Infection Control Standards for Adult Care Homes: Final Standards

INFECTION CONTROL STANDARDS FOR ADULT CARE HOMES: FINAL STANDARDS

FINAL STANDARDS

Standards for Infection Control in Adult Care Homes

STANDARD 1 - Accountability: Accountability Arrangements

Standard Statement

Responsibility for infection control is clearly defined and there are clear lines of accountability for infection control matters throughout the service.

Rationale

Clearly defined responsibility and accountability are required to support the operational and strategic decision making and management of infection control. The Chief Executive/ Owner (i.e. Registered Service Provider) is responsible for ensuring a safe, effective and clean care environment in facilities and must be able to account for the overall management of infection control.

Criteria

1.1 There are clear lines of accountability throughout the service that define the relationships between those with particular responsibility for risk management, governance and infection control functions.

1.2 The infection control programme- see Standard 5, is developed with the support and approval of the Registered Service Provider.

1.3 The Registered Service Provider and those responsible for the risk management function receive the annual report on the infection control programme.

1.4 The Registered Service Provider, or a deputy with authority to make decisions on their behalf, works closely with those responsible for infection control.

1.5 Senior Management ensures that internal support is provided for infection control emergencies out of hours.

1.6 The Registered Service Provider ensures that guidance, on how to obtain infection control advice, is available on a 24-hour basis.

1.7 The Registered Service Provider and those responsible for risk management are informed of any serious problems or issues relating to infection control.

Audit Tool For Standard 1

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
1	There are people identified with responsibility for risk management, Infection Control and governance.
1.1	There is documented (written) evidence of feedback from those with responsibility for risk management, governance and infection control function to the Registered Service Provider. In a larger organisation there could be an organisational chart of accountability.
1.2	There is a documented Infection Control Programme signed off by the Registered Service Provider (Refer to Standard 5 for detail of the programme).
1.3	There is an annual report received by Registered Service Provider and those with responsibility for risk management ( see Standard 8).
1.4	Documented evidence e.g. minutes of meeting between the Registered Service Provider (or deputy) and those responsible for Infection Control
1.5/1.6	As part of out of hours emergency plans senior managers are available to support staff, this may be documented by out of hours emergency contact numbers for senior managers or incident reports. Documented evidence that emergency contact details including out-of-hours service are available to all staff.
1.7	Documented evidence could include records of telephone calls/ emails/memos/ incident reports.

STANDARD 2 - Accountability: Infection Control Function

Standard Statement

There is an Infection Control Group or designated individual(s) that endorse all infection control policies/procedures/guidelines. It also provides advice and support on their implementation and monitors the progress of the annual infection control programme.

Rationale

All aspects of infection control are managed at an operational level. The structure of the group or individual(s) responsible for infection control function should be appropriate to the service. This may mean that a group or individual with a wider remit considers the infection control function (for example within Health and Safety remit or in smaller organisations this responsibility may fall to a single designated individual)

Criteria

2.1 Membership of the Infection Control Group includes, for example:

(a) Registered Service Provider or a nominated senior manager with authority to represent him/her
(b) Unit/ Operational Manager
(c) Infection Control Key Worker(s) refer to Standard 3
(d) A representative senior carer/ nurse
Other members as appropriate, for example:
(e) Identified representatives, from, for example, Estates, Housekeeping and Maintenance, Risk Management and/ or Health and Safety
(f) Person(s) with responsibility for staff health
(g) Other key representatives may include general medical or dental practitioners, allied health professionals
(i) Others as required

2.2 The Infection Control Group agrees Terms of Reference and Accountability arrangements and meets at least four times a year.

2.3 Minutes of the Infection Control Group are widely circulated to all managers and team leaders and are available to all staff and service users.

2.4 The Infection Control Group provides advice and support to the Infection Control Key Worker(s).

2.5 The Infection Control Group endorses the annual infection control programme.

Audit Tool For Standard 2

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
2	Documented evidence could include terms of reference of the group-including details of group membership, minutes and circulation list for minutes. If this is a single person with responsibility for the infection control function then documentation of, for example review of the Infection Control Programme, could be contained within the annual report with notes of progress made and any work required.

STANDARD 3 - Accountability: Infection Control Key Worker (ICKW(s))

Standard Statement

There is a designated Infection Control Key Worker(s) with day to day responsibility for Infection Control in the care home.

Rationale

The Infection Control Key Worker(s)is responsible for the day-to-day implementation of the Infection Control Programme and provides advice on infection control problems, and the management of people with infection. Each care home has a responsibility to provide adequate infection control function.

