Importance of Good Infection Control in Nursing Homes

The Importance of Good Infection Control in Nursing Homes discussed by Bristol Care Homes

The UK has suffered badly from coronavirus, with a mortality rate now equal to the cumulative total per million population in Italy, and over 5 times that in Germany.  Whilst the virus can prove widely life-threatening, the group most vulnerable is the elderly with underlying health conditions, many of whom need professional nursing care, and live in care homes. Care homes then become vulnerable to the virus, requiring a rigorous management response. There is, however, a ‘location fallacy’. Press and TV reports on the impact of the virus on care homes, almost suggest that they are not safe places for the elderly to live, or for people to work. However, this is like stating that in normal times, hospitals are dangerous places to be. It’s not the location which leads to vulnerability but each person’s age and health condition. People who are most vulnerable to coronavirus tend to live in care homes and it’s not because they live in care homes that they are vulnerable. 

This means that even more than ever cleanliness and infection control measures and processes are vitally important in this changing world and this isn’t just in care or nursing homes but in every environment and every business or home.

The Office for National Statistics (ONS) data shows that by 15 May there had been 11,636 deaths from Covid-19 in care homes in England and Wales, which is 34% more than the 34,700 deaths from other causes. However, there are huge difficulties in deciding how to define the cause of death. Many vulnerable care home residents have recovered from Covid-19. Others in end-of-life care may test positive for the virus, but because of the complexity of multiple life-threatening conditions, it is often difficult, if not impossible, to determine the main cause of death. They may indeed have recovered from Covid-19, had that been their only condition. In this case, recording a death as Covid-19 might overstate the impact of the virus. On the other hand, frequent ‘false negatives’ in coronavirus tests, where a resident presents symptoms of the disease whilst testing negative, lead to under-recording of Covid-19 as a cause of death. 

More reliable is data on excess mortality. This shows that by 15 May, 22,436 care home residents had died from Covid-19, which is 75% more than the regular mortality rate of 29,896.This is now falling from a peak of 5,513 extra deaths in the week of 23 April to 2,063 by 15 May.

Both the government and the CQC (Care Quality Commission) have set out guidance and advice for the public and for all social care services:

Government Guidance for Coronavirus COVID19 

https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance

The advice for the public, businesses and any social setting includes the following:

1. The most common symptoms of coronavirus (COVID-19) are recent onset of a new continuous cough or high temperature or a loss of, or change in, normal sense of taste or smell (anosmia). If you have these symptoms, however mild, stay at home and do not leave your house for at least 7 days from when your symptoms started (if you live alone), or 14 days (if you live with someone who has symptoms). You do not need to call NHS 111 to go into self-isolation. If your symptoms worsen during home isolation or are no better after 7 days, contact NHS 111 online. If you have no internet access, you should call NHS 111. For a medical emergency dial 999
2. Wash your hands more often than usual, for 20 seconds using soap and hot water, particularly after coughing, sneezing and blowing your nose, or after being in public areas where other people are doing so. Use hand sanitiser if that’s all you have access to
3. To reduce the spread of germs when you cough or sneeze, cover your mouth and nose with a tissue, or your sleeve (not your hands) if you don’t have a tissue, and throw the tissue in a bin immediately. Then wash your hands or use a hand sanitising gel
4. Clean and disinfect regularly touched objects and surfaces using your regular cleaning products to reduce the risk of passing the infection on to other people
5. At the current time and based on our understanding of what is known of COVID-19 and other similar respiratory viruses, it is likely that older people and those with chronic medical conditions may be vulnerable to severe disease. As more information emerges, recommendations may change

As summarised in the last point, older people and those with chronic medical conditions may be vulnerable to severe COVID19 disease and the recovery from it in a lot of cases can be more difficult. This is why the containment and prevention measures that are put in place by care and nursing homes are essential to protect both residents and staff. 

How Bristol Care Homes are Keeping Residents, Staff and Families Safe 

As always we are working closely with the CQC (the Care Quality Commission) who are sharing their findings of COVID19 in care and nursing homes with local authorities across the UK so all information can be combined and reviewed. The information and trends are being used to understand the impact of the coronavirus pandemic within care settings and advice distributed, including, best practices for infection prevention, disease control, protecting residents and preventing the spread of COVID19.

