National Infection Prevention and Control Manual
The NHSScotland National Infection Prevention and Control Manual (NIPCM) was first published on 13 January 2012, by the Chief Nursing Officer (CNO (2012)1), and updated on 17 May 2012 (CNO (2012)1 Update).
The NIPCM provides IPC guidance to all those involved in care provision and is considered best practice across all health and care settings in Scotland.
The re-launch of the NIPCM by the CNO on 11 July 2022 emphasises the ongoing importance of application of Infection Prevention and Control (IPC) guidance within health and care settings across Scotland.
Video of Chief Nursing Officer re-launching the NIPCM
You can find out more about the NIPCM by watching the animation or going to the About the manual webpage.
Disclaimer
When an organisation, for example health and care setting, uses products or adopts practices that differ from those stated in this National Infection Prevention and Control Manual, that individual organisation is responsible for ensuring safe systems of work including the completion of a risk assessment approved through local governance procedures.
Last updated: 4 October 2021
Standard Infection Control Precautions (SICPs), covered in this chapter are to be used by all staff, in all care settings, at all times, for all patients1 whether infection is known to be present or not to ensure the safety of those being cared for, staff and visitors in the care environment.
The Hierarchy of Controls should also be considered in controlling exposures to occupational hazards which include infection risks.
SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmission of infectious agent from both recognised and unrecognised sources of infection.
Sources of (potential) infection include blood and other body fluids secretions or excretions (excluding sweat), non-intact skin or mucous membranes, any equipment or items in the care environment that could have become contaminated and even the environment itself if not cleaned and maintained appropriately.
The application of SICPs during care delivery is determined by an assessment of risk to and from individuals and includes the task, level of interaction and/or the anticipated level of exposure to blood and/or other body fluids.
To be effective in protecting against infection risks, SICPs must be applied continuously by all staff. The application of SICPs during care delivery must take account of:
Doing so allows staff to safely apply each of the 10 SICPs by ensuring effective infection prevention and control is maintained.
SICPs implementation monitoring must also be ongoing to demonstrate safe practices and commitment to patient, staff and visitor safety.
Further information on using SICPs for Care at Home can be found on the NHS National Education Scotland (NES) website.
1The use of the word 'Persons' can be used instead of 'Patient' when using this document in non-healthcare settings.
Last updated: 28 August 2023
Patients must be promptly assessed for infection risk on arrival at the care area (if possible, prior to accepting a patient from another care area) and should be continuously reviewed throughout their stay. This assessment should influence patient placement decisions in accordance with clinical/care need(s).
Patients who may present a particular cross-infection risk should be isolated on arrival and appropriate clinical samples and screening undertaken as per national protocols to establish the causative pathogen. This includes but is not limited to patients:
For assessment of infection risk see Section 2: Transmission Based Precautions.
Further information can be found in the patient placement literature review.
Further information regarding general respiratory screening questions can be found within the resources section of the NIPCM.
Please note that the term ‘alcohol-based hand rub (ABHR)’ has now been updated to ‘hand rub’. A hand rub (alcohol or non-alcohol based) can be used if it meets the required standards. Please see further information in the hand hygiene products literature review.
Hand hygiene is considered an important practice in reducing the transmission of infectious agents which cause infections.
Adherence with the following points is essential to ensure effective hand hygiene:
Hand washing should be extended to the forearms if there has been exposure of forearms to blood and/or body fluids.
Hand washing sinks must only be used for hand hygiene and must not be used for the disposal of other liquids. See Chapter 4 - 4.1.4 Management of water outlets including taps and showers).
*For health and safety reasons, Scottish Ambulance Service Special Operations Response Teams (SORT) in high-risk situations require to wear a wristwatch.
Hand rubs must be available for staff as near to point of care as possible. Where this is not practical, personal hand rub dispensers should be used.
Application of sufficient volume of hand rub to cover all surfaces of the hands is important to ensure effective hand hygiene. Manufacturer’s instruction should be followed for the volume of hand rub required to provide adequate coverage for the hands. In the absence of manufacturers instructions, volumes of approximately 3ml are recommended to ensure full coverage.
The World Health Organization’s ‘5 moments for hand hygiene’ should be used to highlight the key indications for hand hygiene.
Some additional examples of hand hygiene moments include but are not limited to:
Download and print the 5 moments of hand hygiene poster.
Hands should be washed with warm/tepid water to mitigate the risk of dermatitis associated with repeated exposures to hot water and to maximise hand washing compliance. Compliance may be compromised where water is too hot or too cold. Hands should be dried thoroughly following hand washing using a soft, absorbent, disposable paper towel from a dispenser which is located close to the sink but beyond the risk of splash contamination.
In all other circumstances use hand rub for routine hand hygiene during care.
Staff working in the community should carry a supply of hand rub to enable them to perform hand hygiene at the appropriate times.
Where staff are required to wash their hands in the service user’s own home they should do so for at least 20 seconds using any hand soap available.
Staff should carry a supply of disposable paper towels for hand drying rather than using hand towels in the individual’s own home. Once hands have been thoroughly dried, hand rub should be used.
The use of antimicrobial hand wipes is only permitted where there is no access to running water. Staff must perform hand hygiene using hand rub immediately after using the hand wipes and perform hand hygiene with soap and water at the first available opportunity.
(The video above demonstrating Hand Washing and Drying Technique was produced by NHS Ayrshire and Arran)
For how to:
Hand hygiene posters and leaflets can be found at Wash Your Hands of Them Resources.
WHO World Hand Hygiene Day 2024 - Sharing your knowledge about hand hygiene.
Surgical scrubbing/rubbing applies to persons undertaking surgical and some invasive procedures.
Perform surgical scrubbing/rubbing before donning sterile theatre garments or at other times, for example prior to insertion of central vascular access devices.
Surgical scrubbing using an antimicrobial surgical scrub product should be used for the first surgical hand antisepsis of the day. Or perform hand hygiene using water and a non-antimicrobial liquid soap prior to the first surgical antisepsis of the day, this can be carried out in an adjacent clinical area.
For surgical scrubbing
Further information can be found in the Hand Hygiene literature reviews:
Respiratory and cough hygiene is designed to minimise the risk of cross-transmission of respiratory illness (pathogens).
Staff should promote respiratory and cough hygiene helping those who need assistance with this, for example elderly and children, providing patients with tissues, plastic bags for used tissues and hand hygiene facilities as necessary.
Further information can be found in the cough etiquette/respiratory hygiene literature review.
Before undertaking any care task or procedure staff should assess any likely exposure to blood and/or body fluids and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken.
Reusable PPE items, for example non-disposable goggles, face shields, visors must have a decontamination schedule with responsibility assigned.
Further information on best practice for PPE use for SICPs can be found in Appendix 15.
Double gloving is only recommended during some Exposure Prone Procedures (EPPs), for example orthopaedic and gynaecological operations or when attending major trauma incidents and when caring for a patient with a suspected or known High Consequence Infectious disease. Double gloving is not necessary at any other time.
For appropriate glove use and selection see Appendix 5.
Further information can be found in the Gloves literature review.
The choice of apron or gown is based on a risk assessment and anticipated level of body fluid exposure. Routine sessional use of gowns/aprons is not permitted.
If hand hygiene with soap and water is required, this should not be performed whilst wearing an apron/gown in line with a risk of apron/gown contamination; hand hygiene using ABHR is acceptable.
Further information can be found in the Aprons/Gowns literature review.
Regular corrective spectacles and safety spectacles are not considered eye protection.
Further information can be found in the eye/face protection literature review.
Transparent face masks may be used to aide communication with patients in some settings.
Transparent face masks must:
and
Further information can be found in:
Footwear found to be defective should be repaired or replaced before further use.
Overshoes/shoe covers should not be used in the general health and care environment.
Further information can be found in the footwear literature review.
Further information can be found in the headwear literature review
For the recommended method of putting on and removing PPE see video below and Appendix 6.
The correct order for donning, doffing and disposal of PPE for healthcare workers from NHS National Services Scotland on Vimeo.
PPE may be offered to visitors to protect them from acquiring a transmissible infection. If a visitor declines to wear PPE when it is offered then this should be respected and the visit must not be refused. PPE use by visitors cannot be enforced and there is no expectation that staff monitor PPE use amongst visitors. Below is the PPE which should be worn where it is appropriate to do so and when the visitor chooses to do so.
Visitors do not routinely require PPE unless they are providing direct care to the individual they are visiting.
The table below provides a guide to PPE for use by visitors if delivering direct care.
IPC Precaution |
Gloves |
Apron |
Face covering/mask |
Eye/Face Protection |
---|---|---|---|---|
Standard Infection Control Precautions (SICPs) |
Not required*1 |
Not required*2 |
Where splash/spray to nose/mouth is anticipated during direct care |
Not required*3 |
Transmission Based Precautions (TBPs) |
Not required*1 |
Not required*2 |
If within 2 metres of service user with suspected or known respiratory infection |
If within 2 metres of service user with suspected or known respiratory infection |
*1 unless providing direct care which may expose the visitor to blood and/or body fluids i.e. toileting.
*2 unless providing care resulting in direct contact with the service user, their environment or blood and/or body fluid exposure i.e. toileting, bed bath.
*3 Unless providing direct care and splashing/spraying is anticipated
Care equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious agents. Consequently it is easy to transfer infectious agents from communal care equipment during care delivery.
Adhere to manufacturers’ guidance for use and decontamination of all care equipment.
All reusable non-invasive care equipment must be rinsed and dried following decontamination then stored clean and dry.
Decontamination protocols should include responsibility for, frequency of and method of environmental decontamination.
An equipment decontamination status certificate will be required if any item of equipment is being sent to a third-party, for example for inspection, servicing or repair.
Guidance may be required prior to procuring, trialling or lending any reusable non-invasive equipment.
Further information can be found in the management of care equipment literature review.
For how to decontaminate reusable non-invasive care equipment see Appendix 7.
It is the responsibility of the person in charge to ensure that the care environment is safe for practice (this includes environmental cleanliness/maintenance). The person in charge must act if this is deficient.
Staff groups should be aware of their environmental cleaning schedules and clear on their specific responsibilities.
Cleaning protocols should include responsibility for, frequency of and method of environmental decontamination.
When an organisation adopts decontamination processes not recommended in the NIPCM the care organisation is responsible for governance of and completion of local risk assessment(s) to ensure safe systems of work.
Further information can be found in the routine cleaning of the environment literature review.
This is linen that has been used by a patient who is known or suspected to be infectious and/or linen that is contaminated with blood and/or other body fluids for example faeces.
Local guidance regarding management of linen may be available.
All linen that is deemed unfit for re-use, for example torn or heavily contaminated, should be categorised at the point of use and returned to the laundry for disposal.
Further information can be found in the safe management of linen literature review and National Guidance for Safe Management of Linen in NHSScotland Health and Care Environments - For laundry services/distribution.
Further information about linen bagging and tagging can be found in Appendix 8.
Scottish Government uniform, dress code and laundering policy is available.
Spillages of blood and other body fluids may transmit blood borne viruses.
Spillages must be decontaminated immediately by staff trained to undertake this safely.
Responsibilities for the decontamination of blood and body fluid spillages should be clear within each area/care setting.
If superabsorbent polymer gel granules for containment of bodily waste are used these should be used in line with national guidance. In Scotland refer to Safety Action Notice - SAN(SC)19/03 | National Services Scotland (nhs.scot)
For management of blood and body fluid spillages see Appendix 9.
Further information can be found in the management of blood and body fluid in health and care settings literature review.
Scottish Health Technical Note (SHTN) 3: NHSScotland Waste Management Guidance contains the regulatory waste management guidance for NHSScotland including waste classification, segregation, storage, packaging, transport, treatment and disposal.
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to the safe disposal of sharps.
For care/residential homes waste disposal may differ from the categories described above and guidance from local contractors will apply. Refer to SEPA guidance.
Always dispose of waste:
Liquid waste, for example blood, must be rendered safe by adding a self-setting gel or compound before placing in an orange lidded leak-proof bin.
Waste bags must be no more than 3/4 full or more than 4 kgs in weight and use a ratchet tag/or tape (for healthcare waste bags only) using a ‘swan neck’ to close with the point of origin and date of closure clearly marked on the tape/tag.
Store all waste in a designated, safe, lockable area whilst awaiting uplift. Uplift schedules must be acceptable to the care area and there should be no build-up of waste receptacles.
Local guidance regarding management of waste at care level may be available.
Further information can be found in the safe disposal of waste literature review.
Exposure in relation to blood borne viruses (BBV) is the focus within this section and reflects the existing evidence base.
The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 outline the regulatory requirements for employers and contractors in the healthcare sector in relation to:
Sharps handling must be assessed, kept to a minimum and eliminated if possible with the use of approved safety devices.
Manufacturers’ instructions for safe use and disposal must be followed.
Needles must not be re-sheathed/recapped.*
Always dispose of needles and syringes as 1 unit.
If a safety device is being used safety mechanisms must be deployed before disposal.
An occupational exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids.
Occupational exposure risk can be reduced via application of other SICPs and TBPs outlined within the NIPCM.
A significant occupational exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids from a source that is known, or found to be positive for a blood borne virus (BBV).
Examples of significant occupational exposures would be:
There is a potential risk of transmission of a Blood Borne Virus (BBV) from a significant occupational exposure and staff must understand the actions they should take when a significant occupational exposure incident takes place. There is a legal requirement to report all sharps injuries and near misses to line managers/employers.
Additionally, employers are obligated to minimise or eliminate workplace risks where it is reasonably practicable. Immunisation against BBV should be available to all qualifying staff, and testing (and post exposure prophylaxis when applicable) offered after significant occupational exposure incidents.
For the management of occupational exposure incidents see Appendix 10
Exposure prone procedures (EEPs) are invasive procedures where there is a risk that injury to the healthcare worker may result in the exposure of the patient’s open tissues to the blood of the worker (bleed-back).
There are some exclusions for HCWs with known BBV infection when undertaking EPPs. The details of these and further information can be found in the occupational exposure management (including sharps) literature review.
* A local risk assessment is required if re-sheathing is undertaken using a safe technique for example anaesthetic administration in dentistry.
New research questions have been considered as part of this update. These look at:
New search terms have been added. The evidence search goes back to include all scientific papers that have been published since the year 2000.
See the NIPCM literature review development process for more information.
