To All Nursing and Residential Care Homes

Winter Season 2016- Infection Prevention & Control Messages for Nursing and Residential Care Homes.

With the winter season fast approaching it is important to remember and implement some key infection prevention and control principles that will reduce the risk of infection to residents, staff and visitors and prevent outbreaks of infection within care homes.

  1. Seasonal Flu and Flu vaccination.

Flu is a highly infectious viral illness that can cause serious complications and life threatening illness in the elderly and also in at risk groups. Flu can cause outbreaks in Care homes due to the number of vulnerable residents that live closely together. Please follow the Public Health Wales (2016/17) Flu and Flu vaccine guide for care home managers and staff, available at:

Although Flu can be caught any time of the year, it is more common in the winter months and can be spread via;

  • Droplets of infected respiratory secretions that are released into the air when an infected person coughs or sneezes.
  • Direct contact/skin to skin contact with an infected person, as hands can become contaminated with the flu virus and then transferred into a person’s mouth, nose or eyes.
  • Indirect contact- the flu virus can survive on environmental surfaces for up to 24hours and so a healthy person can then pick up the virus on their hands and transfer it to their mouth, nose and eyes.

Flu symptoms include fever, chills, headaches, cough, sore throat, runny or stuffy nose, body and muscle aches, fatigue and sometimes vomiting and diarrhoea. It can take between 1 to 3 days for symptoms to display after close contact with a person infected with flu and a person can remain infectious from 1day before actual symptoms display and up to several days after.

ACTIONS TO REDUCE FLU RISKS;

  • Ensure all residents are vaccinated against Seasonal flu each year. Each care home should have a written policy for flu immunisation for residents and staff.
  • Each care home Manager must keep an accurate record of the flu vaccination status of residents and staff.
  • It is the care home employer’s responsibility to arrange and provide flu vaccinations for care home staff. Employers must encourage and ensure all care home staff that have direct contact with residents are advised of how important it is that they receive the flu vaccine to protect themselves, their families and also to protect the vulnerable residents that they care for.
  • Any resident with symptoms of flu like illness must be cared for in their own room and have no contact with other residents until recovered.
  • If you think that one of your residents has flu, then contact the G.P as older residents and residents with underlying medical problems are more likely to be at risk of complications. The G.P will make an assessment and decide if it is flu and if appropriate may prescribe antiviral medication for the resident.
  • Care home staff must ensure good infection prevention and control procedures are in place and practised to prevent further spread of flu in the care home. This will include the wearing of personal protective equipment (PPE) when in contact with infected residents such as gloves and aprons, appropriate hand washing and frequent environmental cleaning and disinfection of frequently touched surfaces. High standards of respiratory hygiene with residents must be practised e.g. provision of tissues to cough/sneeze into and a waste disposal bag. Hand hygiene must be encouraged with all residents.
  • 2 or more residents with flu like illness within a few days may indicate an outbreak in the care home – isolate and care for affected residents in their own rooms and do not allow other residents to have contact. Ensure good infection prevention and control procedures are in place in order to prevent spread of flu in the care home. In an outbreak situation the care home must follow their outbreak plan.

Please liaise with the G.P in regard to the affected residents. Inform the Health Protection Team- Mid & West Wales on: 01792607387

  • Ensure staff do not work with flu like illness as they will spread the respiratory infection to residents and other staff.
  • Do not allow visitors to visit the care home whom are unwell with coughs, colds, flu like illness, nausea/vomiting and diarrhoea or any other infectious condition. Visiting to be restricted in outbreak situations.
  • Ensure good standards of environmental cleanliness and hand hygiene by all staff. Visitors to be requested to perform hand hygiene appropriately when visiting.
  • Care Home manager to ensure good stocks of PPE
  • Employers must ensure that care home staff receive training in relation to flu. The care home flu policy and staff training records must be maintained. Education for care home staff on seasonal flu is available via Public Health Wales (PHW) as an on-line e:learning module at:

Detailed information on Infection prevention and control guidance for care homes produced by PHW can be found online:

Infection Prevention and Control in care homes

: All Wales Guidance (PHW,2015). Available at:

NB. This document supersedes NPHS infection Control Guidelines for Care Homes (2007)

2. Viral Gastroenteritis

The most common cause of viral gastroenteritis in care homes is Norovirus (also known as winter vomiting virus). Norovirus is highly infectious and transmitted via the airborne route, faecal – oral route and via contaminated environments or equipment. The incubation period is between 12- 48hours and the illness may last from 1 -3 days. Symptoms of Norovirus include nausea, vomiting of which may be sudden and projectile in nature, pyrexia, headaches and watery diarrhoea.

ACTIONS TO REDUCE NOROVIRUS OUTBREAKS:

  • Do not allow visitors to visit the care home whom are unwell with nausea/vomiting and diarrhoea, coughs, colds, Flu like illness or any other infectious condition. Ensure a visitor notice profiles this and discuss with residents and visitors.
  • Ensure all staff report anydiarrhoea and vomiting (D&V) that they have to the Care home manager and staff exclusion policies for diarrhoea and vomiting must be implemented. Unwell staff will be asked for faecal specimens in order to ascertain the cause of illness during outbreak situations.
  • Immediately isolate any resident with symptoms of gastrointestinal infection. Staff to adhere to the appropriate isolation PPE and to wear masks when in close contact with residents whom are actively vomiting. Liaise with the residents G.P in regard to their D & V illness.
  • Care Home manager to ensure adequate stocks of PPE
  • Care Home manager to ensure all residents have adequate oral hydration at all times.
  • Report 2 or more residents with gastrointestinal symptoms to the Health Protection Team- Mid & West Wales on :01792607387
  • Ensure good standards of environmental cleanliness and hand hygieneusing soap and running water by all staff. Visitors to be requested to perform hand hygiene appropriately when visiting.