Keeping everyone safe has always been one of our highest priorities for Bristol Care Homes and safety applies to our residents, their families and friends, and our staff equally.

The Coronavirus pandemic has presented huge challenges for all care sectors and services but especially in elderly care and nursing homes. Many of the elderly residents in homes have underlying medical conditions which will make them far more vulnerable to severe COVID19 disease and they live in close proximity within their homes making it easier for the disease to spread quickly if good infection control procedures are not in place and are strictly followed.

All of these reasons make residents in care homes one of the most vulnerable groups in regards to catching and being severely ill when it comes to COVID19. However, careful analysis of data from the Office for National Statistics shows that this is due to many residents underlying health conditions, their age and their need for care, not solely because they are living in a care home. 

This means it is even more essential that care and nursing homes have procedures in place which prevent the disease from entering as well as preventing the spread of the disease within them. 

At Bristol Care Homes we are following the government guidelines set out in regards to caring for our residents, families and staff and infection control. This will not result in a zero-risk environment within our homes but it will dramatically minimise the risks that the COVID19 disease can present.

Our number one aim at this time is that our residents are not under any greater risk, and where possible lower risk, compared to either living at home, if they were in hospital or any other care facility and that we continue to provide the best, most professional and caring environment for them.

Our two prime objectives to support this are:

1. our residents are protected from infection
2. any residents who do suffer an infection have the maximum likelihood of a swift recovery

Our detailed, strict and lengthy infection control procedures include every aspect of our home’s environment and services, from caring for our residents physically and mentally, to their medical needs, cleaning, catering and the use of PPE equipment.

Our infection control procedures are detailed and taken seriously within every one of our homes in bristol and they are vigorously checked regularly to ensure they are being carried as they should be and without compromise, whilst still maintaining the high levels of care and support we provide our residents to ensure the risk to our residents and staff are minimised. 

Summary of our Infection Control Procedures 

Public Health England has reviewed and approved our actions and decisions and has been providing us with excellent support at this time.

Residents with a suspected COVID19 infection are immediately seen by our highly skilled and professional on-site nurse team which are there 24/7 and if needed we will request that a doctor attends the home to also assess them. If this happens then there are strict PPE procedures in place to prevent the disease from entering any of our homes when someone externally enters. Our on-site nurses are qualified to administer oxygen when prescribed by a doctor and this is done in a caring and compassionate way by our team. We will ensure the resident is tested for COVID19 if symptoms are present and isolated and barrier nursed for 14 days, or until their symptoms have gone, whether they test positive or negative to the COVID19 test. Any Symptomatic Patients are isolated, in line with Public Health England guidelines.

Staff groups are allocated to specific resident groups to prevent cross-infection.

Residents and staff are screened regularly to identify infections early and isolate any with symptoms.  

Any staff presenting symptoms self-isolate.

Staff travel to work and change into their uniform at work, and then launder their clothing daily immediately arriving home.

Even more intensive deep cleaning regimes have been implemented, focussing on touch surfaces within all of our homes and these are carried out regularly each day, are monitored and signed off at regular intervals.

The ‘My 5 Moments for Hand Hygiene’ approach defines the moments when our carers will carry out hand washing hygiene. This approach is evidence-based, field-tested and has a user-centred approach which is designed to be easy to remember, logical and applicable in a wide range of settings including care and nursing homes.

The ‘My 5 Moments for Hand Hygiene’ approach recommends care workers clean their hands:­

1. before touching a resident
2. before clean/aseptic procedures
3. after body fluid exposure/risk
4. after touching a resident
5. after touching a person’s surroundings and belongings

In addition to this, our residents are being encouraged not to touch their faces, to wash their hands regularly and use hand sanitiser.

As well as washing hands with soap and hot water using the 5 steps our carers and care home staff also use alcohol hand gel regularly and our residents are encouraged to do the same. 

Any new residents who move into our care homes are asked to isolate in their own room for their first 14 days with us. This is very difficult for most residents who come to us and we support them throughout this period to ensure they feel welcomed, at home and don’t feel isolated until they are able to meet and socialise with the other residents within our homes. Moving into a care or nursing home is often difficult at any time and even more so now as we are facing this pandemic so our care and nursing teams spend a lot of time with them during the 14 day isolation period to ensure they don’t feel lonely or isolated. We can assure you that the same high standards of safekeeping and care are delivered at this time which all of our team are fully committed to. 