See the full list of research questions considered and the search terms within the revised literature review. Part A of the Considered Judgement Form has been published alongside the revised literature review to provide a summary of the evidence. The review does not contain any recommendations for practice as these are still being developed by the ARHAI Scotland National Policies Guidance and Evidence (NPGE) Working Group. It is anticipated that recommendations for practice will be available in Spring 2025.
Stakeholders requested that this review also considers where and when healthcare workers should wear masks and the type of mask they should wear (surgical mask or respirator). Evidence for mask effectiveness is being considered in separate literature review updates .
The pandemic highlighted that the way in which respiratory transmission is currently described (droplet and airborne transmission) may not reflect what is happening in real life. We need to look at whether there is a better way to describe transmission, and whether this would lead to any improvements in infection prevention and control (IPC) practice.
Understanding how infectious agents are released into the air and the risks associated with particle size and distance from source will help inform this. Reviewing the evidence to understand if there is increased risk associated with certain medical procedures will also inform IPC practice.
The World Health Organization (WHO) and Centers for Disease Control (CDC) have also reviewed transmission descriptors indicating a global shift in the way transmission routes are described. ARHAI Scotland were invited to meet with the WHO global IPC unit to discuss the topic and our literature review findings were well received.
Work began on reviewing transmission descriptors in 2022 in the third year of the pandemic. The literature review has assessed over 26,000 scientific articles. 61% of all studies included to answer the main research question were published between 2019 and 2022 which reflects the growing interest in this area as the pandemic continued.
The ARHAI Scotland National Policies Guidance and Evidence (NPGE) Working Group are currently developing recommendations for practice. It is likely that ‘droplet transmission’ and ‘airborne transmission’ will be replaced with new definitions to describe respiratory transmission. This will mean changes throughout the NIPCM to update the terminology including the addition of resources to support any guidance changes.
It is too early to understand what might change in practice but it is likely that there will be a need for healthcare workers to consider more factors when risk assessing what PPE to wear.
The goal of the NIPCM is to provide healthcare workers in Scotland with guidance that is evidence based, up-to-date, effective, practical, and as a result, safe. There should be a clear benefit associated with any guidance change and this benefit should outweigh any potential harms. Guidance will only change if these conditions are met.
Supporting resources and education needs will be considered alongside any potential changes to the NIPCM to enable application to practice.
SICPs may be insufficient to prevent cross-transmission of specific infectious agents. Therefore, additional precautions known as transmission based precautions (TBPs) are required to be used by staff when caring for patients with a known or suspected infection or colonisation.
TBPs are categorised by the route of transmission of infectious agents. Some infectious agents can be transmitted by more than one route.
Used to prevent and control infections that spread via direct contact with the patient or indirectly from the patient’s immediate care environment (including care equipment). This is the most common route of cross-infection transmission.
Used to prevent and control infections spread over short distances (at least 3 feet or 1 metre) via droplets (greater than 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Droplets penetrate the respiratory system to above the alveolar level.
Used to prevent and control infections spread without necessarily having close patient contact via aerosols (less than or equal to 5μm) from the respiratory tract of one individual directly onto a mucosal surface or conjunctivae of another individual. Aerosols penetrate the respiratory system to the alveolar level.
Clinical judgement and decisions should be made by staff on the necessary precautions. This must be based on the:
Appendix 11 provides details of the type of precautions, optimal patient placement, isolation requirements and any respiratory precautions required.
Application of TBPs may differ depending on the setting and the known or suspected infectious agent.
Further information on Transmission Based Precautions can be found in the definitions of Transmission Based Precautions literature reviews.
Last updated: 28 August 2023
The potential for transmission of infection must be assessed at the patient’s entry to the care area. If hospitalised or in a care home setting this should be continuously reviewed throughout the stay/period of care. The assessment should influence placement decisions in accordance with clinical/care need(s).
Patients who may present a cross-infection risk in any setting includes but is not limited to those:
Further information regarding general respiratory screening questions can be found within the resources section of the NIPCM.
Isolation facilities should be prioritised depending on the known/suspected infectious agent (refer to Aide Memoire - Appendix 11). All patient placement decisions and assessment of infection risk (including isolation requirements) must be clearly documented in the patient notes.
When single-bed rooms are limited, patients who have conditions that facilitate the transmission of infection to other patients (e.g., draining wounds, stool incontinence, uncontained secretions) and those who are at increased risk of acquisition and adverse outcomes resulting from HAI (e.g., immunosuppression, open wounds, invasive devices, anticipated prolonged length of stay, total dependence on HCWs for activities of daily living) should be prioritised for placement in a single-bed room. Single-bed room prioritisation should be reviewed daily and the clinical judgement and expertise of the staff involved in a patient's management and the Infection Prevention and Control Team (IPCT) or Health Protection Team (HPT) should be sought particularly for the application of TBPs e.g. isolation prioritisation when single rooms are in short supply.
Cohorting of patients should only be considered when single rooms are in short supply and should be undertaken in conjunction with the local IPCT.
Patients who should not be placed in multi bed cohorts:
Consider assigning a dedicated team of care staff to care for patients in isolation/cohort rooms/areas as an additional infection control measure during outbreaks/incidents. This can only be implemented through planning of staff rotas if there are sufficient levels of staff available to ensure consistency in staff allocation (so as not to have a negative impact on non-affected patients’ care).
Individual patient risk factors should be considered, for example there may be prolonged shedding of certain microorganisms in immunocompromised patients). Clinical and molecular tests to show the absence of microorganisms may be considered in the decision to discontinue isolation and can reduce isolation times. The clinical judgement and expertise of the staff involved in a patient’s management and the Infection Prevention and Control Team (IPCT) or Health Protection Team (HPT) should be sought on decisions regarding isolation discontinuation.
Further information can be found in the patient placement literature review.
If an item cannot withstand chlorine releasing agents staff are advised to consult the manufacturer’s instructions for a suitable alternative to use following or combined with detergent cleaning.
For how to decontaminate non-invasive reusable equipment see Appendix 7.
Note: Scottish Ambulance Service (SAS) and Scottish National Blood Transfusion Service adopt practices that differ from those stated in the National Infection Prevention and Control Manual.
Patient isolation/cohort rooms/area must be decontaminated at least daily, this may be increased on the advice of IPCTs/HPTs. These areas must be decontaminated using either:
Manufacturers’ guidance and recommended product "contact time" must be followed for all cleaning/disinfection solutions .
Increased frequency of decontamination/cleaning schedules should be incorporated into the environmental decontamination schedules for areas where there may be higher environmental contamination rates, for example
Patient rooms must be terminally cleaned following resolution of symptoms, discharge or transfer. This includes removal and laundering of all curtains and bed screens.
Vacated rooms should also be decontaminated following an AGP.
The extent of decontamination between patients will depend on the duration of the consultation/assessment, the patients presenting symptoms and any visible environmental contamination.
Equipment used for environmental decontamination must be either single-use or dedicated to the affected area then decontaminated or disposed of following use for example cloths, mop heads.
Following patient transfer, discharge, or once the patient is no longer considered infectious.
Remove from the vacated isolation room/cohort area, all:
The room should be decontaminated using either:
The room must be cleaned from the highest to lowest point and from the least to most contaminated point.
Manufacturers’ guidance and recommended product "contact time" must be followed for all cleaning/disinfection solutions .
Unless instructed otherwise by the IPCT there is no requirement for a terminal clean of an outpatient area or theatre recovery.
Note: Scottish Ambulance Service (SAS) and Scottish National Blood Transfusion Service adopt practices that differ from those stated in the National Infection Prevention and Control Manual.
When an organisation adopts practices that differ from those recommended/stated in the NIPCM with regards to cleaning agents, the individual organisation is fully responsible for ensuring safe systems of work, including the completion of local risk assessment(s) approved and documented through local governance procedures.
A type IIR fluid resistant surgical mask should be worn when caring for a patient with a suspected/confirmed infectious agent spread by the droplet route.
Surgical masks worn by patients with suspected/confirmed infectious agents spread by the droplet or airborne routes, as a form of source control, should meet type II or IIR standards.
A face visor or goggles should be used in combination with a fluid resistant type IIR surgical mask when caring for symptomatic patients infected with droplet transmitted infectious agents.
A face visor or goggles should be used in combination with a fluid resistant FFP3 respirator when caring for symptomatic patients infected with an airborne transmitted infectious agent.
Eye/face protection should be worn
An apron should be worn when caring for patients known or suspected to be colonised/infected with antibiotic resistant bacteria including contact with the patient’s environment.
Plastic aprons should be used in health and social care settings for protection against contamination with blood and/or body fluids.
A fluid repellent gown should be used if excessive splashing or spraying is anticipated.
A full body fluid repellent gown should be worn when conducting AGPs on patients known or suspected to be infected with a respiratory infectious agent.
Further information can be found in the Aprons/Gowns literature review.
Gloves must:
Double gloving is only recommended during some Exposure Prone Procedures (EPPs), for example orthopaedic and gynaecological operations, or when attending major trauma incidents and when caring for a patient with a suspected or known High Consequence Infectious disease. Double gloving is not necessary at any other time.
For appropriate glove use and selection see Appendix 5.
Further information can be found in the Gloves literature review.
PPE must still be used in accordance with SICPs when using Respiratory Protective Equipment. See Chapter 1.4 for PPE use for SICPs.
Where it is not reasonably practicable to prevent exposure to a substance hazardous to health (as may be the case where healthcare workers are caring for patients with suspected or known airborne micro-organisms) the hazard must be adequately controlled by applying protection measures appropriate to the activity and consistent with the assessment of risk. If the hazard is unknown the clinical judgement and expertise of IPC/HP staff is crucial and the precautionary principle should apply.
Respiratory Protective Equipment (RPE), for instance FFP3 and facial protection, must be considered when:
See Appendix 16 for the extant list of Aerosol Generating Procedures which require the application of airborne precautions and details of associated Post AGP Fallow times.
Where staff have concerns, they may choose to wear an FFP3 respirator rather than a fluid-resistant surgical mask (FRSM) when providing patient care, provided they are fit tested. This is a personal PPE risk assessment.
All tight fitting RPE (for instance FFP3) respirators must be:
Poster on compatibility of facial hair and FFP3 respirators can be used when fit testing and fit checking.
Further information regarding fitting and fit checking of respirators can be found on the Health and Safety Executive website.
The following risk categorisation is the minimum requirement for staff groups that require FFP3 fit testing. NHS boards can add to this for example where high-risk units are present. This categorisation is inclusive of out of hours services.
Level 1 – Preparedness for business as usual
Staff in clinical areas most likely to provide care to patients who present at healthcare facilities with an infectious pathogen spread by the airborne route; and/or undertake aerosol generating procedures. These are A&E, ICU, paediatrics, respiratory, infectious diseases, anaesthesia, theatres, Chest physiotherapists, Special Operations Response Team (Ambulance), A&E Ambulance Staff, Bronchoscopy Staff, Resuscitation teams, mortuary staff.
Level 2 – Preparedness in the event of emerging threat
Staff in clinical setting likely to provide care to patients admitted to hospital in the event of an emerging threat, for example Medical receiving, Surgical, Midwifery and Speciality wards, all other ambulance transport staff.
In the event of an ‘Epidemic/Pandemic’ Local Board Assessment as per their preparedness plans will apply.
The decision to wear an FFP3 respirator/hood should be based on clinical risk assessment, for example task being undertaken, the presenting symptoms, the infectious state of the patient, risk of acquisition and the availability of treatment.
For a list of organisms spread wholly or partly by the airborne (aerosol) or droplet routes see Appendix 11.
Further information can be found in the aerosol generating procedures literature review.
Powered respirator hoods are an alternative to FFP3 respirators for example when fit testing cannot be achieved.
Powered hoods must be:
Work is currently underway by the UK Re-useable Decontamination Group examining the suitability of respirators for decontamination. This literature review will be updated to incorporate recommendations from this group when available. In the interim, ARHAI Scotland are unable to provide assurances on the efficacy of respirator decontamination methods and the use of re-useable respirators is not recommended.
Further information can be found in the Respiratory Protective Equipment (RPE) literature review and the Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence (IDHC) literature review.
Frameworks to support the assessing and recording of staff competency in PPE for HCID are available in the resources section of the NIPCM.
The principles of SICPs and TBPs continue to apply whilst deceased individuals remain in the care environment. This is due to the ongoing risk of infectious transmission via contact although the risk is usually lower than for living patients.
It is important that information on the infection status of the deceased is sought and communicated at each stage of handling. Appropriate risk assessment must be carried out before performing activities that may increase the risk of transmission of infectious agents from deceased individuals (see literature review for further information on these activities).
Washing and/or dressing should not be carried out when the deceased is known or suspected to have been infected by any of the following key infectious agents: Hazard Group 4 organisms, anthrax, and rabies. For other HCIDs a local risk assessment should be undertaken to inform any decision making on washing and/or dressing of the deceased.
Viewing of the deceased should be avoided when the deceased is known or suspected to have been infected by Hazard Group 4 organisms, specifically those causing VHFs (including Ebola, Lassa etc.) and anthrax. For other HCIDs a local risk assessment should be undertaken to inform any decision making on viewing of the deceased.
See Appendix 12 Application of infection control precautions in the deceased.
Staff should advise relatives of the appropriate precautions when viewing and/or having physical contact with the deceased including when this should be avoided.
Deceased individuals known or suspected to have a Hazard Group 4 infectious agent should be placed in a sealed double plastic body bag with absorbent material placed between each bag. The surface of the outer bag should then be disinfected with 1000 ppm av.cl before being placed in a robust sealed coffin.
Post-mortem examination should not be performed on a deceased individual known or suspected to have Hazard Group 4 infectious agents. See Appendix 12 Application of infection control precautions in the deceased. Blood sampling can be undertaken in the mortuary by a competent person to confirm or exclude this diagnosis. Refer to Section 2.4 for suitable PPE.
Post-mortem examination of deceased individuals known or suspected to have been infected by transmissible spongiform encephalopathies (TSE) causing agents should be carried out in such a way as to minimise contamination of the working environment. See Literature review for further information.
The purpose of this chapter is to support the early recognition of potential infection incidents and to guide IPCT/HPTs in the incident management process within care settings; (that is, NHSScotland, independent contractors providing NHS services and private providers of care).
This guidance is aligned to the Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams
ARHAI Scotland continue to develop evidence-based guidance to further inform Chapter 4 of the National Infection Prevention and Control Manual (NIPCM) on the built environment and decontamination.