Criteria

3.1 There is an Infection Control Key Worker(s)

3.2 The Infection Control Key Worker(s) has access to:

a) Administrative support
b) Information Technology

3.3 The responsibilities and accountability arrangements of the Infection Control Key Worker(s)are clearly defined.

3.5 The Infection Control Key Worker(s) and relevant continuing development and can provide evidence of both.

3.5 The Infection Control Key Worker(s)and the person(s) with responsibility for work related staff health liaise when dealing with infection control advice relating to the:

a) Health and safety of care home staff
b) Transmission of infection between care home staff and other person(s)

3.6 The Registered Service Provider or authorised deputy and Infection Control Key Worker(s)ensure that there is an effective mechanism in place for reporting to and collaboration with the local NHS Board Department of Public Health when dealing with outbreaks or significant incidents of infection.

Audit Tool For Standard 3

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
3.1	All care home staff should be able to name their local Infection Control Key Worker(s). This named individual or designated role should appear on any prepared organisational accountability chart.
3.2	This could be secretarial support or access to a PC/ typewriter or appropriate time made available within working time for the Infection Control Key Worker(s). This access to IT (Information Technology) can also be used to access training/ educational materials
3.3	This responsibility should be part of the job description of the Infection Control Key Worker(s). It is not necessarily required to be a full time role, but may be incorporated into an existing job description. Documented evidence will include the job description for the Infection Control Key Worker(s).
3.4	Any training whether formal or informal is documented e.g. certificates or copies of course programmes. An example of formal training could be attendance at, for example, courses/ seminars run by practising infection control specialists, or the Cleanliness Champions programme 2 devised by NHS Education Scotland.
3.5	Documented evidence may include ongoing communications on matters which affect staff health between Infection Control Key Worker(s) and person responsible for work related staff health. e.g. skin problems related to hand hygiene.
3.6	Documented evidence of contact details. The mechanism could be a list of numbers which is easily accessible to all care home staff. Staff are aware of this list and use it in appropriate circumstances. Management ensures that this information is accurate, up to date and that staff are aware of its existence

STANDARD 4 - Processes: Planning & Development

Standard Statement

Prevention and control of infection are considered as an integral part of all service development activity

Rationale

To improve quality of care by appropriate decision-making on issues with relevance to infection control.

Criteria

4.1 There is a system in place that ensures where relevant, expert infection control advice is sought, particularly in relation to the following:

a) The development of policies/procedures/guidelines relating to engineering and building services and to the purchase of medical devices, furnishing and equipment i.e. being "fit for purpose" with respect to infection control
b) Early stage planning in respect of engineering and building works and the purchase of medical devices, furnishings and equipment i.e. being "fit for purpose" with respect to infection control
c) All stages of the contracting process for housekeeping and other services that have implications for infection control, e.g. cleaning, laundry, clinical waste, catering.

4.2 This standard should also apply to any contracted/ subcontracted services on the same basis as to services provided in-house.

Audit Tool For Standard 4

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
4.1	Infection control expertise accessed may be available locally or externally. Documented evidence can include a note of any internal/ external consultation related to infection control e.g. new laundry equipment, furnishings or flooring is considered before purchase to ensure it is 'fit for purpose'. Provision of adequate handwashing facilities.
4.2	Infection control issues within these Standards are addressed in all contracted out services. Documented evidence includes infection control detail in contracts.

STANDARD 5 - Processes: Infection Control Programme

Standard Statement

A service-wide annual Infection Control Programme with clearly defined objectives and priorities is produced.

Rationale

Each service should have an annual Infection Control Programme in place which looks at infection control issues relevant to the service needs to ensure that a service wide approach to the risk management of infection control.

Criteria

5.1 The Infection Control Group develops and produces an annual Infection Control Programme based on ongoing risk assessment in full consultation with relevant key stakeholders as appropriate to the service.

5.2 The Infection Control Programme is approved by the Registered Service Provider and Management Team as part of the relevant risk management approach.

5.3 Identified priorities arising from the Infection Control Programme are incorporated within the services annual business plan(s)/ budget.

5.4 The Infection Control Programme is kept under regular review by the Infection Control Group and Infection Control Key Worker(s) and modified as necessary.

5.5 The Infection Control Programme should includes reference to audit of compliance with selected infection control policies/procedures/guidelines as stated in criteria for Standard 6.