Our policies and procedures for the admission of new residents have been endorsed by Public Health England and we have made the decision to allow new residents to move into our homes in consultation with all the health authorities who advise us. New residents moving into our homes will only happen when we are certain we can assure the safety of all of our existing residents. 

By caring for new residents, we are making our contribution to the whole health system which needs to ensure available capacity in hospitals and within the community. We are confident, as are Public Health England who have conducted a thorough risk assessment for us that we have the right measures in place for new admissions to be safe. 

Strict infection control conditions apply to our new residents and this includes ensuring that if they are coming from another healthcare setting that they have a test for coronavirus. Whether this test is positive or negative, they are only allowed in their room for 14 days during which time they will be cared for by our team in full PPE, following strict infection control procedures to avoid any risk of transmitting infection within our homes. Individual risk assessments are carried out by our home management team for all new potential residents to ensure that all risks are minimised.

We have adequate and safe PPE (Personal Protective Equipment) for all of our staff. Surgical masks are worn by our carers and staff at all times for any work within our homes. When caring for residents with a suspected infection FFP2 rated masks are worn by our carers and nurses. FFP2 masks have a minimum of 94% filtration percentage and maximum 8% leakage to the inside. They are mainly used in construction, agriculture, and healthcare professionals against influenza viruses. They are currently used for protection against coronavirus and they are the most filtering mask of the FFPs and for infection control. We have sourced sufficient stock and have a secure future pipeline of orders of our PPE for all of our staff within our homes. All our staff are fully competent in the management of all aspects of PPE use and follow the strict infection control measures we have implemented at all times.  

Implementing these strategies has resulted in Bristol Care Homes achieving a position where, after an initial outbreak of the virus, there are now no residents at any of our homes with an infection. This is a testament to the heroic work of the staff teams at each home. Much of normal life continues. Residents enjoy activities with social distancing. Beautiful gardens currently in full bloom are accessible and there is a happy calm atmosphere so residents can continue to enjoy their lives with us. 

Many elderly people do need the care which only a care home can provide and this now comes with rigorous, professional and effective infection control. At Bristol care Homes our residents feel assured that their care needs are being met, that they face a minimised risk of infection, and can expect a high rate of recovery in the rare event of infection.

Gov.uk has Provided Coronavirus (COVID-19) Adult Social Care Guidance for Infection Control

Information for the adult social care sector on responding to the coronavirus pandemic. can be found here – https://www.gov.uk/government/collections/coronavirus-covid-19-social-care-guidance

• All care homes should have a written policy in place that details the roles and responsibilities of staff in respect of the prevention and infection control
• This should include roles and responsibilities for the management of outbreaks and incidents of infection

You can ask your care or nursing home for a copy of these and their Infection Control policies and procedures at any time.

About Bristol Care Homes

Bristol Care Homes have 4 Nursing Homes situated in different locations across Bristol including:

• Glebe House in Almondsbury which has an Outstanding CQC (Care Quality Commission) Rating
• Beech House in Thornbury which has an Outstanding CQC (Care Quality Commission) Rating
• Field House in Horfield which has a Good CQC (Care Quality Commission) Rating
• Quarry House in Fishponds which has a Good CQC (Care Quality Commission) Rating

Our homes are based around caring and supporting our residents, ensuring they are made to feel welcome when they first come to us and we ensure they feel like it is home. We pride ourselves in the high level of care we provide, our outstanding homes and their gardens, our extensive and varied menus and the quality food cooked by our very own chefs, as well as the social activities which are varied to suit everyone’s needs. 

Bristol Care Homes Holistic Care

Our Nursing Care Homes are committed and focused on elderly care best practice and we continuously review our procedures and always ask for resident and family feedback to continually improve them. We regularly review and assess every resident’s care plan with them and their relatives which ensures any needs are updated and adapted promptly. We have a computerised care planning system which ensures our qualified nursing and care staff teams always have accurate information on every resident’s medical and care needs. The system also provides an audit trail of care and any changes made. We review and discuss your needs with you and your family directly, and we liaise closely with your doctor if we need to.

