This week I carried out a search of the internet to see what advice there is available on the prevention and control of infection for providers of domiciliary care services. I was not surprised to find that there is far from enough. The focus of CQC and NICE is by far and away on the prevention and control of infection in managed social care facilities. While this is understandable, it should not detract from the importance of preventing and controlling infection in a service users’ home where I believe further advice is needed.
This blog article is based on the Bettal Quality Consultancy policy for domiciliary care services on the prevention and control of infection
Importance of prevention and control of infection in a service users’ home
Infection control in the domiciliary care setting is essential for reasons of safety, treatment and quality. With proper infection control, the need for hospitalisation is decreased and the Service Users quality of life improves.
In the past, domiciliary care often referred to the care of the elderly, but domiciliary care is now provided to service users of all ages and backgrounds. What once involved making service users comfortable and monitoring them at home, has now expanded to include invasive procedures and ventilator support, along with other care methods.
It follows then when the nature and type of domiciliary care increases so does the need to provide a safe environment is also increased. If staff follow the proper procedures, the risk of infection will become greatly reduced.
Understanding how infections are transmitted
In order to provide effective infection control in a service users home, staff must understand how infections are transmitted. Infections are often transmitted through direct contact. Direct contact involves the direct physical transfer of germs from person to person by body-to-body contact or surface-to-body contact. This contact often occurs while bathing or turning a Service User.
Infections are spread from indirect contact, as well. Indirect contact involves contracting an infection from hands or an object. This most often occurs while touching a service user or changing soiled clothing or soiled bedding. Other common objects that can transmit infections include phones and TV remote controls.
Legislative responsibilities
Domiciliary care agencies are required to comply with the following legislation when delivering care services:
(a) The Health and Safety at Work Act, etc 1974 and the Public Health Infectious Diseases Regulations 1988.
(b) The Reporting of Incidents, Diseases and Dangerous Occurrences Regulations 1995. Places a duty on an agency to report outbreaks of certain diseases as well as accidents such as needle stick accidents.
(c) The Control of Substances Hazardous to Health Regulations 2002 (COSHH). Places a duty on an agency to ensure that potentially infectious materials within the agency are identified as hazards and dealt with accordingly.
(d) The Environmental Protection Act 1990. Places a duty on an agency, to dispose of clinical waste safely.
(e) The Food Safety Act 1990. Places responsibility on our Agency to ensure that all food prepared in Service Users homes for Service Users is prepared, cooked, stored and presented in accordance with the high standards required by the Food Safety \ Act 1990 and the Food Hygiene (England) Regulations 2005.
Infection control
Standard Infection Control precautions are ways that staff can prevent the transmission of infection from one person to another. The domiciliary care agency should ensure that systems are in place to:
Carry out risk assessments to ascertain how susceptible Service Users are and any risks that their environment and other users may pose to them.
Ensure staff provide and maintain a clean environment in a Service Users home as far as is practical.
Provide suitable accurate information on infections to Service Users and their visitors.
Provide suitable accurate information on infections to any person concerned with providing further support or nursing/medical care in a timely fashion.
Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people.
Ensure that all staff are fully involved in the process of preventing and controlling infection.
Staff adhere to policies, designed for the individual’s care that will help to prevent and control infections.
Ensure, so far as is reasonably practicable, that care staff are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care.
Hand washing
Effective hand washing is the most important means of preventing infection. Staff must ensure that hand washing, and disinfectant of hands takes place:
Before and after each service user contact. that typically means washing hands in the service users’ home before they leave or using an alcohol rub when they get back to their vehicle before driving on to the next home visit.
After contact with environmental surfaces or medical equipment used by or located near the service user;
After removing latex gloves;
After contact with body fluids, mucous membranes, non-intact skin or wound dressings;
After using the bathroom;
Before and after eating;
After sneezing or coughing;
When hands are visibly contaminated.
Summary
It would seem to me that more information on prevention and control of infection should be made available to providers of domiciliary care services along with a focus upon staff training. The involvement of care staff in maintaining a safe environment free from infection is important to the service user’s health and their quality of life.
Albert Cook BA, MA & Fellow Chartered Quality Institute Managing Director Bettal Quality Consultancy