Inform Promote Sustain Coronavirus (COVID-19) Infection Prevention and Control for Nursing & Residential Care Homes Version 1.3 14 th May 2020
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
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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
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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
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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
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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
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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
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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
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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
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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
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How to hand
wash
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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/
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
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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
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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
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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
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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
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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
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Watch the video https://youtu.be/ozY50
PPmsvE
Take PPE off
carefully to
avoid
contaminating
yourself
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https://youtu.be/o
zY50PPmsvE
Watch the video
Summary of PPE
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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
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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
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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
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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
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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
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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
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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
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https://www.gov.uk/gover
nment/publications/testin
g-for-wuhan-novel-cov-
2019-ncov
Break at line
How to take nose and throat swab
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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
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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)
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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
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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
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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.
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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
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Cleaning staff
Clinical
Gloves
Plastic
Aprons
Fluid Resistant
Mask
Eye
protection
Period of use Single use Session of care
Cleaning ✔ ✔ ✔ Assess
risk
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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
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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
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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
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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
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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
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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/
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