CrossroadsCarePrevention and control of infection guidance for volunteers

D.01d

Infection prevention and control guidance for volunteers

1.0 SCOPE

1.1 This guidancesets out Crossroads Care’s approach to the prevention and control of infection for the following groups:

  • Crossroads Care volunteers
  • service users of all ages, including parents, carers, adults, children and young people with care needs.

1.2 Its aim is to protect service users and volunteers against acquiringinfections from activities carried out in your agreed volunteering role.

1.3 Crossroads Care recognises the added value that volunteers can bring to its services and this is reflected by the wide variety of roles they perform. However, the nature of the organisation’s relationship with volunteers is very different to the one it has with paid employees.

Volunteers will not:

  • provide personal care services / support with medication in people’s homes (see Crossroads Care’s policies on personal care and medication)
  • undertake roles where the prompt attendance of the volunteer at a specified time / venue is essential to the safety or wellbeing of a person with care needs.

1.4If your agreed volunteer role involves the possibility of contact with blood or body fluids such as urine, faeces, vomit or sputum, then you are at risk of acquiringor spreading infection. These substances may contain pathogensthat can spread from person to person if the necessary precautions are not taken.

1.5You also need to read Crossroads Care’s guidance for volunteerson:

  • hepatitis (D.02d)
  • HIV and AIDS (D.03d)
  • MRSA (D.04d)
  • tuberculosis (D.05d)
  • food handling and basic hygiene control (D.06d)
  • safe use and disposal of clinical sharps (D.07d)
  • accident, incident and near miss reporting, recording and investigation (F.09).

2.0 INTRODUCTION

2.1We aim to make sure you know, in relation to your volunteering role:

  • how to prevent the spread of infection
  • the safe way to handle any potentially infectious materials you might come into contactwith
  • how to dispose of wastesafely
  • how to prepare, cook, serve, store and transport food safely.

2.2 Appendix 1 at the end of this document gives definitions of:

  • infectious disease
  • infection control
  • pathogens
  • cross infection
  • immunodeficiency.

2.3 Appendix 1 also gives you information about:

  • how infection enters the body
  • how infections spread.

2.4Read this guidance carefully and put it into practice. If you don’t understand anything in it or have any questions, or if you are worried about your own health and safety, speak to your volunteers’ co-ordinator straight away.

3.0 Universal precautions

3.1There is a risk that a person’s blood or bodily fluids are infectious. Never presume to know who has and who does not have an infectious disease. Always use ‘universal precautions’ whatever the age or condition of the service user concerned.

3.2 Universal precautions are infection control guidelines designed to protect people from infectious diseases by preventing contact with blood and body fluids. These are set out below and a summary of them is given in Appendix 3at the end of this document.

3.3 Hand hygiene

3.3.1The most effective precaution against the spread of infection is thorough hand hygiene. Full details of how to wash hands properly are set out in Appendix 2 at the end of this document.

3.3.2 Wash and dry hands:

  • when arriving at or leaving a service user’s home
  • between going from one person to another where direct contact is involved
  • between different activities for the same person
  • after handling any soiled items such as laundry, nappies or pads
  • after carrying outcleaning tasks
  • after blowing your nose or covering a sneeze or cough
  • after touching your mouth, face or hair
  • after using the toilet
  • before eating, drinkingor handling food
  • after handling raw foods (for example meat or eggs)
  • after handling rubbish or waste
  • wheneverhands are obviously dirty or contaminated.

3.3.3 Wearing disposable gloves does not mean a person does not need to wash their hands. It is important to wash hands both before and after using gloves.

3.4 Nails

3.4.1 Nails need to be kept short,clean and free from nail varnish or artificial nails.

  • Long nails may puncture disposable gloves.
  • Bacteria can harbour under long / artificial nails.
  • Nail varnish may chip off and fall into food.

3.5 Jewellery

3.5.1 Jewellery needs to be kept to a minimum. Rings, necklaces, earrings or watches

may snag on clothing, gloves or skin, causing injury and increasing the risk of cross-infection.

