities. In particular, assessing the practical ability to deliver care and implement control measures under the pressure of an increase in service users with suspected or diagnosed COVID-19 and reduced staff numbers due to staff sickness. It is also a sensible time for providers to assess the current workforce and staffing levels.

Segregation/ isolation in a healthcare setting

In all healthcare settings, patients with symptoms of COVID-19 should be segregated from non-symptomatic patients as promptly as possible. With regards to care homes, the guidance states that, Isolation within a care home for a known/suspected infection can be achieved in the persons’ bedroom in most cases. Residents should remain in their bedroom whilst considered infectious (as described above) and the door should remain closed (if unable to isolate the individual then this should be documented).”

If providers have not already done so, they may want to determine how a service would manage if areas for isolation rooms needed to be created including identifying potential areas that could be converted effectively with minimum modifications.

Personal Protective Equipment (PPE)

Employers are under a legal obligation, under control of substances hazardous to health (COSHH) regulations, to adequately control the risk of exposure to hazardous substances where exposure cannot be prevented. The provision and use of personal protective equipment (PPE) assists with this. Employees also have a duty to utilise any control measures, including PPE, provided by their employer. Before undertaking any procedure, staff should assess any likely exposure and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken. All staff should be trained in the proper use of all PPE that they may be required to wear.

As many providers have experienced during the COVID-19 crisis, there have been distribution issues with PPE. On 18 March 2020, the Department of Health and Social Care released a statement about PPE for the care sector, stating that there would be free distribution of fluid repellent facemasks from the pandemic flu stock and that every care home would receive at least 300 facemasks with an estimated delivery date of 24 March 2020.

Currently, health authorities across the UK say equipment such as masks, gloves and gowns should only be used if patients have suspected symptoms or have been diagnosed with coronavirus. Guidelines from the World Health Organisation currently recommend health staff wear a full gown and visor.

According to BBC News, the UK is due to update its guidance for healthcare workers on the use of personal protective equipment (PPE) within two days. Watch this space!

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