5.6 The annual Infection Control Report outlines the progress of the Infection Control Programme.

5.7 A flow chart at annex E details these relationships.

Audit Tool For Standard 5

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
5	A flow chart at Annex E (inside back cover) details the main infection control relationships
5.1	Evidence of a documented Infection Control Programme that may contain the following- 1. Planned review of infection control policies /procedures and any updates 2. Training of staff in above 3. Audit of compliance with infection control policies/procedures/guidelines 4. Identification of infection control related risks and measures required to address This may be adapted to reflect local requirements e.g. Colour coded equipment policies differ for care and domestic staff e.g. use of mops. An audit identifies misuse of this equipment which presents a risk of infection to service users. Action is detailed in Infection Control Programme as standardisation of all colour coded equipment for all staff and new equipment is purchased. A re-audit ensures that work is complete.
5.2	See 1.2
5.3	Documented evidence could include mention of infection control priorities in business plan/ budget e.g. purchase / upgrading of equipment or training in infection control.
5.4	See Standard 2 Documented evidence could include minutes/ agenda of regular meetings at which the Infection Control Programme is reviewed
5.5	It is not expected that all policies in this standard are reviewed each year. An explanation of infection control priority areas selected, based on risk assessment/ local needs, should be documented in the Infection Control Programme

STANDARD 6 - Processes: Policies, Procedures & Guidance

Standard Statement

Written policies/procedures/guidelines for the prevention and control of infection are implemented and reflect relevant legislation and published guidance.

Rationale

Access to up-to-date policies/ procedures/ guidelines is essential for staff to carry out their duties safely and consistently to the required standard.

Criteria

6.1 Policies/ procedures/ guidelines are approved by the Infection Control Group.

6.2 There is a system in place to ensure each unit/ staff group has a current copy of the approved policies/procedures/guidelines pertinent to its activities.

6.3 All staff have access to documentation detailing;

a) an overview of the infection control structure of the service
b) responsibilities for infection control within the service
c) sources of external advice e.g. local NHS services: local authority, local Care Commission Officers, Scottish Water

6.4 Key policies/procedures/guidelines are in place, and where assessed as relevant, include:

a) Cleaning and disinfection of medical devices
b) Collection, handling and delivery of laboratory specimens
c) Environmental hygiene
d) Food hygiene
e) Hand hygiene
f) Identification, management, control and the reporting of incidents and outbreaks of notifiable and communicable disease(s)
g) Immunisation for service users
h) Indwelling medical devices (to include e.g. urinary catheters, percutaneous endoscopic gastrostomy tubes (PEGS), central venous lines)
i) Isolation of service users with known or suspected communicable disease
j) Last Offices
k) Laundry
l) Legionella control
m) Management of exposure to blood borne infections, including the need for treatment after injury
n) Pets
o) Safe handling and disposal of waste, including risk assessment procedures
p) Single use & single patient use devices and other care products
q) Specific advice for the following infections and illnesses:

• Clostridium difficile

• Diahorrea and vomiting or Gastro-enteric infections

• Influenza

• MRSA (Methicillin Resistant Staphylococcus aureus)

• Scabies and lice

• Shingles (Varicella Zoster Virus)

• Tuberculosis

r) specific information for visitors on infection control
s) Staff health policies for prevention and management of communicable infections.
t) Standard infection control precautions (i.e. universal blood and body fluid precautions including other body substance precautions).

6.5 The annual Infection Control Plan includes a timetable stating which key infection control policies/procedures/guidelines are to be reviewed or written that year.

6.6 All policies/procedures/guidelines are clearly marked with the following on every page-

- date of issue,
- a review date, and
- a page number

6.7 Relevant parts of key policies/procedures/guidelines are produced in abbreviated form and are accessible for routine use as aide memoires by operational staff.

Audit Tool For Standard 6

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
6.1	See Standard 2. This should be included in terms of reference for Infection Control Group. Each document should have date of issue, page number and a review date clearly displayed on every page.
6.2/6.3	Documentation is readily available to staff. This may be: a) written evidence of the infection control structure. An example is attached of a hierarchy below b) name and contact details of Infection Control Key Worker(s), c) terms of reference of Infection Control Group (Standard 2.1), d) contact details for sources of external infection control advice
6.4	This list is in alphabetical order and not in order of priority. Documented evidence includes the key policies/ guidelines which are in place. The expectation is that not all policies are in place at all times, but are dependant on client group and should be based on a local risk assessment and reviewed regularly. This list should be changed if, for example, the client group changes.
6.7	Documented evidence of accessible, abbreviated form of key policies, procedures or guidelines e.g. waste/ hand hygiene posters

STANDARD 7 - Processes: Policies, Procedures & Guidelines (Compliance Audit)

Standard Statement

There is an annual programme for the audit of compliance with infection control policies/ procedures/ guidelines.

Rationale

Audit is necessary to provide evidence that the system of infection prevention and control in place is effective.

Criteria

7.1 There is a written agreed programme for the audit of compliance with infection control policies/procedures/guidelines.