3.6Skin

3.6.1Skin that is in good condition and intact (without cuts, grazes or sores) is a natural defence against infection. Cuts and grazesneed to be covered with a water-resistant plaster or dressing.

3.6.2How to handle splashes of blood or body fluidsontoskin or into eyes, nose or mouth, is documented in the safe use and disposal of sharps guidance for volunteers (D.07d Appendix 3).

3.7Personal protective equipment (PPE)

3.7.1Disposable(non-latex, such as vinyl or nitrile)gloves and disposable aprons:

  • need to be worn at all times when handling body fluids, carrying out personal care tasks and when cleaning
  • must only be used once
  • need to be changed between different tasks
  • need to be changed between contact with different people
  • need to be disposed of immediately after use into an appropriate waste disposal bag (see 3.9 below)
  • must not be washed and / or reused.

3.7.2 When a person is wearing PPE such as gloves and aprons it is possible for them to become lax, as they feel protected. Anything that is touched with contaminated gloves will itself become contaminated. PPE is provided just as much for the protection of the service user as for the person using it.

3.7.3 The person using the PPE is responsible for ensuring it is properly used, maintained, replaced and disposed of.

3.7.4Footwear needs to be sturdy, non-slip, have flat heels, enclosed back or strap and enclosed toes. One of the reasons for this is to reduce the risk of injury from sharps and potential exposure to body fluids - see safe use and disposal of sharps guidance for volunteers (D.07d) for details.

3.8Cleaning spillages

3.8.1 Every spillage of body fluids or body waste has to be treated as potentially infectious and dealt with it as quickly as possible. The person dealing with the spillage needs to:

  • put on disposable gloves and apron
  • clear up wetness with paper towels and place in the appropriate waste disposal bag (see 3.9 below)
  • always use fresh cloths and towels in each area where there is a spillage
  • if it won’t cause damage to the soiled surface, use a solution of 10% bleach in water to wipe the area clean
  • on other surfaces (such as carpets) allow remaining spillage to dry, and use a standard cleaning product or hot soapy water to clean
  • remove gloves and aprons and dispose
  • wash hands.

3.8.2 When handling heavily contaminated laundry (such as sheets, towels, clothing, flannels and other cloths) the person carrying out the task needs to:

  • put on disposable gloves and apron
  • wipe away any solids with paper towels and dispose of in appropriate waste disposal bag (see 3.9 below).
  • sluice off the laundry as much as possible and then place in the washing machine
  • close the washing machine door without contaminating it (you can use your knee or elbow or close it after removing PPE and washing hands)
  • remove gloves and aprons and dispose
  • wash hands
  • wash the laundry with detergent at the hottest setting for the fabric concerned with normal washing powder.

3.9Safe disposal of waste

3.9.1 Household waste

Unless otherwise directed, waste containing bodily fluids (for examplesanitary towels, nappies, incontinence pads, soiled disposable gloves and aprons) can be disposed of in ordinary household waste. Items need to be bagged separately and not put into dustbins loose.

3.9.2 Clinical waste

In some circumstances however items containing bodily fluids (for example nappies, pads etc) need to be disposed of as clinical waste rather than household waste (see 3.9.1 above). This will usually be if the service user has a medical condition such as HIV/AIDS, hepatitis or MRSA.

3.9.3When clinical waste is being handled:

  • all flushable material such as urine, faeces and vomit can be disposed of down the toilet
  • other clinical waste containing bodily fluids (for example sanitary towels, nappies, incontinence pads, soiled disposable gloves and aprons)has to be placed into the clinical waste disposal bags provided - these are usually yellow and will be collected separately by an authorised agency
  • clinical waste disposal bags need to be sealed and stored when they no more than three quarters full, ready for collection - if overfull, the bags are more likely to split.

3.9.4A service user’s home must never be left in a soiled condition. Any surfaces that may have come into contact with waste need to be thoroughly wiped down and left clean and tidy.

