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Infection control in care homes

Infection control in care homes

Bacterial infection is a serious concern for the elderly, especially for people with dementia or in long term care. This “at-risk” group are less likely to tell carers how they are feeling.

In America, the stats show that one-third of all deaths in the over 65s age group are due to infectious diseases. Here in the UK, the stats from ONS show that dementia and Alzheimers is the leading cause of death in the same age group. But septicaemia is the leading contributary factor of death.

Septicaemia deaths of UK care home residents aged 65 and over increased 36% in the 10 years ending 2016. Compared to a 9% decrease in septicaemia deaths in the same age group who were not living in a care home (Source: ONS). As septicaemia is caused by large amounts of bacteria entering the bloodstream, this is one example of how important it is to control infection.

So, how do you ensure that you don’t suffer an infection outbreak at your care home? We’ve collated some advice from reputable sources below.

Infection Control Manager

Assign the role of Infection Control Manager to a member of staff to make sure it doesn’t get forgotten about in the day to day running of the care home. This person will be responsible for defining infection control policies. They will also ensure that all members of staff are trained, understand the policies and that appropriate equipment is on hand.

Assessing new residents

At the point of admission into the care home, it’s prudent to run a medical check on all new residents to ensure they’re not carrying an infection. Check for any symptoms that could indicate an infectious disease. These symptoms include vomiting, diarrhoea, coughing, fever or inflamed skin.

A medical professional should be consulted if the new resident does have any of these symptoms, before being admitted. It’s also worth asking whether the individual has been staying in a care home previously where there has been an infectious outbreak. Equally important is whether they have had an infectious disease themselves recently.

Hand hygiene

According to the World Health Organization’s “Five moments” of hand washing (Source: WHO), there are 5 cases that should trigger the carer to wash their hands. They are as follows:

The 5 moments of hand washing

  • Before touching a resident
  • After body fluid exposure or risk of exposure
  • After touching a resident
  • Immediately after wearing surgical gloves or other protective equipment
  • After touching something that the resident has touched such as a wheelchair or door handle

To make it easier to wash hands, it’s recommended that you wear sleeves no longer than the elbow. You should also remove all bracelets and rings.

There are some instances when the use of alcohol gel hand sanitiser is preferred by many, instead of washing with water and soap. For example, when there is no visible soiling on the hands.

Coughing & sneezing precautions

Airborne bacteria are passed by coughing and sneezing, as you’ll know if you remember the old campaign “coughs and sneezes spread diseases!” Some serious infections spread in this way such as SARS, flu and whooping cough.

Make sure all residents understand it is their responsibility to cover their mouth and nose with a tissue before coughing or sneezing. The same applies to all staff who come to work with coughs and sneezes. All used tissues must be placed immediately in a waste bin. Then the person should wash their hands or at least use alcohol gel hand sanitiser to kill any bacteria.

Protective equipment

The NICE Guidelines for care homes states that the carer should assess the risk of infection in each case, wearing gloves and an apron to protect themselves when they think it’s necessary. Protective equipment should be disposed of immediately after competing a task and put on new gloves and apron to start another task. Taking care to wash your hands in between.

Royal College of Nursing guidelines are more specific about when to wear protective equipment. Their guidelines state that you should always protect yourself against contact with blood or bodily fluids as they may contain pathogens.

Waste disposal

Disposing of infected protective equipment and soiled bedding or garments is an unpleasant task but a vital one. The Health and Social Care Act 2008 states that you should have a policy for how waste is disposed to prevent infection outbreak. Prompt decontamination is key! Having separate bins for contaminated waste available in an easily accessible place is essential for staff to easily dispose of this nasty waste.

Visitors following the rules

Friends and family of residents will be naturally careful to ensure they don’t introduce infection into the care home. They will tend to be mindful that the elderly tend to be more susceptible to catching bugs. However, sometimes people forget the importance of hygiene. So the infection control rules should be displayed in public places, alongside hand washing facilities and near hand sanitiser dispensers.

As part of your activity schedule, you probably invite other visitors into the care home such as entertainers, local celebrities and musicians. It’s equally important that they understand the infection control policies and what they must do to prevent introducing infections.

Seasonal preparation

Raise awareness with residents, staff and family/friends. Perhaps create your own posters and hand-outs to give to visitors. Alternatively, you could ask your local health protection team if they have any resources you could use.

Your team ought to ensure that their own vaccinations are up to date, including the annual flu vaccine. This will minimise disruption to staffing levels, you need your team there to help when there’s an outbreak – they can’t be tucked up in their own sickbeds!

Identifying signs of infection

The Nursing Times recommends putting out a BOLO (“be on look out”) to all care home staff to ensure everyone is alert to typical infection symptoms. These signs include:

  • People with the same or similar symptoms at the same time
  • Anyone with a fever
  • People with skin infections, such as an inflamed wound
  • More residents than usual who are very sick.

Who to inform of an outbreak

As soon as you think there’s an infection outbreak at the care home it’s important to warn relevant people.

These include:

When you speak to family and friends, be sure to let them know that visits are not allowed until the outbreak has cleared up and you’ve got everything under control.


Further reading

WHO: Five moments of hand washing

NICE Guidelines for care homes: Helping to prevent infection

Royal College of Nursing: Protective equipment advice

Nursing Times: Identifying signs of infection

Department of Health: Prevention and control of infection in care homes


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