7.2 There is audit of compliance with infection control policies/procedures/guidelines.

7.3 Audit results are fed back to care home staff, including relevant members of management and are included in the infection control annual report.

7.4 Audit results are used to help to inform and improve infection control practice.

Audit Tool For Standard 7

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
7	Audit (see glossary at annex C) can range from simple examples such as monitoring general environmental cleanliness (e.g. use of soap dispensers/ paper towels are a good indicator that regular hand washing occurs) or monitoring of any increased occurrence/ change in pattern of possible/ suspected illness e.g. diahorrea and vomiting
7.1	This should mean a ongoing programme of audit. Evidence should be documented in the Infection Control Programme.
7.2	Documented evidence should include dates and outcomes of any audits.
7.3	Documented evidence that audit results have been fed back to stakeholders e.g. minutes of staff meeting /memos on staff notice board/ communications book
7.4	Evidence in Infection Control Programme of measures taken to address outcomes of previous audits e.g. staff training programmes.

STANDARD 8 - Processes: Infection Control Report

Standard Statement

A comprehensive Infection Control Report is produced by the Infection Control Group on an annual basis, reviewed by the person(s) with risk management responsibility and presented to the Registered Service Provider. This report may be produced separately or as part of another document.

Rationale

Annual Infection Control Reports are an essential element of a service's risk management approach. They allow the Registered Service Provider to monitor and review all aspects of the infection control system to ensure that any issues arising are dealt with effectively.

Criteria

8.1 The annual Infection Control Report contains, as a minimum, information on the following:

(a) A review of reported adverse incidents and outbreaks, including reports by external agencies, e.g. Care Commission, environmental health departments, Health and Safety Executive, Scottish Water.
(b) Any recommendations made on measures taken to prevent recurrence of incidents and outbreaks.
(c) Progress of the Infection Control Programme.
(d) Results of audit and proposed action plans- see Standard 7.4
(e) Education and training undertaken.

8.2 The report is reviewed by the person(s) with responsibility for risk management.

8.3 The person(s) with risk management responsibility brings any significant risks or other issues to the attention of the Registered Service Provider.

Audit Tool for Standard 8

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
8.1	Documented evidence of an Infection Control Report, containing a)- e) as a minimum
8.2	Documented evidence could be that the Infection Control Report is signed by person with responsibility for risk management
8.3	Any risks should be prioritised and brought to the attention of the Registered Service Provider Documented evidence could include identification of significant risks within business plan, minutes of meetings etc.

STANDARD 9 - Capability: Legislation & Guidance

Standard Statement

The Infection Control Group and Infection Control Key Worker(s) have access to up-to-date legislation and guidance relevant to infection control.

Rationale

Access to legislation and guidance is essential for the service to carry out its statutory and mandatory duties and maintain best practice.

Criteria

9.1 The Infection Control Group and Infection Control Key Worker(s) have access to all current up-to-date legislation and guidance.

9.2 As a minimum, the Infection Control Group and Infection Control Key Worker(s) have access to the key references listed in this document, at Annex B.

9.3 There is a mechanism in place to cascade information in a timely manner to all staff throughout the service.

Audit Tool for Standard 9

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
9	As a minimum the documents in Annex B should be available, either in hard copy or via the Internet (see 3.2). Evidence may also be a file of relevant infection control articles from journals which are circulated to staff and initialled when read and understood.
9.2	Evidence would be either copies of documents or access to these on the internet
9.3	Documented evidence of minutes and agenda of staff meetings with infection control on the agenda. An infection control newsletter may be produced in larger organisations. Staff could sign after reading and understanding any key documents circulated.

STANDARD 10 - Capability: Education

Standard Statement

Education, training and instruction in infection control are provided to all staff, including those employed in support services, appropriate to their work activities and responsibilities.

Rationale

All staff should receive training in infection control and prevention to make sure that they are adequately prepared to carry out their duties.

Criteria

10.1 Infection control education appropriate to work activity is included in induction programmes for all new staff in the care home.

10.2 There is a programme of ongoing education for existing staff, including update of:

a) Policies/procedures/guidelines.
b) Risk assessment and incident management.
c) Feedback of audit results and the action needed to correct deficiencies.

10.3 Records are kept of attendance of all staff on infection control education sessions.

10.4 Any contracts with contractors/ subcontractors should ensure that subcontracted staff receive training/guidance on infection control as appropriate to their work activities and responsibilities.

Audit Tool For Standard 10

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
10.1	This can be evidenced by an induction programme, incorporating infection control.
10.2	Documentation could include training records.
10.3	Infection control training may be incorporated into more general education sessions.
10.4	Documented evidence that contracts ensure infection control training/ guidance is provided as appropriate to work.