3.10Personal hygiene

3.10.1 If your volunteering role brings you into contact withservice users, you need to maintain

a high standard of personal hygiene, paying particular attention to clothing and body odour.

3.10.2 If clothing gets significantly dirty, particularly if it becomes soiled with blood or bodily fluids, contact your volunteers’ co-ordinator / the person on call to discuss what action to take.

3.11Avoid unnecessary contact

  • Do not breathe into the face of or carelessly touch the nose, mouth or wound area of a service user.
  • Take steps at all times to prevent contact with blood and body fluids by wearing the personal protective equipment provided.

3.12Look after your own health

3.12.1Take advantage of any health checks offered such as influenza vaccinations. The recommended time to have the vaccine is in October or November, but even later is still useful, as the season can last from October until May.

3.12.2It is recommended that you inform your volunteers’ co-ordinator if any of the following apply:

  • you have psoriasis, eczema or dermatitis on your face, hands or lower arms
  • you are pregnant or planning on becoming pregnant
  • you are immuno-deficient
  • you are undergoing treatment for cancer or on steroid therapy
  • you have an infectious disease , for example MRSA, Hepatitis, TB or HIV / AIDS.

You are not obliged to provide this information but it will be useful to your volunteers’ co-ordinatorwhen considering what volunteering roles are the most appropriate for you.

3.13 Sickness

3.13.1 It is recommended that you do not attend your volunteering role if you have an infection that can be passed on to other people (for example a cold or sore throat) as some people who have lowered immune systems may not be able to shrug off these infections and could go on to develop a serious illness. Inform your volunteers’ co-ordinator of your condition as soon as you can so that they can make the necessary arrangements.

Examples of people who may have lowered immune systems include:

  • frail older people
  • babies, infants and children
  • service users with certain diseases such as HIV / AIDS or hepatitis
  • service users who are taking certain medications such as steroids or medication for the treatment of cancer.

3.13.2 If you develop nausea, vomiting, diarrhoea or stomach cramps, do not attend your volunteering role until 48 hours after the symptoms have disappeared. If you develop these symptoms whilst you are volunteering, inform your volunteers’ co-ordinator / the person on call straight away.

3.14Safe use and disposal of sharps

3.14.1 Details relating to the safe use and disposal of sharps are fully documented in the safe use and disposal of sharps guidance for volunteers (D.07d).

3.15Sharing

6.16.1 Never share items such as towels, flannels, razor blades or toothbrushes with anyone else as these may that may be contaminated with blood or bodily fluids

3.16Environmental cleaning

3.16.1 Dust and dirt are a potential source of healthcare related infection.

  • Placeused crockery, cutlery and kitchen utensils in the dishwasheror wash in hot water and detergent.
  • Clean work surfaces with detergent, rinse with a damp cloth and leave to dry.
  • Use separate cloths and mopsfor the kitchen, bathroom, toilet and other areas to avoid cross-contamination.

3.17Food preparation

3.17.1 TheCrossroads Care’sfood handling and hygiene guidancefor volunteers(D.06d) needs to be followedin order to ensure that food in service users’ homes is prepared, cooked, stored and presented in accordance with the high standards required by law.

5.0 confidentiality

5.1 Crossroads Care expect volunteers to treat people who are ill or disabled(for whatever reason)with dignity and kindness. Everyone has a right to expect their culture, faith and lifestyle to be respected. They also have a right to expect you will treat their situation with confidentiality in accordance with Crossroads Care’s confidentiality and disclosure guidance for volunteers (D.11d).

6.0 REPORTING

6.1 If you acquire one of the notifiable diseases listed below as a result of volunteering for Crossroads Care, inform your volunteers’ co-ordinator as it has to be reported to the Health and Safety Executive.

6.2 Notifiable diseases include: cholera, food poisoning, smallpox, typhus, dysentery, measles, meningitis, mumps, rabies, rubella, tetanus, typhoid fever, viral haemorrhagic fever, hepatitis, HIV / AIDS, whooping cough, leptospirosis, tuberculosis and yellow fever. Full details are available on the HSE website:

6.3 Report any accidents, incidents or near misses (however minor) linked to your volunteering activities to your volunteers’ co-ordinator / the person on call straight away.