Further information is available to support investigation and management of healthcare water-associated infection incidents/outbreaks in Chapter 4.
An Aide-Memoire currently provides best practice recommendations to be implemented in the event of a healthcare ventilation-associated infection incident/outbreak. This will ensure clinical staff, estates and facilities staff, and Infection Prevention and Control Teams (IPCT) have an understanding of the preventative measures required and the appropriate actions that should be taken.
The terms ‘incident’ and ‘Incident Management Team’ (IMT) are used as generic terms to cover both incidents and outbreaks
A healthcare infection incident may be:
See literature review for Infectious Diseases of High Consequence (IDHC)
or
Further information can be found in the literature review Healthcare infection incidents and outbreaks in Scotland.
An early and effective response to an actual or potential healthcare incident, outbreak or data exceedance is crucial. The local Board IPCT and HPT should be aware of and refer to the national minimum list of alert organisms/conditions. See Appendix 13.
Healthcare associated infection (HAI) Surveillance systems should be used to aid incident/outbreak detection using a combination of retrospective detection of cases alongside prospective enhanced surveillance in high-risk settings (ICU/PICU/NICU, oncology/haematology). A risk-based approach should be applied for other vulnerable groups e.g. cystic fibrosis, oncology and those undergoing renal dialysis.
Local surveillance/reporting systems should be used for recognition and detection of potential healthcare infection incidents/outbreaks within NHS boards. Systems should make use of ‘triggers’ to allow prompt detection of any variance from normal limits.
The Infection Prevention & Control Team (IPCT)/Health Protection Team (HPT) should utilise surgical site infection (SSI) surveillance systems to identify specific post-surgical healthcare infection incidents/outbreaks (in line with national SSI surveillance program as a minimum).
Following detection/recognition of an incident/outbreak a member of IPCT or HPT will:
The IPCT/HPT will establish an IMT if required.
If staff screening is being considered as part of the investigation DL (2020)1 must be followed.
The IMT Chair, in discussion with the IMT, should determine whether further reporting on the incident and the incident management is required i.e. SBAR Report and full IMT report template are available in the resources section of the NIPCM website.
The healthcare built environment means the buildings and related infrastructure used for the provision of healthcare. This includes utilities such as water and ventilation and any fixed or semi-permanent components within the healthcare facility with which patients, visitors and staff will interact.
The healthcare built environment plays a critical role in the provision of safe patient care and protection to staff and visitors . Chapter 4 is informed by evidence-based literature reviews and best practice guidance tools and resources relating to IPC in the built environment.
Vulnerable (high-risk) patients may be at a greater risk of infection from water system-associated organisms following exposure to water within healthcare settings during the delivery of healthcare.
It is important that the potential infection risks from water systems are understood by those delivering care. This chapter sets out guidance to help reduce this risk.
High-risk patients are those who are vulnerable to infection as a result of a compromised immune system, underlying health conditions and associated medical treatments.
High-risk patient groups should include as a minimum:
The types of infection that water system-associated organisms may cause include:
Patients may become infected, colonised before they become infected or may be colonised with no active infection.
Each NHS board should have a multidisciplinary water safety group. SHTM 04-01 part B describes in detail the role, responsibilities and membership of the WSG.
As a minimum this WSG should:
It is important that the potential HAI risks from water systems are understood by those delivering care, specifically the potential transmission routes for water system-associated organisms, which can include:
Staff should consider the location and proximity of high-risk patients to tap water, drains and any associated splashing or spraying.
Alternatives to tap water, such as cleansing wipes, hand rub and water free shampoos should be considered while taking into account patient needs, patient choice and infection risk.
Powdered infant formulas should be prepared using freshly boiled water according to manufacturer’s instructions.
Frozen breast milk should be defrosted in one of the following ways:
Any water free warming devices should be single patient use, and stored in an appropriate, clean and patient identifiable container, with a fitted lid.
Once defrosted, any unused milk should be discarded in accordance with local waste policy and never disposed of via a clinical wash hand basin (CWHB).
Installation of ice machines should be by approval of the Water Safety Group (WSG) and in accordance with manufacturer instructions and SHTM 04-01 Part A . A WSG approved cleaning, maintenance and audit schedule should also be in place.
Water outlets that are used infrequently or not at all may present a transmission risk from stagnant water and have the ability to contaminate the wider water system. Consideration should be given to removal of the outlet where there is no longer a clinical need for it. See SHTM 04-01 Parts A & B for further information.
Below is an educational animation which focuses on clinical wash hand basins (CWHBs), their intended purpose, water associated infection risks, and what we all can do together to reduce this risk. The animation is supported by a poster for use beside CWHBs to locally promote good practice for health and care staff as well as the general public who may visit those settings.
Animation: Good practice for clinical wash hand basins
Poster: Good practice for clinical wash hand basins
Staff should report any problems or concerns regarding the safety, maintenance, usage, and cleanliness of water outlets to the appropriate service for example estates and facilities department/ancillary staff.
Water flowing from taps during use should not create any splashing onto surrounding surfaces or equipment.
Flushing of taps should be undertaken at all outlets (See SHTM 04-01 Part B) including little used outlets and outlets within low occupancy areas.
All departments should identify a responsible person to ensure that flushing of all outlets are being performed in their areas as specified, in practice this may be the Senior Charge Nurse, Clinical Lead or domestic manager.
Water dependent equipment includes any items of equipment that comes into direct or indirect contact with a patient or their environment and also uses or requires to process or hold water to function.
Water dependent equipment, is a potential infection source and should be considered as potential sources for infection as part of outbreak or incident investigations.
A POU filter is an external filter that is fitted to a water outlet (taps and showers) to filter out microorganisms and debris.
A POU filter does not remove or kill the microorganism, but traps micro-organisms allowing for the safe use of the water.
The water safety plan (WSP) approved by the WSG should state the types of POU filter which can be used. The WSG should agree local processes and responsibilities for the requirement, installation, maintenance, management and removal of POU filters.
It is important that responsibilities for routine and ad hoc water testing are well defined by the Water Safety Group.
Each NHS board should have processes in place for the receipt, reporting and distribution of results which should include as a minimum:
A sampling plan with appropriate microbiological parameters and should be agreed by WSG prior to tender. As a minimum it should include testing in all settings for:
Testing for P. aeruginosa should be carried out in high-risk settings.
Local risk assessment should determine if there are additional testing requirements.
Samples should be taken no sooner than five days and no later than seven days after a full disinfection process has been completed and a further set of samples should be taken immediately prior to handover.
As part of their commissioning water safety plan, the NHS board should have pre-agreed processes in place should the results of commissioning tests be unsatisfactory. For more details on commissioning, see SHTM 04-01 Part A and BS 8680.
Results from routine water testing over time (trend analysis) provides evidence of effective control measures and also supports early detection of HAI risks.
The WSG should agree the routine water testing required and this should form part of the water safety plan. As a minimum:
As a minimum, testing for P. aeruginosa and Legionella spp. in high-risk settings should occur every 6 months.
The frequency of routine microbiological water testing in other areas and for other microorganisms should be based on a comprehensive risk assessment undertaken by the WSG.
Increases to the frequency of water testing should occur:
Consideration should be given to increasing the frequency of routine water testing when pre-flush trend analysis demonstrates increasing colony forming units (cfu)/100 ml for P. aeruginosa.
Recommended microbiological limits for water samples are detailed in the table below.
Note: Incubate drinking water system samples at 22˚C and 37˚C for 24 hours in accordance with BS EN ISO 6222.
Pathogen |
Colony Forming Units (CFU) |
---|---|
Coliform bacteria (including Escherichia coli) | 0 cfu/100ml |
Enterococci | 0 cfu/100ml |
P. aeruginosa | 0 cfu/100ml |
Legionella spp. | Undetectable in high-risk units. <100 cfu/litre in non-high-risk units |
Legionella pneumophila serogroup 1 (Lp1) | Undetectable |
For all other gram-negative healthcare water system-associated organisms | 0 cfu/ml |
The table below details recommended additional microbiological limits for water samples obtained from water dependent equipment.
Procedure |
Colony Forming Units (CFU) |
Total Viable Count(TVC) |
Endotoxin |
---|---|---|---|
Heater cooler unit water | 0 cfu/100ml for Mycobacterium spp. | TVC cut-off levels of <100 cfu/ml | None |
Hydrotherapy water | <20 cfu/litre for Legionella spp. 0 cfu/100ml for Staphylococcus aureus as part of wider investigations only (local decision) |
TVC cut-off levels of <10 cfu/ml | None |
Endoscopy final rinse water | 0 cfu/100ml for Mycobacterium spp. | TVC cut-off levels of <10 cfu/100 ml | Endotoxin limit of <0.25 EU/ml |
Final rinse water in surgical instrument washer disinfectors | TVC cut-off levels of <1 cfu/100 ml | None | Endotoxin limit of <0.25 EU/ml |
Renal dialysis fluid and water | TVC cut-off levels of <50 cfu/ml | None | Endotoxin limit of <0.125 EU/ml |
For routine testing, samples collected should be pre-flush only unless otherwise directed by the WSG/IPCT or Microbiology.
If post-flush samples are to be taken, the sample should be collected after first running the outlet to flush through the pipes. Post-flush samples may support differentiation between local and systemic colonisation following a positive pre-flush result (see BS 7592 for more information).
A planned targeted sampling plan should be developed by the WSG to include:
Take samples from the proximal and distal ends of each water system with a locally agreed number of sampling points between.
Remedial actions should be agreed by the WSG.
Remedial actions should be determined based on consideration of the water test results in context with the water system as a whole, any existing control measures, and the areas where the result has been obtained.
For more information on whole water system disinfection see (SHTM 04-01 part D ‘Disinfection of Domestic Water Systems’
Routine environmental surface sampling may be beneficial in addition to routine water sampling if seeking to determine the extent of environmental contamination.
Knowledge of environmental sources of contamination can support development of measures to prevent transmission from those sources to patients.
Environmental sources include any sites that are exposed to water.
Environmental surface sampling can also be used to measure the effectiveness of any decontamination methods in use.
See 4.1.9 incident investigation for information on environmental surface sampling in response to clinical cases.
The water safety group should have an agreed WSP that covers all care settings and is inclusive of a business continuity/contingency arrangement in preparation for the event that a water source, for example mains water, system water, tap water, cannot be used or an area cannot be used due to widespread known or suspected contamination.
All high-risk settings should have a setting-specific alert organism list for clinical isolates, which should be informed by the known historical epidemiology of that setting and allow for early identification of single cases of unusual environmental organisms.
As a minimum, this alert organism list should include
See Appendix 13 for more information on alert organisms including the locations/patient cohorts to which each apply.
Colonisation or infection of gram-negative microorganisms or non-tuberculous mycobacteria, isolated from a clinical sample in any patient should raise a high degree of suspicion of a healthcare associated environmental link and should be investigated/reviewed.
An environmental source should be considered when Enterobacteriaceae is isolated from a clinical sample and a data exceedance has been identified.
Isolation of Legionella spp. from a clinical sample in any patient indicates transmission from the environment and should be investigated as a possible healthcare associated infection incident if the incubation period fits and there is no established link to a community source. Further information can be found in the NIPCM A-Z of Pathogens for Legionella spp.
When determining HAI status, the incubation period should be considered, acknowledging the wide variation (a few hours to years) for environmental organisms.
Environmental organism outbreaks and incidents may occur over extended periods of time with significant time between cases. Consideration of an environmental link should be given to cases that have been identified over a wide time period.
Ensure that the risk of a false negative result is considered and further sampling discussed. This can be supported by taking a measured approach to sampling from the outset.
The IMT should agree a water sampling plan to identify and prioritise potential sources taking account of the following:
Water samples should be taken before disinfection of the water system or equipment or before any other remedial actions are initiated.
As a minimum, a pre-flush sample should be taken from each outlet being sampled. Post-flush samples should also be considered.
Sampling instructions can be found in SHTM 04-01 Part C
Where no UKAS accreditation exists for specific healthcare water system-associated organisms, boards should still consider testing and can seek advice from ARHAI Scotland. See the UKAS Technical Bulletin for more information.
Environmental surface sampling (swabbing) should be carried out when there is more than one working hypothesis and an environmental source is suspected.
When considering whether to declare an infection incident or outbreak as ‘closed’ or ‘over’ the IMT should be assured that transmission risks have been mitigated, including exposure from any remaining colonised or infected patients and that there is a surveillance plan in place to allow for early detection of any further potentially linked cases.
Guidance consistently recognises that bed spacing requirements contribute towards the control of HAIs. All NHS boards and care providers should aim to meet the minimum bed spacing requirements laid out in the guidance below and in keeping with the date of design and construction of the building. This takes account of ergonomics within the clinical environment and not just healthcare associated infection (HAI) risk. Some other health and care settings may choose to adopt this guidance e.g. hospice settings.
Adult in-patient facilities designed post 2010 should achieve 3.6m (width) x 3.7m (depth) dimensions of SHPN 04-01, HBN 00-03 and SHFN 30. Width of 3.6m is measured from bed centre to bed centre. Since 2014, HBN 00-03’s Figure 45 states a day treatment bay should achieve 2.45m width/centre-to-centre dimension.
Current NHS Scotland Guidance on bed spacing is listed below:
ARHAI Scotland’s Clinical Assurance programme provides clinical and infection prevention and control (IPC) expertise to complement the work undertaken by the NHSScotland’s Assure (NHSSA) assurance service. More information about the programme and a list of tools and guidance developed is available.
Key Stage Assurance Reviews (KSAR) focus on ensuring infection prevention and control is a key consideration for healthcare construction projects. ARHAI Scotland have developed notes for NHS Board IPC Teams which aim to help navigate this process.
Work undertaken and published to date has been cited here for ease of reference and use at a clinical level.
Many of these publications were produced prior to development of chapter 4 and were published outwith the existing manual methodology.
Updates to publications will be made where required as part of the ARHAI programme work plans.
ARHAI Scotland will work with SG directorates responsible for these areas in planning to establish planned implementation.
The purpose of this addendum is to provide additional guidance to chapters 1,2 and 3 for NNUs.
Undertake assessment for infection risk at the point of entry into the unit before placement of the neonate is decided. This assessment is the minimal microbiological testing required and any additional testing would be determined by the clinical presentation of the neonate. The potential for transmission of infection should be continuously reviewed throughout the stay/period and must be documented in the clinical notes.
