Key measures for infection prevention and control

A guide for social care workers providing care in an individual’s home. Updated January 2021.


Introduction

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.

Before you use this guide please click below to read an important notice about national guidance, including the recently published Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum.


The guide is for social care workers providing support and care to people living in their own homes; particularly care at home and housing support workers, referred to as ‘domiciliary care’ in the national guidance. It acknowledges that many of the people you support may be in the shielding category.

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, as workers, and the people and families we support safe in their homes.

If you’re new to the workforce, please use this information and speak with colleagues if you need support. If you’re an existing social service worker, this information will update you in relation to the COVID-19 response and help you share learning with others as appropriate. If you wish to further your learning around COVID-19 practice issues, including infection prevention and control, the SSSC has further COVID-19 guides on our Learning Zone. NHS Education for Scotland (NES) has practical COVID-19 units ('Skills Bundles') for health and social care workers and many other resources on a dedicated TURAS Learn Infection Prevention and Control (IPC) zone.

This guide is based on, but does not replace, national guidance at the time of publication in particular the two resources below.

  1. The Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum provides specific guidance for community settings including health and social care services which are provided in people’s own homes. This addendum is part of the National Infection Prevention and Control Manual (NIPCM) which aims to ensure the safety of those being cared for, staff and others in the care setting. It sets out Standard Infection Control Precautions (SICPs) and Transmission Based Precautions (TBPs), both of which are included in this guide.

  2. The COVID-19: Guidance for Domiciliary Care from Health Protection Scotland which supports those working in domiciliary care settings and gives staff and users of their services advice about COVID-19. This includes staff who support and deliver care to people in their own homes (including supported living settings).

This guide has larger sections on hand and cough hygiene and PPE. Please also take some time to review the information below about how COVID-19 is spread, and the precautions we must all take to prevent this. You can find more detail in the national guidance.

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’ll get more detail in this resource and in the national guidance identified.

  1. Patient placement/assessment for risk
  2. Hand hygiene
  3. Respiratory and cough hygiene
  4. Personal protective equipment (PPE)
  5. Safe management of care equipment
  6. Safe management of the care environment
  7. Safe management of linen
  8. Safe management of blood and body fluid spillages
  9. Safe disposal of waste (including sharps)
  10. Occupational safety: prevention and exposure management (including sharps)

There’s more information about SICPs in chapter 1 of the NIPCM.

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).

Section 8.1 of the UK national guidance on PPE provides a list of AGPs.

There’s more information about TBPs in chapter 2 of the NIPCM.

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.

There is currently no vaccine to prevent COVID-19. Pages five to seven of the domiciliary care guidance include advice on general measures which we should all follow to help reduce the spread of COVID-19 and to protect people at increased risk of severe illness.

Information on general measures include links to national guidance on stay at home, test and protect, physical distancing, shielding and face coverings.

The domiciliary care guidance also provides further detail on the points below which are specific to your role.

1. Cleaning and disinfection, including care equipment

COVID-19 is readily inactivated by commonly available home disinfectants. Make sure frequently touched surfaces are cleaned regularly, for example door handles and counter tops.

You should clean any equipment used during a visit, such as mobile aids, using detergent or disinfectant and store it safely in the home.


2. Waste

While in the home any waste generated due to personal care (including PPE) should be bagged as normal. If the person has COVID-19 this should be double bagged and held in the home for 72 hours before disposal into the household waste stream for collection. The bag should be marked for storage for 72 hours (add date and time to the bag).

If the household/ individual has a special waste uplift for personal care items, PPE should be bagged and placed in the container.


3. Laundry, including staff uniforms

If the person has COVID-19 symptoms, any laundry should be washed at the highest temperature advised for the fabric as soon as possible.

Shaking linen should be avoided to prevent dispersal of viral particles. Items heavily soiled with body fluids, for example vomit or diarrhoea, or items that cannot be washed should be disposed of with the owner’s consent.

If the individual does not have a washing machine, wait a further 72 hours after their 7-day isolation period has ended. The laundry can then be taken to a public launderette.

It is safe to launder uniforms at home. If the uniform is changed before leaving work, take it home in a disposable plastic bag. If wearing a uniform to and from work, change as soon as possible when you get home.

Uniforms should be laundered daily.

Uniforms should be washed:

  • separately from other household linen
  • in a load not more than half the machine capacity
  • at the maximum temperature the fabric can tolerate, then ironed or tumble dried.

4. Work and personal travel

When travelling for work or for personal purposes national guidance on physical distancing and staying safe should be followed.