STANDARD 11 - Monitoring & Review of the system in place for control of infection

Standard Statement

The system in place for control of infection is monitored and reviewed by management in order to make improvements to the system.

Rationale

The Registered Service Provider is responsible for ensuring a safe, effective and clean care environment in facilities, and is able to account for the overall management of infection control.

Criteria

11.1 Monitoring and review of the infection control system includes:

(a) Accountability arrangements.
(b) Staff knowledge, expertise and resources
(c) Positive or negative outcomes.
(d) Processes, including risk management arrangements.
(e) Policies/ procedures/ guidelines.

11.2 The person(s) with risk management responsibility plays an important role in monitoring and reviewing all aspects of the system as a basis for establishing significant information that is presented to, and dealt with by, the Registered Service Provider.

11.3 The Infection Control Group reviews the detailed issues surrounding infection control resulting from management's monitoring and review.

11.4 Infection control audits and findings are reviewed and appropriate action taken.

Audit Tool For Standard 11

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
11	This standard is intended to ensure that functioning systems are in place and corporate responsibility is endorsed. Outcome of standard is that Registered Service Provider should be content with the system in place for infection control. Annex E outlines the key relationships.	N/A	N/A
11.1	Documented evidence is included elsewhere in Standards, for example; a) Standards 1-3 accountability b) Standards 9-10 capability c) Audit findings d) Standards 1-3 e) Standards 6/7
11.2	Documented evidence that the risk manager/ individual with responsibility for risk management has reviewed the infection control system and produced an infection control risk management report. This risk management report should be presented to Registered Service Provider
11.3	Require that any evidence e.g. minutes/ memos / action plans is fed back to the Infection Control Group.
11.4	Copy of action plan and completion dates.

STANDARD 12- Practice: Hand Hygiene

Standard Statement

A clear hand hygiene policy and mechanism to ensure effective implementation is in place.

Rationale

There is good evidence that an effective hand hygiene policy reduces the risk of spread of infection. Therefore, a hand hygiene policy should reflect the principles of good practice related to hand hygiene, developed by 'The EPIC Project: Developing National Evidence based Guidelines for Preventing Healthcare Associated Infections' commissioned by the Department of Health (England). See annex C for reference.

Criteria

12.1 There is a hand hygiene policy/procedure/guidelines which reflects the principles of good practice and includes:

(a) Hand decontamination immediately before and after every episode of direct contact/ care or any activity that potentially results in hand contamination.
(b) Use of liquid soap and water for hands visibly soiled or potentially contaminated with dirt or organic material.
(c) Use of alcohol-based hand rub or hand washing with liquid soap and water to decontaminate hands between different service users or between different caring activities on same service users.
(d) Removal of all wrist and, ideally, hand jewellery at the beginning of each shift before regular hand decontamination begins.
(e) Covering all cuts and abrasions with a waterproof dressing.
(f) Effective hand washing including:

- Wetting hands under tepid running water before applying liquid soap.
- Hand wash solution must come into contact with all surfaces of hands;
- Vigorous rubbing of hands for minimum of 10-15 seconds with particular attention to tips of fingers, thumbs and between fingers;
- Thorough rinsing;
- Drying with good quality paper towels.

(g) Effective alcohol hand rub technique:

- Use only on hands free of dirt and organic material;
- Hand rub solution must come into contact with all surfaces of hands;
- Vigorous rubbing of hands, with particular attention to tips of fingers, thumbs and between fingers, until the solution evaporates and hands are dry.

(h) Application of an emollient hand cream regularly to protect skin from drying effects of regular hand decontamination.
(i) Access to staff health advice in the event of skin irritation caused by a particular soap, hand hygiene or alcohol product.

12.2 There are arrangements to support and promote hand hygiene by care workers.

12.3 Induction programmes for all staff include the topic of hand hygiene.

12.4 Compliance with hand hygiene policy/procedure/guidelines forms part of the systematic risk review.

Audit Tool for Standard 12

Standard/ Criteria	Explanation/ Examples	Achieved Y/N	Action Required for Registered Service Provider
12.1	Self monitoring may include- Evidence of handwashing policy/ promotional posters or audit of hand hygiene of staff. e.g. by observation. Evidence that liquid soap dispensers work. Evidence of alcohol hand gel/rub and paper towel availability.
12.2/3	Training records of staff should indicate that they have received hand hygiene training. This may be covered by other Standards e.g. Standard 10.3
12.4	Documented evidence included elsewhere in Standards e.g. Standard 8.1