Neonates who present as a cross infection risk include those who:
From mothers who have:
If a neonate is considered to be a cross infection risk then the clinical judgement of those involved in the management of the baby should assess the placement by prioritising the incubator/cot in a suitable area pending investigation i.e. place in a single room or cohort area/room with a wash hand basin.
Information/advice must be given to parents/carers of all neonates; particularly during outbreaks/incidents
In addition to the definitions in Chapter 3, in a neonatal unit investigation by IPCT is also required if:
Additionally, the local IPC team should consider the possibility of any onward transmission and potential for an incident/outbreak where there is:
Assigning a dedicated team to care for infected or colonised neonates may also be required. During outbreaks or incidents the ratio of staff to neonates may need to increase and it may be necessary to restrict admissions to the area. Prior to closing or restricting a neonatal unit, communication must be agreed across neonatal services and risk assessed.
Transfers to other units during incidents or outbreaks should be avoided, where possible; however this should take into consideration the clinical needs of neonates, and any practical or logistical issues for parents/carers.
Due to the vulnerability of some neonates the use of tap water for personal care requires consideration and this is outlined in Chapter 4, 4.1.3 Safe clinical care of the NIPCM. For example, an assessment should be made on the neonate’s condition and whether tap water can be used or if an alternative, such as sterile water, is considered more appropriate.
For guidance on the safe management of neonatal incubators, see Chapter 4; 4.1.5 Neonatal incubators.
In addition incubators/cots should not be placed near any water source where spraying or splashing may occur.
Further information for neonatal IPC management of healthcare incidents and outbreaks can be found in the supporting literature review.
Quality improvement tools provide short practice points which when followed correctly can help reduce HAIs and improve patient safety.
These quality improvement tools are based on scientific literature reviews and practice recommendations from ARHAI Scotland.
Materials including posters are available for the following procedures/situations:
When an organisation uses products or adopts practices that differ from those stated in this Care Home Infection Prevention and Control Manual, that individual organisation is responsible for ensuring safe systems of work including the completion of risk assessments approved through local governance procedures.
Use of this manual online is advised as printed versions are uncontrolled.
The ARHAI Scotland Transmission Based Precautions (TBPs) literature review is currently ongoing and so the information may be subject to change.
View latest news and updates for the NIPCM and CHIPCM
Last updated: 21 August 2024
The Care Home Infection Prevention and Control Manual (CH IPCM), referred to as ‘the manual’ throughout, was first published in 2021. It is evidence-based and is intended to be used by all those involved in care home provision in Scotland.
The manual is context specific and has been co-produced with national and local stakeholders. The content of the manual is completely aligned to the evidence based National Infection Prevention and Control Manual (NIPCM) which was first published in 2012, by the Chief Nursing Officer (CNO (2012)1).
The manual currently contains
The manual is a practice guide for use in care homes. When used, it can help reduce the risk of infections and ensure the safety of residents, as well as staff and visitors in the care home environment. It is the Scottish Government expectation that care home settings apply guidance contained within this manual to achieve the aims.
The manual aims to:
The manual should be adopted for all IPC practices and procedures within care home settings.
The recommendations for practice made in the manual are fully aligned to the NIPCM and are based on real-time reviews of the current scientific literature (for example Medical Journals) and best practice. Any major changes identified in the scientific literature may lead to a change being made to the content, and so, it is recommended that the online version is always accessed and used locally.
The appendices can be used as practical implementation of the manual and contain graphical representations (for example diagrams and charts) that can be used along with the contents of the manual.
Many of the appendices can be printed off as posters for local use throughout the care home.
There are links throughout the manual to additional resources and the resources page links to IPC campaign materials, education, training links and posters.
In addition you may find it useful to read the literature reviews and SBARs for the manual.
A glossary section has been provided.
Yes, all content including appendices work on mobile devices for example laptops and smartphones.
The manual should be used by:
In order for infection to occur several things have to happen. This is often referred to as the chain of infection. The six links in the chain are:
Infection can be prevented by breaking the chain of infection.
The overall aim of Standard Infection Control Precautions (SICPs), is to break the chain of infection.
The chain of infection diagram illustrates and gives examples of actions that can be taken to break it.
Select image for full size version.
Use the NES SIPCEP Breaking the Chain of Infection module to learn about breaking the chain of infection in care homes.
The hierarchy of controls (HoC) is a system used to help prevent the transmission of infection. It details the most to least effective controls. You will note that PPE is the last level of control in the hierarchy, used when all other controls have not reduced the risks sufficiently. To be effective, PPE must be used correctly which means putting it on and removing it correctly and safely.
See the Health and Safety Executive’s (HSE) toolkit on managing risks and risk assessment at work.
The HoC principles can be broadly interpreted for care home settings and include:
Here are some examples of how to apply the HoC principles in care home settings. These examples do not cover every situation where you might need to use HoC principles.
Measures such as vaccination, testing and isolation help to reduce the risk of infection. Not coming to work when ill, isolating while infectious and recognising and reporting infections promptly, all help to prevent infections spreading.
When faced with a particular risk, such as an outbreak, we may need to change what we do. This might include reducing communal activities, considering limiting visiting for a short period of time, or cleaning the care home environment more frequently. The local IPCT and/or HPT should always be contacted for advice and support in outbreak situations.
It is very unlikely that we will be able to change where we work but the care home setting should be made as safe as possible.
You can reduce opportunities for pathogens to survive in the care home by ensuring fixtures and fittings are in good repair and can be easily cleaned and following water safety guidelines.
Ventilation is also an effective measure to reduce the risk of some respiratory infections, by diluting and dispersing the pathogens which cause them. Consider opening windows and vents more than usual, even opening a small amount can be beneficial. Opening windows and doors may present security and safety issues and so a local risk assessment should always be undertaken.
Changing the way, we organise and work in the care home can also help reduce risk. This might include reducing the number of people in a space at any one time and minimising the movement of staff between different settings as well as using administrative controls.
Administrative controls include local risk assessments, staff training, IPC audits, and providing clear signage and instructions throughout the care home.
The basic IPC measures that should be used in your care home are called Standard Infection Control Precautions (SICPs).
SICPs are used to reduce the risk of transmission of infectious agents from known and unknown sources of infection.
These should be used by all staff, in all care settings, at all times, for all residents whether infection is known to be present or not to ensure the safety of residents, staff and visitors in the care home.
SICPs should be part of everyday practice and applied consistently by everyone in the care home.
It is essential that optimal IPC measures are applied continuously as residents living in care homes are more vulnerable, therefore increasing their risk of acquiring infections which may then be serious and potentially life threatening. By applying optimum IPC precautions you will provide a safe environment and effective care.
For residents being discharged from hospital to a care home/hospice the Public Health Scotland COVID-19 information and guidance for social, community and residential care settings should be followed.
Before a resident is admitted to the care home it is important to risk assess for infection as part of resident’s care plan, an IPC admission assessment should be undertaken by staff.
If you suspect or are aware that a resident has an infection, then details should be confirmed for the correct IPC precautions to be put in place for the safety of the resident and others.
Obtaining infection details may include appropriate clinical samples and/or screening to establish the causative organism which may be on advice from your local GP, IPCT or HPT.
Further information regarding general respiratory screening questions can be found within the resources section of the NIPCM.
Note: If a resident requires isolation because of infection or in an outbreak situation, this should be individually risk assessed to ensure the safety and health and wellbeing needs of the resident. Isolation periods must be monitored on daily basis and be for the minimum period specified.
Appendix 11 of the NIPCM gives you further information on the precautions required for different infections.
Read the placement literature review to understand the evidence base for resident placement.
Please note that the term ‘alcohol-based hand rub (ABHR)’ has now been updated to ‘hand rub’. A hand rub (alcohol or non-alcohol based) can be used if it meets the required standards. Please see further information in the hand hygiene products literature review.
The most important thing you can do to prevent the spread of infection in a care home is to keep your hands clean. This is called hand hygiene.
Adherence with the following points is essential to ensure effective hand hygiene:
Hand washing should be extended to the forearms if there has been exposure of forearms to blood and/or body fluids.
Hand washing sinks should only be used for hand hygiene and should not be used for the disposal of other liquids.
The World Health Organization’s ‘4 moments for hand hygiene’ should be used to highlight the key indications for hand hygiene:
Some additional examples of hand hygiene moments include, but are not limited to:
It is important that residents are routinely encouraged to perform hand hygiene and given assistance if required.
The four moments for hand hygiene poster can be used in your care home to show staff when hand hygiene should be done and the reasons why.
Select image for full size version.
Hands should be washed with liquid soap and water if/when:
Note:
Hands should be washed with warm/tepid water to mitigate the risk of dermatitis associated with repeated exposures to hot water and to maximise hand washing compliance. Compliance may be compromised where water is too hot or too cold.
Hands should be dried thoroughly following hand washing using a soft, absorbent, disposable paper towel from a dispenser which is located close to the sink but beyond the risk of splash contamination.
The use of antimicrobial hand wipes is only permitted where there is no access to running water. Staff should perform hand hygiene using hand rub immediately after using the hand wipes and perform hand hygiene with soap and water at the first available opportunity.
In all other circumstances use hand rub for routine hand hygiene.
Do not use refillable containers or communal tubs of hand cream in the care home setting.
Read the hand hygiene literature reviews to find out more about the evidence base for hand hygiene.
To make sure you clean your hands properly with soap and water you should follow the steps in the poster ‘How to hand wash step by step images’. This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.
Select image for full size version
To make sure you clean your hands properly with hand rub you should follow the steps in the poster ‘How to hand rub step by step images’. This poster can be printed off and displayed throughout the care home to ensure that all staff and visitors are aware of and practice this hand hygiene method when required in the care home.
Select image for full size version
Infections can spread by coughing and sneezing, therefore it is very important that respiratory and cough hygiene is used by everyone including staff, residents and visitors.
Any resident displaying symptoms of respiratory illness should be encouraged to wear a surgical (for instance TYPE IIR FRSM) face mask where it is clinically safe and can be tolerated by the wearer, especially in communal areas.
What you need for respiratory and cough hygiene• disposable tissues• waste bin and waste bags• hand hygiene products
If a resident has a cough, cold or other respiratory symptoms then they should be supported and encouraged to:
Staff should:
Read the respiratory and cough hygiene literature review to find out the evidence for respiratory and cough hygiene practice.
PPE products you might need in the care home:• gloves• aprons• masks• eye protection
Before doing any procedure or task staff should risk assess any likely exposure to blood and/or body fluids and ensure PPE is worn that provides adequate protection against the risks associated with the procedure or task being undertaken.
All PPE should be:
Reusable PPE items, for example non-disposable goggles, face shields and visors, should have a decontamination schedule with responsibility assigned.
Read further information on best practice for PPE in Appendix 15.
The order for putting on PPE is:
It is important that PPE is removed in the correct order.
The order for taking off PPE is:
Note:
Always carry out hand hygiene immediately after taking off PPE.
All PPE should be removed before leaving the area and disposed of as healthcare waste
A video demonstrating the order for donning and doffing PPE is available.
The correct order for donning, doffing and disposal of PPE for healthcare workers from NHS National Services Scotland on Vimeo.
A poster showing the order for putting on and removing PPE is available to print.
Select image for full size version
Gloves should be:
Note:
Using gloves reduces the risk of contamination but does not remove all risk.
Gloves should not be used instead of carrying out hand hygiene.
Gloves should not be worn inappropriately in situations such as to go between residents, move around a care area or whilst at workstations (on the telephone or computer).
Gloves should never be decontaminated or cleaned with hand rub or by washing with cleaning products.
Use the glove selection chart to support you to select the correct glove type.
Select image for full size version
Aprons should be:
The choice of apron or gown is based on an individual risk assessment and anticipated level of blood/body fluid exposure. Routine sessional use of gowns/aprons is not permitted.
Eye/face protection (including full face visors) should:
Note:
Eye/face protection (including visors) should not be touched when worn.
Facial accessories such as piercings or false eyelashes should not be worn when using eye/face protection.
Regular glasses or safety glasses are not considered eye protection.
Fluid Resistant Type IIR surgical face masks should be:
If you are using droplet precautions, you should always wear a Type IIR surgical face mask as well as the full-face visor (droplet precautions will be discussed further in Chapter 2 Transmission Based Precautions).
Transparent face masks may be used to aid communication with residents where required.
Transparent face masks should:
and
Read the aerosol generating procedures literature review and surgical face masks literature review for further information regarding the evidence base.
See appendix 11 for further information.
At times, PPE may be offered to visitors to protect them from acquiring a transmissible infection. If a visitor declines to wear PPE when it is offered then this should be respected, and the visitor should not be refused entry to the care home. PPE use by visitors cannot be enforced and there is no expectation that staff monitor PPE use amongst visitors. Below is the PPE which should be worn where it is appropriate to do so and when the visitor chooses to do so.
Visitors do not routinely require PPE unless they are providing direct care to residents they are visiting.
Table 1 is a guide to PPE for use by visitors if delivering direct care.
IPC Precaution | Gloves | Apron/Gown | Face covering/mask | Eye/face protection |
---|---|---|---|---|
Standard Infection Control Precautions (SICPs) | Not required unless providing direct care which may expose the visitor to blood and/or body fluids, for instance toileting. | Not required unless providing care resulting in direct contact with the resident, their environment or blood and/or body fluid exposure, for instance toileting, bed bath. | Where splash/spray to nose/mouth is anticipated during direct care | Not required unless providing direct care and splashing/spraying is anticipated. |
Transmission Based Precautions (TBPs) | Not required unless providing direct care which may expose the visitor to blood and/or body fluids, for instance toileting. | Not required unless providing care resulting in direct contact with the resident, their environment or blood and/or body fluid exposure, for instance toileting, bed bath.
|
If within 2 metres of resident with suspected or known respiratory infection | If within 2 metres of resident with suspected or known respiratory infection |
Read the PPE literature reviews to find out more information about the evidence base for PPE use.
Care equipment is easily contaminated with blood, other body fluids, secretions, excretions and infectious agents and this can spread infection.
Important words and what they meanRoutine cleaning is regular cleaning which is carried out on a scheduled basis, not on an unplanned basis and not in response to an outbreak. For routine cleaning general purpose detergent and water solution or detergent impregnated wipes are sufficient.Cleaning is the removal of any dirt by use of an appropriate cleaning agent such as detergent.Decontamination is removing, or killing pathogens on an item or surface to make it safe for handling, re-use or disposal, by cleaning, disinfection and/or sterilisation.Disinfectant is a chemical used to reduce the number of infectious agents from an object or surface to a level that means they are not harmful to health.Detergent is a chemical cleansing agent that can dissolve oils and remove dirt.
