Infection Prevention and Control for Nursing & Residential Care - PowerPoint PPT Presentation

Coronavirus (COVID-19) Infection Prevention and Control for Nursing & Residential Care Homes Version 1.3 14 th May 2020 Inform Promote Sustain

What is Coronavirus and COVID-19  Coronaviruses are a large family of viruses - they cause infections ranging from the common cold to Severe Acute Respiratory Syndrome (SARS)  Sometimes new variants of coronavirus emerge - such as SARS CoV-2 which causes COVID-19  SARS CoV-2 has the potential to spread widely as lack of immunity means everyone in the population is susceptible Inform Promote Sustain

What are the symptoms of COVID-19?  Symptoms start 5 -11 days after exposure Common Symptoms of  Illness can be similar to flu COVID-19  Most people have fever and dry cough (but Fever >37.8 o C less common in elderly) Dry cough  Elderly people may present with confusion, Fatigue lethargy, decline in alertness/mobility, diarrhea Sputum  Most people have symptoms for 5 - 6 days Shortness of breath  20% have more severe illness (from day 7) Muscle/joint pain   Shortness of breath Sore throat  Lung inflammation Headache  Pneumonia Hoarseness Nasal discharge Inform Promote Sustain

How severe is COVID-19 illness?  Many people have no obvious Critical Respiratory/multi-organ symptoms (30%) failure  Of those with symptoms 80% Severe Shortness of breath; are mild  Respiration;  O 2 sats  More severe disease in:  Older people Mild Fever, cough  Diabetics  Heart disease  Chronic respiratory disease  Immune compromised Undetected  Only 1% of cases fatal  Highest in high risk groups Inform Promote Sustain

How does COVID-19 spread?  Exposure to respiratory droplets  Coughing/sneezing droplets onto mouth, nose, eyes  Requires close contact (within 2m)  Contact with respiratory secretions  Hands  Contaminated surfaces, tissues  Transferred by touching nose, mouth, eyes with contaminated hands Inform Promote Sustain

Sustained Community Transmission  This means that COVID-19 is affecting many people in the community and they may not all have had obvious contact with someone who had symptoms of the infection.  During this period of sustained community transmission infection control precautions will need to be taken with all residents not just those with symptoms of COVID-19 Inform Promote Sustain

Preventing the spread of COVID-19 Infection Prevention & Control 1. Cough etiquette 2. Hand hygiene 3. Personal protective equipment (PPE) 4. Social distancing 5. Protecting the vulnerable - shielding 6. Isolation of symptomatic residents 7. Cleaning Inform Promote Sustain

Personal hygiene to prevent spread  Cough etiquette  Cover mouth and nose with a tissue or your sleeve (not your hands)  Dispose of tissues directly into bin  Hand hygiene  after contact or coughing/sneezing Ensure patients have hand wipes or alcohol gel available Inform Promote Sustain

Hand Hygiene in care of all residents Hand hygiene is essential to prevent both staff and residents acquiring COVID-19  Immediately before touching a resident  Immediately after touching a resident or their surroundings  After removing gloves Alcohol gel is effective against COVID-19 Soap and water should be used if hands are soiled Inform Promote Sustain

Other times when care workers should wash their hands Before After  arriving at work  leaving home  Touching surfaces in • food preparation residents’ rooms • eating any food  decontaminating equipment • eating snacks  handling waste • taking a break • using the toilet • leaving work • after taking a break • after smoking Inform Promote Sustain

How to hand wash  Wash hands AND forearms after close contact with a resident  If no elbow taps use a clean paper towel to turn it off NHS Hand wash video https://www.nhs.uk/live- well/healthy-body/best-way-to- wash-your-hands/ Inform Promote Sustain

Patient hand hygiene  Encourage residents to clean their hands  After coughing/sneezing  Before eating  After using the toilet  Hand wipes or alcohol gel need to be easily available for the resident to use Inform Promote Sustain