The following general infection prevention and control measures should also be followed.

  • Hand hygiene - use handwashing facilities or, where available, alcohol based hand rub before and after journeys.
  • Catch coughs and sneezes in tissues or cover mouth and nose with sleeve or elbow (not hands), dispose of the tissue into a bin and wash hands immediately.
  • Practice physical distancing. For example, sit or stand approx. 2 metres from other passengers, travel in in larger vehicles where possible or use vehicles with cab screens, if available.
  • If using public transport, wear a face covering and try to avoid busier times of travel to ensure you can practise physical distancing.
  • Clean vehicles between different drivers or passengers as appropriate.

See Transport Scotland’s advice on how to travel safely for further information.

Hand and cough hygiene Washing and drying hands, and cough and respiratory hygiene

Performing regular and thorough hand hygiene is the single most important thing you can do to reduce the transmission of any infection, including COVID-19, in any care setting.

Hand hygiene is something that everyone in the household must stick to, including social care workers, carers and family members. You may like to share this message with others in the household.

Good cough and respiratory hygiene measures are also essential for minimising COVID-19 transmission.

We appreciate your role will often involve providing very personal care. Where possible encourage the person to do as much for themselves as they are able.

Click on each category to learn more.

You should wash your hands with soap and water in the person’s home for at least 20 seconds on arrival before care takes place and when leaving. Where this is not practical, rubbing with alcohol based hand rub (ABHR) should be performed on arrival and when leaving.

Hand washing must also be performed immediately before every episode of direct care and after any activity or contact that potentially results in hands becoming contaminated including:

  • after coughing or sneezing
  • before handling food and eating
  • after going to the toilet
  • after any personal hygiene or cleaning task
  • after removing PPE
  • after waste handling.
Before washing
  • Expose your forearms to the elbow.
  • Remove all hand and wrist jewellery including watches (you can wear one plain metal finger ring but this must be moved or removed when hand washing so you can wash the area it usually covers).
  • Make sure fingernails are clean and short (artificial nails, varnish or nail products should not be worn).
  • Cover all cuts and abrasions with a waterproof dressing.
Washing
  • Washing your hands properly should take about as long as singing Happy Birthday twice and at least 20 seconds.
  • You can use alcohol based hand rub (ABHR) if your hands are not visibly soiled or dirty.
You can click the images to read the full steps for washing and using ABHR. The links will take you to a page on the National Infection Prevention and Control Manual (NIPCM) where the images include Alternative Text for those using screenreaders. You can also download PDFs from this page. Watch out also for the sometimes missed and frequently missed areas shown in the final image from the Royal College of Nursing.

If it is known or possible that forearms have been exposed to respiratory secretions (for example cough droplets) or other body fluids, hand washing should be extended to include both forearms. Wash the forearms first and then wash the hands.

Drying

Drying your hands is important. Avoid using hand towels in other people’s homes. You should use single use disposable paper towels or, if not available, something like kitchen roll.

When drying hands you should:

  • dry palms and backs of your hands first
  • work the towel between your fingers and dry around and under your nails
  • place the paper towel in a bin, making sure you don’t touch the bin lid with your hands.
Please encourage individuals and others in the household you visit to:
  • use disposable, single use tissues to cover their nose and mouth when sneezing, coughing or wiping and blowing their nose
  • dispose of used tissues promptly in the nearest waste bin; some people may need help, for example those whose mobility is restricted will need a container (for example, a plastic bag) readily at hand
  • clean their hands (using soap and water if possible, otherwise using ABHR) after coughing, sneezing, using tissues or after any contact with respiratory secretions and contaminated objects
  • keep hands away from the eyes, mouth and nose whenever possible.
Important actions to help you are to:
  • try to stop touching your face and avoid direct hand contact with your eyes, nose and mouth
  • minimise any direct contact with people that have a respiratory illness, for example avoid using their personal items such as their mobile phone
  • (if you don’t have a tissue) cough into the crook of your elbow and not in your hand
  • keep your fingertips as clean as possible (if you have to make contact with surfaces, try to use the backs of your hands, knuckles or elbows)
  • wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or after contact with respiratory secretions or objects contaminated by these secretions
  • where there is no running water available or hand hygiene facilities are lacking, use hand wipes followed by ABHR and then wash your hands at the first available opportunity.

Here are three videos to help you understand good hand, cough and respiratory hygiene.