If the resident has a known infection or the equipment is contaminated with blood or body fluids, then a disinfection agent needs to be used.
Note:
Do not use household bleach as the required dilution cannot be guaranteed.
Do not refill bottles for cleaning products as there is a risk of contamination.
or
or
There are three different types of care equipment that you will use in your care home and it is important that you know how to deal with each type.
You should follow manufacturers guidance for all equipment and products you use including those used for cleaning and decontamination.
Before using any sterile equipment, you should check that:
1. Single-use - equipment which is used once on a single resident and then discarded.
Single-use equipment must never be reused even on the same resident. The packaging carries the symbol.
Note:
Needles and syringes are single-use devices. They should never be used for more than one resident or reused to draw up additional medication.
Never give medications from a single-dose vial or intravenous (IV) bag to multiple residents.
2. Single individual use – equipment which can be reused by same resident for example a sling and decontaminated following use as per manufacturers instructions.
3. Reusable non-invasive equipment (often referred to as ‘communal equipment’) – equipment which can be reused on more than one resident following decontamination between each use for example commode, moving and handling equipment or bath hoist.
Residents should be given their own reusable (communal) non-invasive equipment where possible.
Reusable equipment should be checked frequently for cleanliness and signs of integrity. This will include mattresses and pillows which should be clean, have a waterproof covering which is in a good state of repair.
Pillows used on resident’s beds may not require a waterproof cover if they are single resident use and are subject to regular checks/laundering. Resident pillows may require labelling where appropriate.
Reusable equipment should be cleaned or decontaminated:
Staff should:
or
a combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.)
or
a general purpose neutral detergent in a solution of warm water followed by disinfection solution of 1,000ppm av.cl;
Note: When an organisation use products or adopts practices that differ from those stated in this manual, that individual organisation is responsible for ensuring safe systems of work including the completion of risk assessments approved through local governance procedures.
Read the management of care equipment literature review to find out more about why we do things this way for care equipment.
The decontamination of non-invasive care equipment poster can help staff decide how to clean equipment.
Select image for full size version
There are many areas in care homes that become easily contaminated with microorganisms (germs) for example door handles, toilets, waste bins, surfaces.
Furniture and floorings in a poor state of repair can have microorganisms (germs) in hidden cracks or crevices.
To reduce the spread of infection, the environment should be kept clean and dry and where possible clear from clutter and equipment.
Non-essential items should be stored and displayed in such a way as to aid effective cleaning
Keeping a high standard of environmental cleanliness is important in the care home as the residents are often elderly and vulnerable to infections.
The care home environment should be:
Staff should:
Cleaning schedules should include:
Cleaning services should be managed in a systematic way, and staff responsible for cleaning should be appropriately trained to carry out the tasks they are responsible for.
The care home manager is responsible for managing the cleaning service which has a number of essential elements outlined in the cleaning services diagram.
Select the Care Homes Cleaning Specification for full size version of cleaning services diagram.
Select the diagram for full size version
An effective service will include all of the elements above.
The Care Homes Cleaning Specification provides a guide to planning cleaning services. It has tools to help with the planning and recording of cleaning activities and with the management activities marked with a * in the diagram above. These include:
The tools within the Cleaning Specification should be used by the care home manager in the planning, training of staff, delivery, and checking of standards of the cleaning services they provide.
Manufacturer’s instructions and recommended contact times should be adhered to.
Table 2 provides an example of a cleaning schedule and record. These tools are examples and designed to support local practice, however care homes can use their own tools if preferred. If a local tool is used, it should reflect the standards set out in the Care Homes Cleaning Specification.
Table 2: Example cleaning schedule residents room
Each SOP outlines the correct equipment, safety considerations, method, and outcomes required for each task. Table 3 shows the important steps that must be taken during the cleaning of floors.
Table 3: Example cleaning SOP: Floors
A process for checking the cleanliness of the care environment, to ensure standards are being maintained and to identify areas for improvement.
Decontamination of soft furnishings may require to be discussed with the local HPT/ICT. If the soft furnishing is heavily contaminated with blood or body fluids, it may have to be discarded. If it is safe to clean with standard detergent and disinfectant alone then follow appropriate procedure.
If the item cannot withstand chlorine releasing agents staff are advised to consult the manufacturer’s instructions for a suitable alternative to use following or combined with detergent cleaning.
Note: When an organisation adopts decontamination processes not recommended in the CH IPCM the care organisation is responsible for governance of and completion of local risk assessment(s) to ensure safe systems of work.
Read the routine cleaning of the care environment literature review to find out more about why we do things this way for the care environment.
Examples of linen you may have in the care home includes:
Clean – Linen washed and ready for use
Used – All used linen in the care setting not contaminated by blood or body fluids
Infectious – All linen used by a person known or suspected to be infectious and/or linen that is contaminated with blood or body fluids for example faeces
Used or infectious linen may also be categorised as heat-labile: usually personal clothing where the clothing may be damaged (shrinking/stretching) by washing at a higher than recommended temperature than the label advises and therefore, cannot be subject to thermal disinfection. If such linen needs to be washed at a higher temperature for example if soiled or resident has a known infection they or their relatives need to be advised that the clothing may be damaged.
All clean, used and infectious linen should be handled with care and attention paid to the potential spread of infection. Appropriate temperatures for processing all used and infectious linen should be adhered to achieve thermal disinfection.
Staff should:
Staff should not:
Staff should:
If using external laundry services both used and infectious linen bags/receptacles should follow local procedure and arrangements. Store all used/infectious linen in a designated, safe, lockable area whilst awaiting uplift.
All linen that is deemed unfit for re-use, for example torn or heavily contaminated, should be categorised at the point of use and disposed of in the appropriate local healthcare waste stream.
Appendix 1 National Guidance for Safe Management of Linen in NHSScotland Health and Care Environments - For laundry services/distribution contains information that is particularly relevant and may be useful for residential care settings where domestic-type (household) washing machines may be in place for laundering resident’s personal items and clothing.
Domestic-type washing machines are not typically programmed with the temperature settings required for thermal disinfection, therefore domestic-type machines may only be used for laundering personal items of clothing belonging to residents, such as those that are heat-labile.
Other types of used linen such as sheets should be reprocessed using a machine that is capable of a validated temperature disinfection stage.
If using a domestic type washing machine to launder resident’s personal items:
It is considered best practise to launder a resident’s personal items separately, that means not to mix items from multiple persons within a single load.
If visitors wish to take their relatives clothes home to be laundered, place laundry in an appropriate bag and provide them with a washing clothes at home leaflet.
If the residents clothing is very soiled or infectious, staff may recommend that the clothing is washed in the care home’s laundry service if available, otherwise, the item should be disposed of in the appropriate healthcare waste stream following discussion with the resident or their relative(s).
Read the safe management of linen literature review to find out more about why we do things this way when dealing with linen.
Spillages of blood and other body fluids may transmit blood borne viruses.
Important words and what they meanA blood borne virus is a virus carried or transmitted by blood, for example Hepatitis B, Hepatitis C and HIV.Body fluids are fluids produced by the body such as urine, faeces, vomit or diarrhoea. These body fluids may also contain blood.
Responsibilities for the decontamination of blood and body fluid spillages should be clear within each area/care setting.
Read the management of blood and body fluid spillages literature review to find out more about why we do things this way for blood and body fluid spillages.
Use the poster management of blood and body fluids to help you when you clean up blood and body fluid spillages.
Select the image for full size
Different types of waste will be produced within care homes.
Some waste may be disposed of through the domestic waste route but other types of waste needs special handling and disposal for example sharps and waste from people who have or may have an infection.
Waste bags in care settings should be colour coded to denote the various categories of waste.
Local procedures and policies on waste disposal should be followed.
Care home waste disposal may differ from categories described and guidance from local contractors may apply.
Care home managers and staff should ensure:
All staff should:
Read the safe disposal of waste literature review to find out more about why we do things this way when dealing with waste.
All care homes should have policies in place to ensure that staff are protected from occupational exposure to microorganisms (germs), particularly those that may be found in blood and body fluids.
Important words and what they meanOccupational exposure is exposure of staff to blood or body fluids in the course of their work.A sharp is a device or instrument such as needles, lancets and scalpels which are necessary for the exercise of specific healthcare activities and are able to cut, prick and/or have the potential to cause injury.Safety device or safer sharp is a medical sharps device which has been designed to incorporate a feature or mechanism that minimises and/or prevents the risk of accidental injury. Other terms include (but are not limited to) safety devices, safety-engineered devices and safer needle devices.
The Health and Safety (Sharp Instruments in Healthcare) Regulations (2013) outline the regulatory requirements for employers and contractors in the healthcare sector in relation to:
Sharps handling must be assessed, kept to a minimum and eliminated if possible with the use of approved safety devices.
A significant occupational exposure is when someone is injured at work from using sharps or exposed to risk from blood or body fluids which may then result in a blood borne virus (BBV) or other infection.
Examples of this would be:
If you think or know you have had a significant occupational exposure you should:
Read the management of occupational exposure to Blood Borne Viruses (BBVs) literature review to find out more about why we do things this way for occupational exposure.
The management of occupational exposure incidents flowchart should be used within your care home so you know what to do for an occupational exposure.
Select the image for full size
The pandemic highlighted that the way in which respiratory transmission is currently described (droplet and airborne transmission) may not reflect what is happening in real life and so, there is a need to identify alternatives ways to describe respiratory transmission routes.
Understanding how infectious agents are released into the air and the risks associated with particle size and distance from source will help inform this. Reviewing the evidence to understand if there is increased risk associated with certain medical procedures will also inform IPC practice.
The World Health Organization (WHO) and Centers for Disease Control (CDC) have also reviewed transmission descriptors indicating a global shift in the way transmission routes are described. ARHAI Scotland were invited to meet with the WHO global IPC unit to discuss the topic and our literature review findings were well received.
ARHAI are currently developing recommendations for practice. It is likely that ‘droplet transmission’ and ‘airborne transmission’ will be replaced with new definitions to describe respiratory transmission. This will mean changes throughout the CHIPCM to update the terminology including the addition of resources to support any guidance changes.
It is too early to understand what might change in practice, but it is likely that there will be a need for care home staff to consider more factors when risk assessing what PPE to wear.
The goal of the CHIPCM is to provide care home staff in Scotland with guidance that is evidence based, up-to-date, effective, practical, and as a result, safe.
Use of the CHIPCM online is always advised to ensure access to up to date guidance. Updates to the CHIPCM content are communicated to stakeholders via the Care Home IPC Oversight and Advisory Group in addition to the news section of the NIPCM.
For further detail please use this link to the Transmission Based Precautions Definitions Literature Review.
In certain circumstances using standard infection control precautions (SICPs) won’t be enough to stop an infection spreading and you will need to use some extra precautions. These extra precautions are called Transmission Based Precautions or TBPs.
Clinical judgement and decisions should be made by staff to determine the necessary IPC precautions required (the local IPCT and/or the HPT should be contacted for advice and support where required).
Clinical judgement and decisions should be based on the:
TBPs should be used if a resident has a suspected or known infection or colonisation.
Important words and what they meanColonisation is the presence of microorganisms on a body surface (such as the skin, mouth, intestines or airway) that does not cause disease in the person or signs of infection.
Infections can be transmitted or spread by:
TBPs are categorised by the route of transmission of infectious agents (some infectious agents can be transmitted by more than one route). Appendix 11 provides details of the type of precautions, optimal resident placement, isolation requirements and any respiratory precautions required. Application of TBPs may differ depending on the setting and the known or suspected infectious agent.
You might have heard of some infections like norovirus, Meticillin-resistant Staphylococcus aureus (MRSA), Clostridioides. difficile (C.diff/CDI) and flu but there are lots of others.
You can find out more information about the infection the individual has and the precautions you should use in Appendix 11 and/or A-Z of pathogens in the NIPCM.
You can also contact your local IPCT or HPT for further advice if required.
Before using transmission based precautions you need to find out:
There are different ways you can find out if a resident has an infection that needs TBPs to be put in place. You can get information about a resident’s infection status from:
Local processes should be followed when obtaining this information.
Further information on transmission based precautions can be found in the definitions of Transmission Based Precautions literature review.
All residents require to be regularly monitored for infection throughout their stay for the correct IPC precautions to be put in place to minimise the risk of infection being spread.
Residents may be an infection risk if they have:
*CPE should be considered if the resident meets any of the following criteria within the 12-month period before admission:
See the CPE toolkit for non-acute settings for further information and requirements.
Staff should do the following if any resident displays signs and/or symptoms of infection:
Residents should not be moved within the care home if they have signs and symptoms of infection unless essential.
Residents may require to be isolated in their own room because of a known or suspected infection. During this time it is important that:
Note: If a resident requires isolation because of infection or in an outbreak situation, this should be individually risk assessed to ensure the safety and health and wellbeing needs of the resident. Isolation periods must be monitored on daily basis and be for the minimum period specified.
Read the patient placement, isolation and cohorting literature review to find out more about why we do things this way for resident placement for TBPs.
Cleaning and decontamination of care equipment is essential to reduce the spread of infection when infection is confirmed/suspected.
When dealing with the equipment used in the resident’s isolation room staff should:
Read the management of care equipment literature review to find out more about why we do things this way for patient care equipment for TBPs.
Staff should:
a combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.));
or
a general purpose neutral detergent in a solution of warm water followed by disinfection solution of 1,000ppm av.cl.
Do not refill spray containers for cleaning products as there is a risk of contamination.
A terminal clean is carried out when the resident is no longer considered infectious and/or when the environment is cleaned/decontaminated to ensure it is safe for a new resident.
A terminal clean is carried out by:
The room should then be decontaminated using either:
The room should be cleaned from the highest to lowest point and from the least to most contaminated point.
Manufacturers’ guidance and recommended product "contact time" should be followed for all cleaning/disinfection solutions.
Appendix 7 is a poster flowchart for decontamination of reusable non-invasive care equipment that you may wish to print off and place in the care home.
Note: When an organisation use products or adopts practices that differ from those stated in this manual, that individual organisation is responsible for ensuring safe systems of work including the completion of risk assessments approved through local governance procedures.
In addition to PPE used for Standard Infection Control Precautions, appendix 15 of the NIPCM outlines what type of PPE and RPE you will need to wear for infections spread by different transmission routes.