3.Other immunisation considerations for Residents.

Apart from the annual seasonal flu vaccination of residents, please ensure that all residents are up to date with all immunisations e.g. pneumococcal, shingles.

4. General Principles to Avoid Infections in Residents.

  • Hand Hygiene –Encourage residents to wash their hands after toileting and before meals to reduce risks of infection. If residents are unable to do this, then please assist them with hand hygiene at a sink or with hand wipes.Care Home staff must ensure that they appropriately decontaminate their hands at all times.
  • Keep Residents Hydrated- Drinking plenty of water- water is the best way to stay hydrated. Good hydration supports all systems of the body and helps to prevent tiredness, headaches and will also help to prevent infections. Encourage residents to drink water and the best way to do this is to sip/ drink water throughout the day, with the aim of at least 6-8 cups of water a day. If residents are on a restricted fluid intake than adhere to the doctors advise.
  • Avoid Urinary Tract Infections– Urinary tract infections are common in the elderly but can have a detrimental effect on well-being and the health of residents. To reduce the risk; please adhere to the following advice:

Encourage residents to drink plenty of water to reduce the risk of a urinary tract infection. Drinking plenty of water i.e. 6-8 cups a day will generally flush any bacteria out of the bladder and prevent any bacteria from adhering to the bladder wall, multiplying and causing a urinary tract infection and in rare situations blood poisoning.

Hygiene-It is important that women after passing urine wipe themselves dry from front to back, to avoid any bacteria entering the bladder from the back passage and causing a urinary tract infection. Patients that are incontinent need high standards of hygiene to reduce the risks of a urinary tract infection. Residents must be encouraged not to hold on to a full bladder and delaying going to the toilet; as this will increase the risk of an infection, residents should go to the toilet as soon as they can when theyfeel the need to.

Avoid Constipation- as this will prevent the bladder emptying properly and this may increase the risk of developing a urinary tract infection. Constipation can be minimised with a high fibre diet that includes fruit and vegetables along with a good fluid intake of water each day.

Look after Residents skin - it is important to maintain the integrity of resident’s skin, as we get older our skin becomes drier and less strong and is than more likely to become damaged. Any breaks in the skin may deteriorate and become infected. Bathe/shower residents regularly and after gentle dryingof skin it is a good idea to moisturise the skin as this has shown to reduce skin damage from trauma. Inspect the patients skin regularly, especially over bony areas such as heels, hips and sacral areas for red marks or breaks in skin as this may indicate pressure damage. Try and offload high risk heel areas from continued pressure using pillows. Seekhelp immediately if you suspect the patient has pressure damage. If you notice any damage to residents skin such as boils, cuts and sores that are not healing than please discuss with the residents G.P.

  • Look after Residents feet- ensure toe nails are carefully cut to avoid cuts on the skin that can place residents at risk of infections. Ensure feet are kept clean and moisturise regularly. Treat any fungal infections and seek advice for any sores or wounds on resident’s feet that are not healing.
  • Look after Residents teeth- teeth and gums that are in poor condition can lead to mouth infections and can place residents at increased risk of blood poisoning and endocarditis which is an infection / inflammation of the heart valves. Please ensure any dental/gum issues are assessed and dealt with appropriately.
  • Avoid Antibiotics unless assessed as necessary- doctors will always try and avoid giving antibiotics and will only prescribe antibiotics if it is really necessary. This is because the more antibiotics that are used the greater the chance of bacteria becoming resistant to them; so that the antibiotics no longer work on infections. Antibiotics can also cause side effects such as rashes, thrush, stomach pains and diarrhoea. Milder infections such as the common cold and sore throats often get better without antibiotics. If it is deemed necessary for residents to take antibiotics to treat an infection, than it is very important that they complete the course. If any resident whilst on antibiotics or recentlycompleted a course experiences more than one bout of diarrhoea, then please save a specimen and inform the G.P.
  • Indwelling Devices- urinary catheters, feeding tubes or intravascular lines are risk factors for infection in residents and it is extremely important to maintain the Aseptic and Aseptic non touch technique procedure with these devices at all times, to reduce the infection risks to the resident.
  • Clean and tidy care home environment -It is important that the Care home environment , furniture and equipment is maintained and kept to a high standard of cleanliness at all times, to avoid cross infection to the residents.
  • Staff Education- All Care home staff should receive training on the prevention and control of infection at induction for new staff and in ongoing training programmes for all staff. All Infection Prevention & Control training must be documented in staff records. It is important that all staff have a clear understanding of their role and individual responsibilities to prevent the spread of infection. All staff must be familiar with care home infection prevention and control policies and procedures. Also available online for staff in care homes are infection prevention & control education modules for staff in direct care (level 2) and indirect care (level1). Care home staff can self register for these infection prevention & control modules at https:learning.wales.nhs.uk/

INFECTION PREVENTIONCONTROL TEAM- HDUHB

Twitter – Infection Prevention @IPHywelDda

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