The last few years have served as a lesson to us all about the importance of maintaining good hygiene standards, particularly in healthcare settings, in order to avoid the spread of infection.
From government slogans to the mandatory wearing of face coverings in public indoor spaces, measures were introduced in an attempt to halt the spread of COVID-19. Crucial to these efforts has been ensuring that those who are infected do not pass it on to others, particularly in hospitals, care homes and other places where vulnerable people are being cared for.
What is infection control?
Infection control refers to the measures put in place to prevent or stop the spread of infections in healthcare settings. These measures include staff wearing personal protective equipment (PPE), ensuring any cases of infection are isolated from uninfected patients and maintaining good hygiene standards to reduce the risk of spread.
Where do infections come from?
Germs or microbes are found everywhere, although, most won't harm you as your immune system protects you from infection. However, as germs mutate, some do break through your immune system's defence. Infection is the process of infectious agents entering your body and multiplying. Infections become diseases when the body's cells are damaged - from infection - and the person becomes ill.
Infectious agents present themselves in a number of different forms, meaning that they can also be 'caught' in a variety of ways and settings. Infectious agents include:
- Bacteria - the production of toxins by disease-causing bacteria damage the cells, causing illness, whilst other bacteria invade or damage tissues. Bacterial infections include tuberculosis and urinary tract infections (UTI).
- Viruses - viruses invade the body's cells in order to reproduce, eventually destroying these host cells and causing diseases such as AIDS, coronavirus (COVID-19), common cold and measles.
- Fungi - we often eat fungi. Mushrooms are fungi and so is the mould on blue cheese. Even the yeast used for making bread is a type of fungus. However, some fungi, like candida, can cause illnesses such as thrush, and skin conditions including athlete's foot or ringworm.
- Protozoans - single-celled organisms that generally enter your body through the food or water that you intake. One disease caused by protozoa is malaria, where the malaria protozoans enter the body via mosquito bites.
- Helminths - larger parasites (or their eggs) that live off the body's nutrients in the intestinal tract, brain, lungs, skin or liver. Tapeworms and roundworms are both helminths.
Health and social care settings can also provide environments where these infectious agents can get to work. Hospital-associated infections (HAI) or healthcare-associated infections (HCAI) are acquired while under medical care and are often referred to as nosocomial infections.
These infections are connected to the types of medical procedures and therapies used by the health and social care professionals, as well as the patients' underlying diseases or illnesses. Common HAIs or HCAIs include catheter-associated urinary tract infections (UTI), ventilator-associated pneumonia (VAP) and surgical site infections (SSI).
What is the role of CQC in infection prevention and control in care homes?
When it comes to care home safety, we must consider the role of CQC in infection prevention and control.
The Care Quality Commission (CQC), which monitors, inspects and regulates health and adult social care services in England, carries out infection prevention and control (IPC) assessments in care homes inspecting 8 areas:
Infections in care homes can spread from a variety of hosts: patients, staff, or visitors. The care home should, therefore, put in place measures to prevent visitors, including family, friends and professionals, from either catching infection in the care home or bringing it in from outside. The CQC evaluates the measures in place for these visitors upon entering the home and during their visit, as well as how well they are explained and followed. Should people be unable to visit in person, the CQC also judges the alternatives that the care home has put in place.
Shielding and social distancing are important means of halting the spread of infection. Care homes are assessed by the CQC on how the well-being of staff and people using their services is supported, such as the measures in place (e.g. isolation) in the event of an infection or outbreak, or when social distancing is not possible.
Admission concerns the people coming in to use the services of the care home, and the procedures established to prevent infection from spreading when they are admitted (from another service or the community). These must follow current guidance.
Personal protective equipment (PPE)
PPE is used to effectively safeguard staff and people using the service from becoming infected. Care homes will be IPC assessed on the procedure that staff go through for putting on and taking off PPE, the disposal of PPE after use, whether the care home’s PPE complies with current guidance and if specific PPE training has been provided. Moreover, in healthcare settings such as these, vulnerable people may be anxious or fearful of staff wearing PPE. The CQC judges how these people are reassured.
Staff and care home service users should have enough access to testing. Care homes are assessed on the regularity of which staff and service users are tested and have access to testing, as well as the response of the care home if someone returns a positive test, shows symptoms of infection, or refuses a test.
Infection prevention and control measures do not just concern people, but also that the layout of the premises promotes safety from infection. For instance, the CQC concerns itself with the cleanliness and hygiene of the premises, how this is maintained (both the regularity of cleaning and the cleaning products used), as well as ventilation and how communal indoor and outdoor spaces have been optimised to use safely.
Staff should be able to stop the transmission of infections and manage outbreaks. This is a question of staff training, as well as the practices employed by the care home and how staff are deployed.
The IPC assessment evaluates the service’s ability to support the well-being of its staff. This includes minimising staff movement and transmission in and between care homes, the changing of staff rotas, shifts and handovers to ensure prevention and control, as well as the care provided to them should they become unwell, such as the provision of sick leave and helping them return to work safely.
The CQC also analyse the care home’s use of agency staff, checking that there is a procedure to ensure that these staff members follow IPC measures and are not working between other services, as well as the infection control and prevention training given to staff to aid them in providing safer care.
The final area that the CQC assesses regarding a care home’s infection prevention and control methods is its IPC policies and how these are implemented.
Infection can pose a great risk to vulnerable people in care homes. How these organisations assess and manage these risks is inspected, alongside the action they take to reduce the impact on those disproportionately at risk of infection.
Inspecting that the care homes actioned the changes required following their most recent audit and that they’ve put in place plans to address future outbreaks of infection will be considered in the IPC assessment.
Who is responsible for infection control?
Under the Health and Social Care Act 2008, all primary care providers are required to employ an Infection Prevention and Control (IPC) Lead to manage the infection control and prevention measures for the organisation. The organisation's IPC Lead will likely be responsible for making sure that the healthcare setting that they are responsible for meets the expectations set out in the CQC IPC assessment inspection criteria. By completing Infection Control Awareness and Advanced Infection Control training courses, IPC Leads and any other staff members who are responsible for the prevention and control of infection in healthcare settings will be given all the necessary knowledge and tools to make their organisation safer from infection.
Meanwhile, all registered NHS care providers are required under current legislation to employ a Director of Infection Prevention and Control (DIPC).
Ultimately, preventing or controlling the spread of infection should be a team effort from everybody, including the patient suffering from an infection, and there should be a unanimous understanding of the whole IPC process, from cleaning equipment or identifying symptoms of infections to carrying out safety procedures to prevent the spread.
For information about infection prevention in the production of food in health and social care settings, read our article 'Top 5 Food Safety Rules To Be Aware Of'. If you want to make sure the infection prevention and control measures that your staff and organisation follow are in line with current regulations, consider our Infection Control Train the Trainer course, which certifies you to train your staff.