Gloves are a single-use item and should be donned immediately prior to exposure risk and should be doffed immediately after each use or upon completion of a task.
Gloves should:
For appropriate glove use and selection see the flowchart poster which may be printed off and placed in the care home.
Further information can be found in the Gloves literature review.
An apron should be worn when caring for residents known or suspected to be colonised/infected with antibiotic resistant bacteria including contact with the resident’s environment.
Plastic aprons should be used in care home settings for protection against contamination with blood and/or body fluids.
A fluid repellent gown should be used if excessive splashing or spraying is anticipated.
A full body fluid repellent gown should be worn when conducting AGPs on residents known or suspected to be infected with a respiratory infectious agent.
Further information can be found in the Aprons/Gowns literature review.
A face visor or goggles should be used in combination with a fluid resistant Type IIR surgical mask when caring for symptomatic residents infected with droplet transmitted infectious agents.
A face visor or goggles should be used in combination with a fluid resistant FFP3 respirator when caring for symptomatic residents infected with an airborne transmitted infectious agent.
Eye/face protection should be worn:
Read Appendix 11 for details of the type of precautions, optimal resident placement, isolation requirements and any respiratory precautions required.
A Type IIR fluid resistant surgical mask (FRSM) should be worn when caring for a resident with a suspected/confirmed infectious agent spread by the droplet route.
FRSMs should be worn (where tolerated) by residents with suspected/confirmed infectious agents spread by the droplet or airborne routes, as a form of source control and should meet type II or IIR standards.
Read Appendix 11 for details of the type of precautions, optimal resident placement, isolation requirements and any respiratory precautions required.
PPE should still be used in accordance with SICPs when using respiratory protective equipment (RPE). See Chapter 1.4 for PPE use for SICPs.
The use of FFP3s is governed by health and safety regulations and they must be fit tested to the user to ensure the required protection is provided.
The Health and Safety Executive (HSE) provides information regarding fitting and fit checking of RPE.
Respiratory Protective Equipment (RPE), for instance FFP3 and facial protection, should be considered when:
It is an HSE requirement that staff who need to wear an FFP3 respirator must be fit tested.
FFP3 respirators should not be worn by staff who are not trained in their use or who have not been fit tested.
All FFP3 respirators must be:
Signs that a change in respirator is required include:
A poster containing information on compatibility of facial hair and FFP3 respirators can be used when fit testing and fit checking.
Further information regarding fitting and fit checking of respirators can be found from the Health and Safety Executive
An AGP is a medical procedure that can result in the release of airborne particles from the respiratory tract and is associated with an increased risk of transmission when treating someone who is suspected or known to be suffering from an infectious agent transmitted wholly or partly by the airborne or droplet route.
The most common AGPs undertaken in the Care Home Setting are Continuous Positive Airway Pressure Ventilation (CPAP) or Bi-level Positive Airway Pressure Ventilation (BiPAP) or tracheostomy procedures (insertion or removal) and open suctioning beyond the oro-pharynx.
The full list of medical procedures that have reported to be aerosol generating and are associated with an increased risk of respiratory transmission can be found in appendix 16.
A poster is also available on PPE when undertaking AGPs within health and social care settings.
Rooms should always be decontaminated following an AGP. Clearance of infectious particles after an AGP is dependent on the ventilation and air change within the room. In an isolation room with mechanical ventilation 10-12 air changes per hour (ACH) a minimum of 20 minutes is required; in a side room with 6 ACH this would be approximately one hour.
It is often difficult to calculate air changes in areas that have natural ventilation only, meaning no mechanical ventilation. Natural ventilation, particularly when reliant on open windows can vary depending on the climate. An air change rate in these circumstances has been agreed as 1-2 air changes/hour.
Rooms should always be decontaminated following the completion of an AGP. Regardless of the number of air changes, a period of 10 minutes should pass to allow larger droplets to settle before the room can be cleaned. Staff are required to wear the appropriate PPE until the fallow time has been met.
For further information on fallow times refer to Table 1 in Appendix 16.
Further information can be found in the literature reviews aerosol generating procedures, Respiratory Protective Equipment (RPE), Personal Protective Equipment (PPE) for Infectious Diseases of High Consequence (IDHC)
Time is required after an AGP is performed to allow the aerosols still circulating to be removed/diluted. This is referred to as post AGP fallow time (PAGPFT) and is a function of the room ventilation air change rate.
The post aerosol generating procedure fallow time (PAGPFT) calculations are detailed in appendix 16. It is often difficult to calculate air changes in areas that have natural ventilation only.
If the area has zero air changes and no natural ventilation, then AGPs should not be undertaken in this area.
The duration of AGP is also required to calculate the PAGPFT and clinical staff are therefore reminded to note the start time of an AGP. It is presumed that the longer the AGP, the more aerosols are produced and therefore require a longer dilution time. During the PAGPFT staff should not enter this room without FFP3 masks. Other residents, other than the resident on which the AGP was undertaken, should not enter the room until the PAGPFT has elapsed and the surrounding area has been cleaned appropriately. As a minimum, regardless of air changes per hour (ACH), a period of 10 minutes should pass before rooms can be cleaned. This is to allow for the large droplets to settle. Staff should not enter rooms in which AGPs have been performed without airborne precautions for a minimum of 10 minutes from completion of AGP. Airborne precautions may also be required for a further extended period of time based on the duration of the AGP and the number of air changes. Cleaning can be carried out after 10 minutes regardless of the extended time for airborne PPE.
Contact your local HPT/IPCT if further advice is required.
Read the RPE literature review to find out more about why we do things this way for respiratory protective equipment.
If a resident dies when in the care home SICPs and TBPs should still be applied. This is due to the ongoing risk of infectious transmission via contact although the risk is usually lower than for the living.
It is important that information on the infection status of the deceased is sought and communicated at each stage of handling and risk assessments performed.
Viewing, washing and/or dressing of the deceased see Appendix 12 - Application of infection prevention precautions in the deceased for guidance on the precautions required and what is permitted for certain types of infections.
Staff should advise relatives of the appropriate precautions to be taken when viewing and/or having physical contact with the deceased, including when this should be avoided.
Read the infection prevention and control during care of the deceased literature review to find out more about why we do things this way when dealing with the deceased.
These appendices from the NIPCM can be used in care homes.
Appendix 5 - Glove use and selection
Appendix 6 - Putting on and removing PPE
Appendix 7 - Decontamination of reusable care equipment
Appendix 8 - Management of linen at care level
Appendix 9 - Management of blood and body fluid spillages
Appendix 10 - Management of occupational exposure incidents
Appendix 12 - Application of infection control precautions in the deceased
Appendix 17 - Hierarchy of controls
The resources section can be used as supporting tools for the Care Home Infection Prevention and Control Manual (CH IPCM).
If you have any questions or feedback about the Care Home IPCM then you can contact us by email or telephone.
Telephone: 0141 300 1175
This page links to the following archived COVID-19 guidance that was in the NIPCM:
Public Health Scotland hold the archive of COVID-19 Guidance and Publications.
Version |
Date |
Summary of changes |
26/10/2020 |
First publication |
|
28/10/2020 |
Update to section 5.7 ‘Safe Management of the Care Environment’ to reflect detail of 2nd daily clean. Update to section 5.5 ‘Personal Protective Equipment’ to be more explicit. |
|
06/11/2020 |
Update to align references to changing of facemasks between pathways. |
|
20/11/2020 |
New section on communications when transferring a suspected/confirmed case New section on car sharing New section on visiting Update to definition of recovered patient |
|
09/12/2020 |
New section on PPE requirements for delivery of vaccinations New section on outbreaks |
|
17/12/2020 |
New section on COVID-19 testing New section on Patients returning from weekend/day pass New section on Whole Genome Sequencing (WGS) Link to RCPCH paediatric guidance for pre-operative admission assessment and testing requirements New FRSM poster (ways to improve fit) |
|
23/12/2020 |
Update to 5.0.3 to reflect changes in stepdown guidance Inclusion of SG link to asymptomatic staff testing information New section on 5.1.1 Non-COVID patient transfers between different wards and hospitals |
|
22/01/2021 |
Update to the COVID-19 testing section and associated testing table New section on guidance for the Discontinuation of Infection control precautions and discharging COVID-19 patients from hospital Update to PPE guidance specifically in relation to visors New section on the hierarchy of controls |
|
18/02/2021 |
Update to resources and Rapid reviews content Additional wording added to definition of suspected case section to reflect wide variety of presenting symptoms Strengthening of triage question relating to travel history Additional paragraph in PPE section reinforcing need for visiting staff to seek clarity on patient pathway and PPE requirements prior to patient contact |
|
26/03/2021 |
Sessional PPE use no longer accepted beyond eye protection in the high risk pathway and FRSMs across all pathways. Update to stepdown requirement for inpatient table to recognise need for clinical assessment Useful tools section |
|
07/05/2021 |
Environmental risk assessment |
|
14/05/2021 |
Change to AGP list to remove upper airway suctioning during Upper GI Endoscopy and replace with suctioning beyond the oro-pharynx. |
|
18/05/2021 |
Update to COVID-19 testing table to reflect the need to test all contacts of confirmed cases. |
|
25/06/2021 |
Update to PPE table to emphasise Risk Assessment in low and medium risk pathway Addition of risk associated with valved respirators Change in controls for management of linen, waste and environmental cleaning from TBPs to SICPs within the Medium Risk pathway |
|
8/7/2021 |
5.2 COVID-19 testing. Update made to include 'or the first positive test, if asymptomatic or other symptoms, unless they develop new possible COVID-19 symptoms' regarding any patient who has previously tested positive for SARS-CoV-2 by PCR. 5.3.8 Update to table 2 - stepdown table for 'Patient discharging to a care facility including nursing homes and residential homes' 5.3.8 Inclusion of section on 'Patients discharged from hospital to a care home (non-COVID-19) |
|
19/7/2021 |
Update to Hierarchy of control including risk assessment algorithm Inclusion of a specific paragraph advising on the use of FFP3 masks |
|
30/8/2021 |
Update to physical distancing |
|
|
29/11/2021 |
Replaced by Version 1.0 of the respiratory addendum |
Version |
Date |
Summary of changes |
07/01/2021 |
First version |
|
25/01/2021 |
Addition of section 7.2.5 'Discontinuing IPC control measures in community health and care settings for COVID-19 individuals' |
|
31/03/2021 |
Health Centres included in list |
|
08/07/2021 |
7.5.5 Change to AGP list to remove upper airway suctioning during Upper GI Endoscopy and replace with suctioning beyond the oro-pharynx. |
|
25/08/2021 |
Inclusion of dental services within the addendum |
|
31/08/2021 |
Update to physical distancing |
|
15/09/2021 |
Update to physical distancing to include further information for visitors and residents within residential homes. |
|
|
29/11/2021 |
Replaced by Version 1.0 of the respiratory addendum |
Version |
Date |
Summary of changes |
16/12/2020 |
First version |
|
25/01/2021 |
Inclusion of new section 6.2.4 'Discontinuing IPC precautions in care homes for residents who are COVID-19 positive' |
|
31/03/2021 |
6.1.2 Definition of suspected case; Additional information and links included. |
|
8 July 2021 |
6.1.3 Triaging of residents admitted to a care home updated with changes to testing and self-isolation |
|
31/08/2021 |
Updates to physical distancing |
|
|
29/11/2021 |
Replaced by Version 1.0 of the Respiratory Addendum |
Version |
Date |
Summary of changes |
29/11/2021 |
Guidance launched |
|
13/12/2021 |
Update to ‘Determining the IPC precautions required for AGPs’ |
|
17/01/2022 |
Addition of advice for regular testing in critical care units where AGPs are regularly performed on the non respiratory pathway. Reduction of COVID-19 duration of precautions from 14 days to 10 days. |
|
20/01/2022 |
Update to Non COVID-19 discharges (non respiratory pathway) from hospitals to care homes Addition of sections for primary care and care homes to reinforce and support assessment using the hierarchy of controls. |
|
03/02/2022 |
Additional information for visitors entering AGP zones. |
|
23/02/2022 |
Risk assessment for management of patient placement in long term residential community settings (section 5.8 and section 5.12.2) Update to hospital testing table |
|
01/04/2022 |
The following updates reflect changes to healthcare COVID-19 pandemic controls as outlined in DL (2022) 07 as follows; Changes to patient testing requirements including Hospital Testing Table Inclusion of the wider use of Rapid Diagnostic Testing (including POCT) or LFD testing Changes to management of contacts including inclusion of 28 day contact exemption Changes to respiratory screening questions Changes to testing requirement pre AGP on the non respiratory pathway Withdrawal of car sharing guidance Removal of physical distancing guidance Please note: the above changes within version 1.6 are not applicable in care homes, prisons and social community and residential care settings at the time of version update; Extant guidance remains in place for these settings. |
|
07/04/2022 |
Update to include definition of fully vaccinated Addition to physical distancing noting that services may choose to retain physical distancing where they deem it necessary |
|
27/04/2022 |
Addition of testing responsibilities at an organisational level and clarity of testing language Change to isolation advice for service users with COVID-19 Removal of vaccination as part of contact management. |
|
|
11/07/2022 |
The respiratory addendum was archived and relevant content included in the NIPCM |
Version |
Date |
Summary of changes |
10/05/2022 |
First publication – Marks transition from Winter Respiratory Infection IPC Addendum back to NIPCM. |
|
30/05/2022 |
Reference to COVID-19 screening removed. |
|
13/07/2022 |
Addition of dental services and GPs to title. |
|
28/07/2022 |
Removal of GPs in title as now included in Appendix 22. |
|
22/08/ 2022 |
Changes made to testing requirements in line with DL 2022(29) issued on 22nd August 2022 |
|
16/09/2022 |
Update following Directors Letter (2022)32 - pause in asymptomatic COVID-19 testing in health and social care |
|
28/09/2022 |
Removal of ‘Primary Care Settings’ from Table 2 – Respiratory Screening Questions |
|
06 /10/ 2022 |
Broken links replaced and update to COVID-19 testing requirements in line with Directors Letter (2022)32 |
|
18/11/2022 |
Updated to reflect that the advice contained within the Scottish Government’s DL(2022)10 remains extant. |
|
|
20/03/2023 |
Replaced with new Appendix 21 - COVID-19 Pandemic IPC for health and social care settings |
Version |
Date |
Summary of changes |
29/06/2022 |
First publication – Marks transition from Winter Respiratory Infection IPC Addendum to a Community COVID-19 Pandemic Appendix. |
|
28/07/2022 |
GP surgeries included in this this appendix and removed from Appendix 21 – COVID-19 acute settings |
|
16/09/2022 |
Content revised to reflect SG Extended Use of Facemasks Policy for ASC settings. |
|
04/10/2022 |
Link added to revised content from SG clarifying use of facemasks in social care settings by healthcare staff |
|
18/11/2022 |
Updated to reflect that the advice contained within the Scottish Government’s DL(2022)10 remains extant. |
|
|
20/03/2023 |
Replaced with new Appendix 21 COVID-19 Pandemic IPC for health and social care settings. |
Version |
Date |
Summary of changes |
20/03/2023 |
New appendix which combines content from COVID-19 Appendix 21 for acute settings and Appendix 22 for community settings into a single pandemic appendix for health and social care settings. |
|
16/05/2023 |
Amendments to content made following Withdrawal of the Coronavirus (COVID-19): Extended Use of Face Masks and Face Coverings Guidance Across Health and Social Care Scottish Government DL (2023) 11. Renumbered as Appendix 19 on 2 June 2023 due to the archiving of outdated COVID-19 appendices. Appendix 19 was removed on 28 August 2023 due to changes in the SG COVID-19 testing procedures and the NIPCM was updated to reflect this. |
Version |
Date |
Summary of changes |
23/12/2020 |
First version produced by Scottish Government |
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22/02/2021 |
ARHAI Scotland taking responsibility for producing table. Inclusion of frontpage and review of content undertaken. |
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18/05/2021 |
Update made to testing requirement 3 regarding emergency admissions and PCR/POCT testing. Update made to requirement 7 Transfer of a non COVID-19 patient to another hospital/NHS board about transferring patient while waiting for test results. Update to section Testing Contacts of confirmed COVID-19 cases. |
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06/09/2021 |
Updates to sections on staff testing. Reference to household member testing positive removed. |
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01/12/2021 |
Updated to be in line with the respiratory addendum. |
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02/12/2021 |
Update to frontpage reference to discharge to care homes to include for those still in the 14 day isolation period. |
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21/12/2021 |
Update to frontpage to include definition of admissions. Update to testing prior to an AGP to include further information on negative tests before an AGP. |
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23/02/2022 |
Addition of relevant policy letters or guidance relevant to each testing recommendation. |
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01/04/2022 |
Updates to reflect changes to healthcare COVID-19 pandemic controls outlined in DL (2022) 07 as follows
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07/04/2022 |
Clarity relating to COVID-19 testing terminology |
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25/04/2022 |
Additional clarifications relating to COVID-19 testing terminology |
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10/05/2022 |
Changes to reflect transition of Winter Respiratory IPC addendum to COVID-19 appendix |
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22/08/2022 |
Changes made to testing requirements in line with DL 2022(29) issued on 22nd August 2022 |
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16/9/2022 |
Testing requirements updated with new paragraphs on symptomatic and asymptomatic testing. Addition of Appendix 1- List of PCR-based and non-PCR based tests in use in Scotland |
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06/10/2022 |
Update to duration of precautions to reference NIPCM and A-Z |
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The hospital testing tables were removed on 28 August 2023 due to changes in the SG COVID-19 testing procedures and the NIPCM was updated to reflect this. |
Every winter health and care providers experience additional demand for services due to an increase in seasonal viruses. These include:
These infections can spread quickly in areas such as hospital wards or care homes causing service users (for example patients and residents) and staff to become unwell.
