Key measures for infection prevention and control

A guide for social care workers providing care in an individual’s home. Updated 11 June 2020.


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 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.

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 page.

This guide is based on, but does not replace, national guidance at the time of publication (22 May 2020, and updated 11 June 2020) in particular the two resources below.

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).

The National Infection Prevention and Control Manual (NIPCM) for Scotland which is for all those involved in care provision in any setting, including care at home. It 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.

Please click below to read an important notice about national guidance.


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.

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.

You can find further detail to the points below in the domiciliary care guidance.

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.

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.

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 as regularly as possible including:

  • on entering the person’s home (before care takes place)
  • after coughing or sneezing
  • before handling food and eating
  • after going to the toilet
  • after any personal hygiene or cleaning task
  • after removing PPE and before leaving the person’s home.
Before washing
  • Expose your forearms to the elbow.
  • Remove hand and wrist jewellery including watches (you can wear one plain band 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. Drying

Drying hands is important for removing remaining germs. 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.
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).

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.

Your employer’s policy and practice should comply with this PPE guidance (2 April 2020), jointly published by the Department of Health and Social Care, Health Protection Scotland, Public Health Wales, Public Health Agency Northern Ireland, Public Health England and NHS England. The PPE guidance can be accessed through the Health Protection Scotland COVID-19 webpage.

In a joint statement (9 April 2020) on protecting the social care workforce, the Scottish Government, Council of Scottish Local Authorities (COSLA) and the Scottish Joint Council (SJC) unions made clear that “this is the official and fully comprehensive guidance on the matter of the use of PPE in the context of COVID-19”.

Recommendations in this national guidance for all health and social care workers include:

  • staff should be trained on donning (putting on) and doffing (taking off) PPE
  • staff should know what PPE they should wear for each setting and context
  • staff should have access to the PPE that protects them for the appropriate setting and context
  • gloves and aprons are subject to single use, as per SICPs, with disposal after each patient or resident contact
  • fluid repellent surgical mask and eye protection can be used for a session of work rather than a single patient or resident contact
  • gowns or coveralls can be worn for a session of work in higher risk areas
  • hand hygiene should be practiced and extended to exposed forearms, after removing any element of PPE
  • staff should take regular breaks and rest periods.

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.

This table (the first image below) sets out what PPE is recommended for different settings and circumstances, including an individual’s home, when COVID-19 is not suspected.

This table (the second image below) sets out what PPE is recommended for different settings and circumstances, including an individual’s home, when COVID-19 is suspected or confirmed, or if individuals are shielding.

Table uses ticks and crosses to show which PPE to use, for example gloves, aprons and surgical mask, when there are not necessarily confirmed cases yet there is a sustained transmission of COVID-19. Click to read from live PDF. Table uses ticks and crosses to show which PPE, for example gloves, aprons and surgical mask, for use during COVID-19 when individuals you support have suspected or confirmed COVID-19, or are in a shielding category. Click to read from 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 in a social, community or residential setting.

This image (green) is for when COVID-19 is not suspected.

This image (red) is for when COVID-19 is suspected or confirmed.

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.

Remember to wash your hands first. PPE should be put on before entering the room where the individual you are caring for is.

Putting on PPE

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.

Remember to keep your hands away from your face and your PPE. Change your gloves if they get torn or become heavily contaminated.

Removing PPE

To minimise cross-contamination you should apply the order below to remove PPE, even if you’ve not used all the items listed.

Remove PPE somewhere away from the main care area, for example the hall, and place in a waste bag. Wash your hands after you’ve removed all PPE. Do not go back into the care area or within two metres of the person receiving care.

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
  1. Untie or break the bottom ties, followed by the top ties or elastic.
  2. Remove by handling the ties/elastic only and dispose of it appropriately.

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)


About NHS Education for Scotland

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

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.

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.

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.

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.


SSSC

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.

Our Learning Zone has a range of COVID-19 learning guides, including


NHS Education for Scotland
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