Washing hands with liquid soap and warm water

About Vimeo

Hand hygiene using Alcohol Based Hand Rub (ABHR)

About Vimeo

Top practical tips and advice from the NHS by an Infection Prevention and Control Manager

About Youtube

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.

Remember to check you are always using the most up to date national guidance which is described below.

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).

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.

Table 2 (the first image below) describes the PPE applicable to the care at home (domiciliary care) setting when staff are providing care for suspected or confirmed cases, or for individuals who are at extremely high risk of severe illness with COVID-19.

Table 4 (the second image below) sets out what PPE is recommended for any settings in which particular types of care is being provided to individuals who are not currently possible or confirmed cases.

Table showing which PPE to use. Click on the image to read from the live PDF. Table showing which PPE to use. Click on the image to read from the live PDF.

The joint statement from the Scottish Government, COSLA and the SJC unions made clear that in Scotland, "if they consider it necessary for their own safety, and that of the individual they are caring for, social and home care workers can wear a fluid resistant face mask, along with other appropriate PPE, when the person they are visiting or otherwise attending to is neither confirmed or suspected of having COVID-19".

The following posters shows what PPE social care workers should wear when working with someone who has confirmed COVID-19 (high risk Red pathway poster) or whose COVID-19 status is unknown (medium risk Amber Poster).


Confirmed COVID (red) poster.

COVID status unknown (amber) poster.

Clicking on an image will take you to the live web location. Remember to reload the page in your browser to make sure you are viewing the most recent versions.

Before Putting on PPE remember to check what the required PPE is for the task/visit (see above section) and make sure it is the correct size. You’ll also need to perform hand hygiene.

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:

  1. apron/gown
  2. surgical mask
  3. eye protection (where required)
  4. 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’ve not used all the items listed.

Removing gloves
  1. Grasp the outside of one glove with the opposite gloved hand and peel it off.
  2. Hold the removed glove in your gloved hand.
  3. Slide the fingers of your un-gloved hand under the remaining glove at your wrist.
  4. Peel this glove off and dispose both appropriately.
Removing an apron or gown
  1. Unfasten or break the ties.
  2. Pull the apron/gown away from your neck and shoulders, touching the inside of the apron/gown only.
  3. Turn the apron/gown inside out, fold or roll into a bundle and dispose of it appropriately.
Removing eye protection
  1. 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.

  1. Untie or break bottom ties, followed by top ties or elastic.
  2. Remove by handling the ties only (as front of mask may be contaminated).
  3. For face masks with elastic, stretch both the elastic ear loops wide to remove and lean forward slightly.
  4. Dispose of mask appropriately.

Perform hand hygiene immediately after removing all PPE.

Here are three videos to help you use PPE safely.

COVID-19: the correct order for donning, doffing and disposal of PPE for HCWs in a primary care setting

About Health Protection Scotland

Perfectly removing your Personal Protective Equipment (PPE)



b About NHS Education for Scotland

COVID-19: infection prevention and control in health and social care settings, an overview (currently unavailable)

About Health Protection Scotland

Keeping safe Other ways to keep you safe and well

We know this is an incredibly difficult time for all social care workers and keeping up to date with and following infection control measures is physically and emotionally demanding.

We know you have a sense of responsibility to minimise the risk of taking infection into the homes of those you care for and also back into your own homes. You are having to make many visits, travel between them and negotiate a range of different washing and hygiene facilities, while not wanting to cause any additional distress for the people you care for.

Despite these pressures we know many of you are doing fantastic work and going the extra mile. We know the skilled care and compassion you provide means so much to those you care for and their families. It’s important to remember to keep yourself safe and well during this difficult and pressurised time.

Health and safety

You have rights as an employee under health and safety legislation to be protected by your employer. You may find this advice note from the Health and Safety Executive helpful.

Underlying health conditions and pregnancy

If you have an underlying health condition which puts you at increased risk of severe illness from COVID-19, including if you are immunosuppressed, you should not provide direct care to individuals with suspected or confirmed COVID-19. If you think you may be at increased risk seek advice from your line manager or local Occupational Health Service.

If you are shielding you should follow shielding advice on the NHS Inform website and only work from home. If you are pregnant seek advice from your line manager or local Occupational Health Service.

Testing for COVID-19

As a social care worker, you are in a priority group for testing which you can access either through your employer or by self-referral. Speak to your employer if you think you should be tested for COVID-19 and they should be aware of the contact in your local Health Board or Health and Social Care Partnership. Information about testing for health and social care workers is available on this page from NHS Inform.

Should you wish to self-refer, see the Scottish Government's guidance on coronavirus testing, including who is eligible for a test, how to get tested and the different types of test available.