Below you will find key infection prevention and control actions and supporting tools you can use in your winter planning preparations and during outbreaks and incidents. These should be used alongside the content of the National Infection Prevention and Control Manual (NIPCM) and Care Home Infection Prevention and Control Manual (CHIPCM).
It includes:
It is essential that infection prevention and control is included within these winter plans.
Health and care organisations should assess local preparedness for the winter period and identify local actions needed to help relieve pressure points across the organisation to:
To make sure that your health and care area is ready for winter you should have the correct products, procedures and communications in place to stop infections spreading.
At all times Standard Infection Control Precautions (SICPs) should be followed. SICPs are the basic infection prevention and control measures necessary to reduce the risk of transmission of infectious agents from both recognised and unrecognised sources of infection.
SICPs may be not be enough to prevent cross-transmission of specific infections so you might need to also use additional precautions known as Transmission Based Precautions (TBPs) when caring for patients with a known or suspected infection or colonisation.
Further information on SICPs and TBPs can be found in the NIPCM and CHIPCM.
Make sure that you have the contact details for your local infection prevention and control (IPC) team and NHS board health protection (HPT) team so you can easily get advice and support on infection control and outbreak management during the winter season.
Norovirus and respiratory viruses can spread very quickly in hospitals and care homes and cause outbreaks. Outbreaks of infections can lead to:
A Healthcare Associated Infection Outbreak can happen when there are:
An early and effective response to an actual or potential healthcare incident, outbreak or data exceedance is crucial.
Please note that depending on local processes, care homes should contact their local IPCT or HPT for support and advice regarding outbreaks in their care areas.
NHS Boards should follow Chapter 3 of the NIPCM Healthcare Infection Incidents, Outbreaks and Data Exceedance for incidents and outbreaks including for norovirus and respiratory infections.
Chapter 3 includes detailed definitions on outbreaks and incidents.
Local surveillance and reporting systems should be used for recognition and detection of potential healthcare infection incidents and outbreaks. Systems should make use of ‘triggers’ to allow prompt detection of any variance from normal limits.
Closely monitor rates of respiratory viruses including COVID-19 and provide infection prevention and control advice and guidance as required.
The Healthcare Infection Incident Assessment Tool (HIIAT) should be used by the IPCT or HPT to assess every healthcare infection incident and report all HIIAT assessed Green, Amber and Red reports to ARHAI Scotland through the electronic outbreak reporting tool (ORT).
Incidents assessed as Red, Amber or Green, where ARHAI support is requested, will be reviewed for onward communication to Scottish Government Healthcare Associated Infection Policy Unit.
The Outbreak Checklist is designed to support staff with the prevention and control of suspected or confirmed incidents and outbreaks in hospital settings.
An incident/outbreak data collection tool template is available to help identify the total number of confirmed/probable/possible exposed cases.
Once the incident is declared over, and in addition to reporting via the electronic outbreak reporting tool (ORT), the IMT/NHS board should decide on the most appropriate format for a report to communicate any lessons learned from completing the Hot Debrief Tool.
After the winter season has ended it is important for health and care organisations to review how well the season went and include aspects of preparation, communications, outbreak and incident management. This can include measuring against:
It is important for organisations to celebrate successes and share achievements both locally and nationally.
Areas that can be considered for improvement include:
The organisations multi-disciplinary team should actively consider learning opportunities presented by HAI data exceedance, incidents and outbreaks and disseminate, escalate, and share all relevant lessons learned via established local and national governance and reporting routes.
The Hot Debrief Tool can assist in sharing of lessons learned.
The results of these lessons learned should be used as recommendations for next years winter season and used as an improvement measure.
The recommendations for practice made in the NIPCM are based on living systematic literature reviews. Any changes identified in the scientific literature may lead to a change being made to the NIPCM following stakeholder engagement.
Literature reviews are undertaken following agreed processes for evidence identification and appraisal as well as following defined governance structures before publication on the NIPCM. Details on the research methods and terms used can be found in the Development Methodology document.
The scientific evidence for the NIPCM is reviewed on a real time basis and details of the reviews reported quarterly.
Please note that changes to the methodology are currently being piloted with the IPC Working Groups to increase transparency and improve rigour of development of the NIPCM. Following approval by the ARHAI Scotland IPC Oversight and Advisory Group, the development process will be updated. It is anticipated that review of the pilot methodology will be complete by December 2024. The draft methodology is available to view.
The scientific evidence for the NIPCM is reviewed on a real time basis and details of the reviews reported quarterly.
SICPs and TBPs
Statement: Please note that SBARs published before December 2023 make reference to alcohol based hand rub (ABHR). As of date 11 January 2024 this is now referred to as hand rub in the NIPCM based on the updated recommendations in the hand products literature review (with the exception of surgical hand antisepsis which has its own body of research).
An SBAR (Situation, Background, Assessment, Recommendation) is a communication tool presented in 4 standardised sections that allow organisations to present key information and communicate it in a clear and concise way. SBARs are often used in healthcare settings to:
View ARHAI SBARs
ARHAI Scotland have published in scientific journals
The use of the word 'Persons' can be used instead of ‘Patient’ when using this document in non-healthcare settings.
A graze. A minor wound in which the surface of the skin or a mucous membrane has been worn away by rubbing or scraping.
This is a unique, demanding and fast-paced environment designed to accommodate a wide variety of urgent, or emergent patient care needs.
An event that could have caused or did result in harm to people or groups of people.
An AGP is a medical procedure that can result in the release of airborne particles from the respiratory tract when treating someone who is suspected or known to be suffering from an infectious agent transmitted wholly or partly by the airborne or droplet route.
The spread of infection from one person to another by airborne particles (aerosols) containing infectious agents.
Very small particles (of respirable size) that may contain infectious agents. They can remain in the air for extended periods of time and can be carried over long distances by air currents. Aerosols can be released during aerosol generating procedures (AGPs).
A group of transmission-based precautions to prevent the spread of airborne pathogens.
A gel, foam or liquid containing one or more types of alcohol that is rubbed into the hands to inactivate microorganisms and/or temporarily suppress their growth.
An organism that is identified as being potentially significant for infection prevention and control practices. Examples of alert organisms include Meticillin Resistant Staphylococcus aureus (MRSA), Clostridioides difficile (C.diff) and Group A Streptococcus.
Refers to the alveoli which are the small air sacs in the lungs. Alveoli are located at the ends of the air passageways in the lungs, and are the site at which gas exchange takes place.
An area with a door from or to the outside corridor and a second door giving access to the patient area (where both doors will never be open at the same time).
An agent that kills microorganisms, or prevents them from growing.
Antimicrobials are grouped according to the microorganisms they act against, such as, antibiotics, antivirals, antifungals and antiparasitics.
Hand wipes that are moistened with an antimicrobial solution or agent at a concentration sufficient to inactivate microorganisms and/or temporarily suppress their growth.
The ability of a microorganism to resist the action of an antimicrobial drug or agent which previously could treat the infection caused by that microorganism.
The process of preventing infection by inhibiting the growth and multiplication of infectious agents. This is usually achieved by application of a germicidal preparation known as an antiseptic.
A healthcare procedure designed to minimise the risks of exposing the person being cared for to pathogenic micro-organisms during simple (for example dressing wounds) and complex care procedures (for example surgical procedures).
Not showing any symptoms of disease but where an infection may be present.
In the context of infection prevention and control, most care designated as augmented will be that where medical or nursing procedures render the patients susceptible to invasive disease from environmental and opportunistic pathogens. However, there is no fixed definition of ‘augmented care’.
Machine used for sterilising re-usable equipment using steam sterilisation. Re-usable equipment is exposed to steam at a required temperature, pressure, and time.
A partly enclosed area within a ward containing one bed (single bay) or multiple beds (multi-bed bay).
Viruses carried or transmitted by blood, for example Hepatitis B, Hepatitis C and HIV.
Fluid produced by the body such as urine, faeces, vomit or diarrhoea.
National standards specify the requirements for application in the particular country.
Includes but is not limited to general practice, dental and pharmacy (primary care), acute-care hospitals, emergency medical services, urgent-care centres and outpatient clinics (secondary care), specialist treatment centres (tertiary care), long-term care facilities such as nursing homes and skilled nursing facilities (community care), and care provided at home by professional healthcare providers (home care).
Any person who cares for patients, including healthcare support workers and nurses.
An intravenous catheter that is inserted directly into a large vein in the neck, chest or groin to give intravenous drugs, fluids and blood and to allow for quick medical tests.
A chemical that is used for disinfecting, fumigating and bleaching.
The removal of any dirt, body fluids (such as blood, vomit) by use of an appropriate cleaning agent such as detergent.
A sink designated for hand washing in clinical areas.
A bay or ward in which a group of patients (cohort) with the same infection are placed. Cohorts are created based on clinical diagnosis, microbiological confirmation when available, epidemiology, and mode of transmission of the infectious agent.
The presence of microorganisms on a body surface (such as the skin, mouth, intestines or airway) that does not cause disease in the person or signs of infection.
Mucous membranes that cover the front of the eyes and the inside of the eyelids.
The inflammation of the skin (epidermis and adjacent dermis) resulting from direct contact of a substance that could either be an irritant (irritant contact dermatitis) or allergen (allergic contact dermatitis) with the surface of the skin.
Series of procedures/interventions used in addition to routine practices to prevent transmission of infectious agents that spread by direct or indirect contact.
The spread of infectious agents from one person to another by contact. When spread occurs through skin-to-skin contact, this is called direct contact transmission. When spread occurs via a contaminated object, this is called indirect contact transmission.
The presence of an infectious agent on a body surface; also on or in clothes, bedding, surgical instruments or dressings, or other inanimate articles or substances including water and food.
Source control measures intended to contain respiratory secretions in order to limit transmission of respiratory pathogens.
Spread of infection from one person, object or place to another.
The process of removing, or killing pathogens on an item or surface to make it safe for handling, re-use or disposal, by cleaning, disinfection and/or sterilisation.
A chemical cleansing agent that can dissolve oils and remove dirt.
Passing looser more frequent stools than is normal for the individual.
Spread of infectious agents from one person to another by direct skin-to-skin contact.
A chemical used to reduce the number of infectious agents from an object or surface to a level that means they are not harmful to health.
The treatment of surfaces or equipment using physical or chemical means, for example using a chemical disinfectant, to reduce the number of infectious agents from an object or surface to a level at which they are not harmful to health.
To remove (an item of clothing or an item of PPE).
Waste produced in the care setting that is similar to waste produced in the home.
To put on (an item of clothing or an item of PPE).
A small drop of moisture, larger than airborne particle, that may contain infectious agents. Droplets can be released when a person talks, coughs or sneezes, and during some medical or patient care procedures such as open suctioning and cough induction by chest physiotherapy. It is thought that droplets can travel around 1 metre (3 feet).
Droplet nuclei are aerosols formed from the rapid evaporation/desiccation of larger droplet particles when expelled/exhaled from the respiratory tract.