7.0 BRIEFING AND INDUCTION

7.1 Your volunteers’ co-ordinator is responsible for assessing the roles undertaken by volunteers (including trustees) within their scheme and the level of briefing / induction those volunteers require in relation to the prevention and control of infection guidance for volunteers (D.01d).

8.0 ACCEPTANCE

8.1 You are required to sign to indicate that you have received, read and understood the content of this guidanceas directed by your volunteers’ co-ordinator and on completion of your briefing and induction, it is your personal responsibility to follow it.

APPENDIX 1

1.0 definitionS

Infectious disease

Some diseases are infectious which means they can be passed from one person to another. Examples of infectious diseases include MRSA, hepatitis, TB and HIV / AIDS (the list is not exhaustive).

Infection control

‘Infection control’ refers to a wide range of procedures and techniques intended to prevent the spread of infectious diseases.

Pathogen

A pathogen is any disease-producing agent, for example a virus, bacterium or other micro-organism.

Cross- infection

This refers to the transmission of pathogens from one person to another.

Immunodeficiency

Some part of the body’s immune system is inadequate and its resistance to infectious diseases is reduced.

2.0 How infection enters the body

Infections pass between people in different ways. They can:

  • be breathed in (for example, coughs, colds, influenza)
  • be swallowed (for example, eating infected food or drink may result in an 'upset stomach', diarrhoea or vomiting)
  • get through the skin (for example through bites, scratches, puncture wounds)
  • enter the body through the mouth, nose or eyes
  • be blood-borne (for example hepatitis B or C and HIV / AIDS)
  • enter the body through the urinary and reproductive systems (for example urinary tract infections and Chlamydia).

3.0 How infectionS SPREAD

Whether an infection spread depends on a number of different things, including a person’s general health and how strong the pathogen is.

Some people are at greater risk of getting an infection, especially:

  • babies and young children
  • frail older people
  • those who have a disability
  • people who have a catheter, as this gives bacteria a way into the body
  • those who are already ill from other conditions, especially if they are taking long-term drugs such as steroids
  • people who have a poor diet, don’t or aren’t able to take much exercise or are stressed
  • those who live in homes with poor sanitation and inadequate waste disposal.

APPENDIX 2

HAND HYGIENE

  • First wet your hands with warm, running water, then apply soap. Use liquid rather than bar soap wherever possible. Lather well.
  • Rub your hands together vigorously for at least 10–15 seconds, paying particular attention to the tips of your fingers, your thumbs andthe area between your fingers (see diagram below).
  • Rinse thoroughly.
  • Dry your hands thoroughly with a disposable, paper towel wherever possible or with a clean fabric towel.
  • Never share towels – dishcloths, tea towels and towels are common sites for bacterial cross-infection.
  • After your hands are dry, use a paper towel to turn off the tap.
  • Use hand cream to stopyour skin becoming dry and cracking.

Diagram showing how to thoroughly rub your hands:

Handwashing facilities will normally be available in a service user’s home. When facilities are not suitable, or clean running water is not available, you can use an alcohol-based hand sanitizer as an alternative, so long as your are not soiled with dirt or organic material in which case they do need to be washed in soap and water.

Please note:some hand sanitizers do not contain alcohol. Use the alcohol-based products unless you are allergic to them or object to using alcohol in which case, non- alcohol based products are available.

To use a hand sanitizer:

  • read the label for dosing instructions
  • apply sanitizer to the palm of your hand
  • rub your hands together, covering all surfaces of your hands, paying particular attention to the tips of your fingers, your thumbs and between your fingers.
  • Continue rubbing until the solution has evaporated and hands are dry.

APPENDIX 3

A SUMMARY OF universal precautions

Never presume to know who has and who does not have an infectious disease.