Contact with a case of COVID-19

If you have contact with someone who has suspected or confirmed COVID-19, and you’re concerned about exposure to infection, tell your employer and give them details of the contact. They have procedures to follow and will advise you of what you need to do.

Be vigilant for COVID-19 symptoms you may develop during the incubation period following exposure (up to 14 days). If you develop symptoms stay at home and seek advice from NHS Inform.

Returning to work if you have had suspected or confirmed COVID-19

You should not return to work until:

  • your self-isolation period is completed
  • your symptoms resolve with the exception of a cough and loss of/ change in taste and smell, as these symptoms may persist for several weeks (they are not an indication of ongoing infection when other symptoms have resolved)
  • you have been without fever (afebrile) for 48 hours without the use of medication (anti-pyretics) to control this
  • you feel clinically better.
  • When you return to work, you must continue to follow all relevant infection control and prevention measures as for all staff including PPE.

You are likely to be under increased pressure over this period and you will need appropriate support.

It’s crucial that we’re 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.

The National Wellbeing Hub

Organisations from across Scotland, including the SSSC, worked together to create a new platform to help health and social care workers and carers look after their physical and mental health.

Specifically tailored to support the challenges you face during COVID-19, the hub provides you with comprehensive advice on self-care and personal resilience to help you recognise ‘warning signs’.

There’s also information about services and resources available at national and local level within NHS boards, health and social care partnerships (HSCPs) and local authorities.


Workforce support and wellbeing during the COVID-19 outbreak

The SSSC has created this webpage which highlights supports and resources for you as a worker, for individuals you support and for employers. It is based on a resource by NHS Education for Scotland and highlights principles and strategies which are based on good, reliable science and evidence that can help you manage the ongoing stress caused by COVID-19 as effectively as possible.

Scottish Government

Much of the national guidance on COVID-19 for employers and employees comes from the Scottish Government. On this page you will find a range of guides for example, guidance for self-directed support, palliative care and much more.

There is also advice, information and educational resources on aspects of how to keep well and stay safe, both as an individual and as a worker, during the COVID-19 pandemic.


NHS Inform

NHS Inform is Scotland's national health information service. This page provides the latest guidance about COVID-19 from NHS Scotland and the Scottish Government including social distancing, stay at home advice, caring for a cough and fever and looking after your mental wellbeing.

There is also NHS coronavirus advice for key workers.


NHS Education for Scotland

To help respond to the demand for quick access, ‘bite-size’ learning during the COVID-19 pandemic, we have developed a suite of guides on themes asked for by those working in the sector.

Our COVID-19 webpages include the latest information for social service workers and employers including a wide range of guidance and information on what we are doing to help in our role as regulator.

They can all be accessed on our Learning Zone at learn.sssc.uk.com/coronavirus

Coronavirus (COVID-19) and adult support and protection: a quick guide

With the COVID-19 pandemic and self-isolation, some people will be at greater risk of harm. As a social service worker, you have a legal and moral duty to make sure the adults you work with are safe and protected. Adult protection is everyone’s responsibility.


Guidance to help social workers respond to COVID-19

Specific information aimed at social workers, to be used alongside local guidance, policies and procedures. Includes links to national legislation, COVID-19 specific advice and guidance and other useful resources.


Key measures for infection prevention and control

A guide for social service workers providing care in an individual’s home. 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).


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Person-centred Care

This guide will provides a summary of what being person-centred means in practice, tips on how to have good conversations and how this rights-based approach is supported by the Health and Social Care Standards and the SSSC Codes of Practice.


Support with death, dying and bereavement during COVID-19

A guide for social service workers and those caring for others. Information to support you to deliver compassionate, person-centred palliative and end of life care.


The safe use of medication during the COVID-19 pandemic

A guide offering support, information and resources for social care workers who have the responsibility to either prompt, assist and administer medication.


Workforce support and wellbeing during the COVID-19 outbreak

A guide for social service workers and employers which gives advice and guidance to help you look after your own wellbeing, and the wellbeing of others.


Working from home (PDF)

A short guide for social service workers who may need to work from home for the first time. During the current COVID-19 health crisis, we are being encouraged to work from home if possible. For many of us, this will be the first time we've had to do this, so we've put together a short guide to help you get the most out of this experience, while being mindful of your own wellbeing.


Working safely

This guide offers information, accessible advice and links to current resources and has been designed to support individuals working at home, or in communities and outlines what managers can do to support their colleagues.

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