The spread of infection from one person to another by droplets containing infectious agents.
A product used to moisturise the skin. It works by covering the skin with a protective film which traps in moisture.
En-suite facilities should contain a shower, WC and a general wash-hand basin.
A room with space for one patient with en-suite facilities.
A single case of rare infection that has severe outcomes for an individual AND has major implications for others (patients, staff, visitors), the organisation or wider public health, for example, high consequence infectious disease (HCID) OR other rare infections such as extensively drug resistant tuberculosis (XDR-TB), botulism, polio, rabies, or diphtheria.
Waste products produced by the body such as urine and faeces (bowel movements).
The condition of being exposed to something that may have a harmful effect such as an infectious agent.
Certain medical and patient care procedures where there is a risk that injury to the healthcare worker may result in exposure of the patient’s open tissues to the healthcare worker’s blood, for example the healthcare worker’s gloved hands are in contact with sharp instruments, needle tips or sharp tissues inside a patient’s body.
A term that applies collectively to items used to cover the nose and mouth. Also referred to as a face mask.
These should not be confused with items of PPE.
The period of time required for droplets and/or aerosols to settle and be removed from the air following a procedure. It is also known as settle time.
Respiratory protection that is worn over the nose and mouth designed to protect the wearer from inhaling hazardous substances, including airborne particles (aerosols). FFP stands for filtering facepiece. There are three categories of FFP respirator: FFP1, FFP2 and FFP3. An FFP3 respirator or hood provides the highest level of protection, and is the only category of respirator legislated for use in UK healthcare settings.
A fit check, otherwise known as a user seal check, is a simple and quick method of checking that a respirator has been donned correctly to form a tight seal around the face. Fit checks are not substitutes for, and should not be confused with, fit testing.
A method to evaluate how well a tight-fitting respirator fits the wearer and seals adequately to their face. This process verifies the correct model, style, and size of respirator suitable for an individual.
A term applied to fabrics that resist liquid penetration, often used interchangeably with 'fluid-repellent' when describing the properties of protective clothing or equipment.
An inanimate substance or object that can transfer a pathogen to a host.
An agent capable of destroying microorganisms, particularly organisms that are pathogenic.
General practitioner (your family doctor).
Definition taken from the HSE Approved list of biological agents www.hse.gov.uk/pubns/misc208.pdf
Group 4 infections cause severe human disease and are a serious hazard to employees; they are likely to spread to the community and there is usually no effective prophylaxis or treatment available.
The process of decontaminating your hands using either hand rub or liquid soap and water.
A gel, foam or liquid containing one or more types of active ingredient that is rubbed into the hands to inactivate microorganisms and/or temporarily suppress their growth. A hand rub should meet the required British or European Standards as defined in the hand products literature review.
A team of healthcare professionals whose role it is to protect the health of the local population and limit the risk of them becoming exposed to infection and environmental dangers. Every NHS board has a HPT.
Infections that occur as a result of medical care, or treatment, in any healthcare setting.
Two or more linked cases associated with the same infectious agent, within the same healthcare setting, over a specified time period; or a higher than expected number of cases in a given healthcare area over a specified time period.
A greater than expected rate of infection compared with the usual background rate for the place and time where the incident has occurred.
An exposure of patients, staff, or the public to a possible infectious agent, as a result of a healthcare system failure or near misses for example ventilation, water or a decontamination incident.
Waste produced as a result of healthcare activities for example soiled dressings, sharps.
This is a systematic process which provides a consistent approach to minimising or eliminating exposures to hazards in the workplace.
A High Consequence Infectious Disease (HCID) is defined according to the following criteria:
Previously referred to as an Infectious Diseases of High Consequence (IDHC).
Used by the IPCT or HPT to assess every healthcare infection incident, meaning all outbreaks and incidents including decontamination incidents or near misses in any healthcare setting, (that is the NHS, independent contractors providing NHS services and private providers of healthcare).
Waste that is produced from personal care. In care settings this includes feminine hygiene products, incontinence products and nappies, catheter and stoma bags. Hygiene waste may cause offence due to the presence of recognisable healthcare waste items or body fluids. It is usually assumed that hygiene waste is not hazardous or infectious.
A chlorine-based disinfectant such as bleach.
To provide immunity to a disease by giving a vaccination.
Any person whose immune response is reduced or deficient, usually because they have a disease or are undergoing treatment. People who are immunocompromised are more vulnerable to infection.
Cannot be penetrated by liquid.
A multidisciplinary group with responsibility for investigating and managing an incident.
An incident/outbreak may be:
The spread of infectious agents from one person to another via a contaminated object.
Invasion of the body by a harmful organism or infectious agent such as a virus, parasite, bacterium or fungus.
A multidisciplinary team responsible for preventing, investigating and managing an infection incident or outbreak.
Any organism, such as a virus, parasite, bacterium or fungus, that is capable of causing an infection or infectious disease.
The time when an infectious agent may be transmitted directly or indirectly from an infected person to another person. Also known as “period of infectiousness” and “communicability”.
A patient is termed an inpatient when they occupy a staffed bed in a hospital and either remains overnight (whether intended or not), or is expected to remain overnight but is discharged earlier. An inpatient’s admission can be an emergency, an elective or as a transfer.
A device which penetrates the body, either through a body cavity or through the surface of the body. Central Venous Catheters (central line), Peripheral Arterial Lines and Urinary Catheters are examples of invasive devices.
A medical or healthcare procedure that penetrates or breaks the skin or enters a body cavity.
Physically separating patients to prevent the spread of infection.
An isolation suite/room consists of enhanced en-suite single bedrooms.
An en-suite single bedroom is defined as: consisting of a bed, locker or wardrobe, clinical wash-hand basin and en-suite shower, WC and wash-hand basin. (In new build, space for a social support zone for overnight stay and a clinical support zone is also provided).
No terms
No terms
A test carried out using a small medical device that tests whether or not a sample contains a particular substance, gene and so in. For example, to identify those who have COVID-19 but are not presenting symptoms.
Long term care facilities provide a variety of services, both medical and personal care, to people who are unable to live independently.
Mechanical ventilation brings fresh air into a building from outside via a controllable method. Basic systems consist of a fan and either collection (extraction) or distribution (supply) ductwork.
Any living thing (organism) that is too small to be seen by the naked eye. Bacteria, viruses and some parasites are microorganisms.
The way that microorganisms spread from one person to another. The main modes or routes of transmission are airborne (aerosol) transmission, droplet transmission and contact transmission.
An incident in which the mucous membranes (for example mouth, nose, eyes) or non-intact skin have been contaminated with blood or other bodily fluids.
The surfaces lining the cavities of the body that are exposed to the environment such as the lining of the mouth and nose.
A room that contains more than one bed.
The acceptable maximum number of beds in a multi-bed room is four. Multi-bed rooms require two clinical wash-hand basins and must have en-suite sanitary facilities. Ideally, an assisted shower room (with WC, shower and general wash-hand basin) and a separate semi-ambulant WC (with general wash-hand basin) both en-suite.
A room which maintains permanent negative pressure. Air flow is from the outside adjacent space (for example corridor) into the room and then exhausted to the outside.
The room should be used to accommodate a patient known or suspected to be infected with a microorganism spread by the airborne route whilst the patient is considered infectious.
Skin that is broken for example by cuts, abrasions, dermatitis, chapped skin, eczema.
An incident in which non-intact skin is exposed to blood or body fluids.
Care procedure that does not need to be undertaken in conditions that are free from bacteria or other microorganisms.
An infection occurring in a patient during the process of care in a hospital or other health care facility, which was not present or incubating at the time of admission.
Scientifically, novel is used to refer to things of recent origin or introduction, such as a novel pathogen.
An occupational exposure is a percutaneous or mucocutaneous exposure to blood or other body fluids.
Any living thing that can grow and reproduce, such as a plant, animal, fungus or bacterium.
An outpatient is a patient who attends a consultant or other medical/healthcare clinic or has an arranged meeting with a consultant or a senior member of their team out with a clinic session. Outpatient attendances involve treatment or assessment that only take a short time to complete. Outpatient attendances are categorised as new or return (follow-up).
Within health and care settings, this is the state of being filled past capacity/comfort and therefore being burdened by excessive demands for services.
A disease outbreak that occurs over a wide geographical area (such as multiple countries and/or continents) and typically affects a significant proportion of the population.
Any disease-producing infectious agent.
Placing a group of two or more patients (a cohort) with the same infection/strain in the same bay/ward. Cohorts are created based on clinical diagnosis, microbiological confirmation, epidemiology, and mode of transmission.
Highly accurate tests used to diagnose certain infectious diseases.
An injury caused by a needle or sharp, instrument, bone fragment, human scratch or bite cutting or puncturing the skin.
Equipment a person wears to protect themselves from risks to their health or safety, including exposure to infections, for example disposable gloves and disposable aprons.
Keeping a distance from other people, in order to stop transmission of a disease to another person or other people.
The time period when someone has the infection but has not yet developed symptoms but does go on to develop symptoms later in the disease.
These provide the first point of contact in the healthcare system which includes general practice, dentistry, community pharmacies.
A group that is convened by the Infection Prevention and Control Team (IPCT)/Health Protection Team (HPT) to assess a healthcare incident/outbreak/data exceedence and determine if further action is required.
The assessment and outcome may be:
A pseudo-outbreak describes a situation where there is an increased rate of microorganisms identified within clinical patient samples, without evidence of infection within the patient.
Pseudo-outbreaks may be caused by several factors, including contaminated equipment and water supply systems.
No terms
To put a needle or other sharp object back into its plastic sheath or cap. Also known as ‘re-sheathing’.
A small droplet >5 μm in diameter, such as a particle of moisture released from the mouth during coughing, sneezing, or speaking.
Respirators are devices that cover the nose and mouth and are designed to filter the air breathed in to protect the wearer from inhaling hazardous substances.
They provide respiratory protection from infectious agents transmissible by the airborne (aerosols) route. FPP3 respirators are recommended for use in UK health and care settings when exposure to aerosols is anticipated.
A medical sharps device which has been designed to incorporate a feature or mechanism that minimises and/or prevents the risk of accidental injury. Other terms include (but are not limited to) safety devices, safety-engineered devices and safer sharps devices.
Any device designed to reduce the risk of injury from needles. This may include needle-free devices or mechanisms on a needle, such as an automated resheathing device, that cover the needle immediately after use.
All sinks and furniture in a bathroom, including a toilet, bath, shower.
Performing a test or enquiry to identify individuals at risk of a specific disorder or infection to warrant further investigation or direct preventive action.
Provided by health professionals who generally are not the first point of contact for a patient. These settings are usually hospitals but can also be community-based.
Any body fluid that is produced by a cell or gland such as saliva or mucous, for a particular function in the organism or for excretion.
Physically separating or isolating from other people.
A life-threatening condition that arises when the body’s response to a severe complication of infection for example pneumonia (lung infection) injures its own tissues and organs. This can lead to multiple organ failure and death. Early recognition, treatment and management is key to successful patient outcomes.
A ‘sharp’ is a device or instrument used in healthcare settings with sharp points or edges, such as needles, lancets and scalpels which have the potential to cause injury through cutting or puncturing the skin.
A type of percutaneous injury caused by a sharp instrument or device which cuts or penetrates the skin.
See percutaneous injury.
A percutaneous, mucocutaneous or non-intact skin (abrasions, cuts, eczema) exposure to blood or other body fluids from a source that is known (or later found to be) positive for a bloodborne virus infection.
An incident which involves a used needle that has exposed, or may have exposed, the employee to blood/body fluids.
A room with space for one patient and usually contains as a minimum: a bed; locker/wardrobe; clinical wash-hand basin.
Single-bed rooms should also have en-suite sanitary facilities comprising of a shower, WC and a general wash-hand basin.
Skin being intact, and in an unimpaired condition.
This term encompasses all physical measures used to control the transmission of an infectious agent.
A reproductive cell produced by fungi and some types of bacteria under certain environmental conditions. Spores can survive for long periods of time and are very resistant to heat, drying and chemicals.
A dedicated team of healthcare staff who care for a cohort of patients, and do not care for any other patients.
These are a group of basic infection prevention and control practices that need to be adopted by all staff in health and care settings, irrespective of infectious status of patient.
Free from live bacteria or other microorganisms.
Care procedure that is undertaken in conditions that are free from bacteria or other microorganisms.
The procedure of making some object free of all germs, live bacteria or other microorganisms (usually by heat or chemical means).
A disposable fluid-resistant mask worn over the nose and mouth to protect the mucous membranes of the wearer’s nose and mouth from splashes and infectious droplets and to protect patients. When recommended for infection control purposes a 'surgical face mask' typically denotes a fluid-resistant (Type IIR) surgical mask.
Surgical scrubbing or surgical rubbing. More thorough than routine hand hygiene. In addition to the removal of visible soiling and transient bacteria, it prevents the growth of resident microbial skin flora before performing an invasive procedure.
The process of surgical hand antisepsis using ABHR prior to performing a sterile or surgical procedure. An alternative to surgical scrubbing when hands are not visibly soiled.
The process of removing debris and sterilising hands prior to performing a sterile or surgical procedure.
This is an infection which occurs after the surgery at the site of the surgical incision due to introduction and multiplication of pathogens at the surgical site.
Way of closing bag by twisting the top of the bag (must not be more than 2/3 full), looping the neck back on itself, holding the twist firmly, and placing a seal over the neck of the bag (such as with a tag).
Cleaning/decontamination of the environment following transfer/discharge of a patient, or when they are no longer considered infectious, to ensure the environment is safe for the next patient or for the same patient on return.
These are surfaces that are frequently touched by different people throughout the day and are therefore more likely to be contaminated with bacteria or viruses for example doorknobs, tables, phones, which can then easily transfer to the user.
These are additional measures that are used in conjunction with SICPs when caring for patients with a known or suspected infection or colonisation.
No terms
Treatment with a vaccine to produce immunity against a disease.
A suspension that is administered in order to stimulate the immune response of the body against an infectious agent.
Any medical instrument used to access a patient’s veins or arteries such as a Central Venous Catheter or Peripheral Vascular Catheter.
Ventilation is a means of removing and replacing the air in a space. In its simplest form this may be achieved by opening windows and doors.
The viral load or viral burden is a numerical expression of the amount of virus present in biological fluids or environmental specimens.
An area forming a division of a care setting (or a suite of rooms) shared by patients who need a similar type of care.
No terms
No terms
No terms