Personal Protective Equipment (PPE)  PPE will only prevent spread of infection if it is:  Used and changed at the right time  Accompanied by good hand hygiene  Cough etiquette is applied  Mobile phones should not be used whilst wearing PPE  All staff, including cleaners & housekeepers, must be trained in how to use PPE Inform Promote Sustain

Disposable Gloves  Wear for any care that involves touching a resident  Wear within 2 metres of a resident who is coughing  Remove and wash hands between different tasks e.g. between helping a resident to the toilet and mouth care  Always remove gloves and wash hands after handling body fluids  Remove gloves and wash hands after each episode of care Be careful not to touch your mouth, nose or eyes while wearing gloves Inform Promote Sustain

Disposable Plastic Aprons  Wear for any care that involves touching a resident  Wear when within 2 metres of a resident who is coughing  Use to protect your uniform or clothes from contamination when providing care  Remove and discard apron after each episode of care Inform Promote Sustain

Fluid Resistant Surgical Masks  Masks protect: o your nose & mouth from respiratory droplets from residents o residents and other staff from respiratory droplets from your mouth and nose (as you might be carrying the infection)  You can wear a mask for caring for different residents BUT do not touch the mask o you could transfer virus to your hands  Wear the mask on your face – NOT round your neck  Remove and discard the mask when: o you take a break or finish your shift o it is damp, soiled, uncomfortable, difficult to breathe Inform Promote Sustain

Eye Protection  Wear for direct contact with residents if there is a risk of respiratory droplets getting into eyes o e.g. resident who is coughing or vomiting  Clean after each use using either:  disinfectant wipe  detergent and water  followed by chlorine disinfectant 1000ppm  check manufacturer’s guidelines Inform Promote Sustain

Watch the video https://youtu.be/ozY50 PPmsvE Inform Promote Sustain

Take PPE off carefully to avoid contaminating yourself Watch the video https://youtu.be/o zY50PPmsvE Inform Promote Sustain

Summary of PPE Fluid Clinical Plastic Resistant Eye Gloves Aprons Mask protection Period of use Single use Session of care Direct contact with Assess ✔ ✔ ✔ resident risk Resident coughing Assess ✔ ✔ ✔ (within 2m) risk No direct resident ✗ ✗ ✔ ✗ contact ✗ ✗ ✗ Communal areas ✔ Inform Promote Sustain

PPE for Aerosol Generating Procedures Some procedures on patients who have COVID-19 can generate tiny particles from the respiratory tract which might be inhaled by people in the room  Undertake these procedures in a single room  Only people involved in procedure should be present  Wear high level PPE Aerosol Generating  Long-sleeved gown Procedures*  Eye protection (visor or goggles) Airway suctioning (open system)  FFP3 respirator Intubation & extubation High flow nasal oxygen Sputum induction (by physiotherapists) Non-invasive ventilation (BiPAP, CPAP) * Check www.gov.uk for updates to list Inform Promote Sustain

Putting on & removing PPE for AGP Inform Promote Sustain

Social distancing & shielding  Avoid close contact (2 metres) Common Symptoms of between all people in the home COVID-19*  Ensure elderly/vulnerable Fever >37.8 o C Dry cough residents are shielded: Fatigue  Stay in the home Sputum  Avoid close contact with other Shortness of breath Muscle/joint pain residents/visitors Sore throat  Isolate residents with symptoms Headache  Check residents and staff daily Hoarseness for symptoms of COVID-19 Nasal discharge *In elderly other signs include:  confusion/lethargy,  mobility/alertness, diarrhoea Inform Promote Sustain

What to do if there is Contact your local Health Protection Unit an outbreak? If 2 or more residents develop symptoms of COVID19  Isolate those with symptoms in a single bedroom  Resident should stay in their room (including for meals)  Isolate for 14 days  If not en-suite – dedicate nearly bathroom to the resident  Isolate residents who have been in close contact with symptomatic residents in a single bedroom  for 14 days after exposure to a possible case  Dedicate medical equipment for COVID-19 residents  eg thermometers, pulse oximeters  Clean and disinfect before use on another resident  Do not store PPE in room Inform Promote Sustain