We have a podiatrist and physiotherapist who visit our homes regularly as well as optician, dental and hospital appointments arranged when and if they are needed.

Bristol Care Homes Clinical Care includes:

• Competent and professional 24/7 qualified nurses and carers
• High quality, qualified chefs who produce tasty, varied and nutritious meals suitable for every residents’ needs
• Computerised care system and individual care plans which are regularly reviewed and adapted as needed
• Our own regular internal care quality audits which review any feedback, actions and progress to ensure we continually review and adapt
• Wheelchair provision which includes a fully configured Action 3 wheelchair to fully support any resident in complete comfort if required
• State of the art, highly supportive and technically advanced baths and walk-in showers which provide a choice of bathing in comfort for every resident

Bristol Care Homes Creative Arts and Social Activities

We have an active community life in every one of our homes as we understand the extremely positive benefits of social activities. Elderly social care research has proven that social activities when in residential care, enhance a person’s life both physically and mentally.

Age UK state:

• Regular activity can lower your risk of heart disease, stroke, some cancers, depression and dementia
• Moving more helps your thinking skills – like problem-solving, decision-making and remembering facts and words
• Being active can lessen aches and pains, help you stay steady on your feet and boost your mood

We have a varied programme of interesting and stimulating activities which take place across all of our homes and we have a dedicated social engagement and well-being manager Marcia. Marcia is responsible for ensuring meaningful social activities are planned and taking place in each of our care homes. Every week the activities are planned and led by our inhouse activity team who are dedicated to ensuring each resident feels happy, contented and fulfilled in their life. 

At this time COVID19 has resulted in some of our social activities not continuing where external providers come into our homes, however, any that don’t involve this we are carrying on with and finding new and different social activities that our residents and care staff can enjoy at this time.

Our Social Activities include:

• Leading musicians from ‘Live Music Now’ who attend our homes regularly
• Artists’ workshops, commissions of art and exhibitions with Jamaica Street Studios
• Creative gardening and outdoor mosaic workshops with Garden Support
• A variety of creative inputs from Alive Activities
• A fully equipped and customised minibus which provides regular trips out to the local countryside and places of interest. 
• Pet Therapy including dogs, cats and alpacas
• Birthday celebrations with residents and families 
• Afternoon teas
• Card Games
• Bingo
• Book Clubs
• Board Games
• Games Nights
• Singing groups and activities
• Entertainment Events
• Family Days
• Exercise Classes
• Quiz nights
• Outings to local attractions, gardens and events

Bristol Care Homes Facilities

All 4 of our care homes are bright, airy and continually updated and decorated to ensure they retain their fresh, homely and inviting appeal. 

• Beautiful and well-maintained gardens
• Environmentally designed buildings with 24/7 air circulation keeping the atmosphere fresh and airy
• Spacious rooms with increased ceiling height to make them feel bigger and more open
• Wide corridors to ensure easy access for residents walking and in wheelchairs helping them maintain independence
• A television, DVD player and direct line telephone and internet access in every resident’s room
• Regular maintenance and replacement cycle of new carpets and decoration to keep our homes always looking attractive and feeling fresh

The strategies and policies that Bristol Care Homes has implemented have resulted in a position where, after an initial outbreak of the virus, there are now no residents at any of our 4 care and nursing homes in Bristol with an infection. This is a testament to the outstanding work and care of our teams at each home. Much of normal life continues and our residents can still enjoy lots of our social activities with social distancing in place. Our beautiful gardens are currently in full bloom and are accessible and there is a happy calm atmosphere within our homes that everyone can still enjoy which is a high priority for us to maintain.

Many of the elderly people living in our homes need the care which only we can provide and it comes with rigorous, professional and effective infection control. Our residents and their relatives still feel their care and social needs are being met, and we are fully confident that they face a minimised risk of infection.

We would like to thank everyone involved with Bristol Care Homes, including our residents, relatives, staff, suppliers, and friends for their ongoing support during the Coronavirus crisis.

We are extremely proud of and grateful to our wonderful care team, many of whom are going beyond the call of duty to ensure that our service remains running to a very high standard and that our residents are cared for, happy and content.

Contact us today to find out more about us, the exceptional care and nursing services we offer in our 4 Bristol Care Homes, the care and nursing spaces we have available, and if you have any questions about the importance of good infection control in nursing homes.