Infection Control Guidance
Contents
Last Updated: September 2004
Review Date:
Ownership: Yvette Jones
Purpose
An explanation of why we need to practice infection control, universal infection
control procedures and where to seek additional advice from.
Infection Control Guidance
Contents
Infection Control in the community .................................................................... 3
Further advice on Infection Control ................................................................... 4
Universal Infection control Procedures .............................................................. 4
Guideline 1 – General Hygiene Guidelines ........................................................... 5
Handwashing..................................................................................................... 5
Handwashing Technique ................................................................................... 5
Gloves ................................................................................................................... 6
Personal Care ....................................................................................................... 7
Aprons and tabards............................................................................................... 8
Disposal of waste .................................................................................................. 8
Clinical Waste ....................................................................................................... 9
General cleaning ................................................................................................... 9
Crockery and cutlery ....................................................................................... 10
Laundry ........................................................................................................... 10
Guideline 2 – blood and body fluids .................................................................... 12
Dealing with spillages of blood or body products............................................. 12
Puncture wounds ................................................................................................ 13
Dealing with “sharps” injuries .......................................................................... 13
Spitting and biting ............................................................................................... 14
Vaccination ......................................................................................................... 15
Animals ........................................................................................................... 15
Care of a client with diarrhoea or vomiting – D & V............................................. 16
Cleaning .......................................................................................................... 17
Longer term ..................................................................................................... 17
If you have Diarrhoea and/or vomitting ............................................................ 17
Looking after a client with MRSA..................................................................... 19
Guideline 5 - Scabies .......................................................................................... 21
Caring for someone with Scabies .................................................................... 21
Treatment of Scabies ...................................................................................... 22
Guideline 6 – Head lice ....................................................................................... 23
Infection Control Guidance
Caring for someone with head lice .................................................................. 23
Treatment ........................................................................................................ 23
Guideline 7 – Blood borne infections - HIV infection and AIDS ........................... 25
Confidentiality .................................................................................................. 26
Other information............................................................................................. 26
Guideline 8 – Blood borne infections – Hepatitis B and other forms of Hepatitis 28
Symptoms of HBV ........................................................................................... 28
Protection against HBV ................................................................................... 29
Departmental Policy on HBV – Information and Vaccination ........................... 29
Infection Control Guidance
This information consists of:
An explanation of why we need to practice infection control.
Where to seek additional advice when needed.
An explanation of Universal Infection control procedures
Guideline 1
General guidance including:
Hand hygiene
Personal Care
Use of gloves, aprons and Tabard
Disposal of waste
Clinical Waste arrangement
General cleaning
Laundry
Guideline 2
Blood and body fluids including:
Dealing with spillages of blood or body products
Puncture wounds
Sharps injuries – needlestick injuries
Spitting and biting
Guideline 3
Gastroenteritis – Diarrhoea and/or vomiting
Guideline 4
MRSA – Methicillin Resistant Staphylococcus Aureus
Guideline 5
Scabies
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Guideline 6
Headlice
Guideline 7
HIV and AIDS – including information on general departmental policy
Guideline 8
Hepatitis B
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Infection Control
Infection control is about preventing the spread of infection.
Infection Control in the community
Many people with an infection do not need to go to hospital, and can remain in
the community quite safely. Hospitals and GP’s advise people and their carers
about how to manage their infection, and their advice is always based on the risk
the infection might pose the service user or to others visiting them or living with
them.
Infections in the community setting are often managed very differently to how
they would be managed in a hospital. This is to stop unnecessary precautions
being taken which might restrict the service user’s normal life and recovery, and
because the service user in the community is less likely to have close contact
with people who are susceptible to infection.
In hospital nowadays most people are at high risk of catching an infection
because they are mainly elderly, ill, frail, very young, have low resistance to
infection due to drugs and treatment, or may have open wounds, drips or drains.
Therefore precautions taken in hospital are very strict, but in the community this
is usually not necessary.
Infection control is very important for Carers in any Social Services setting
because you may have contact with or visit a number of older, frail vulnerable or
ill people during your working day, and you have a duty to make sure you do not
carry infection from one person to another. You also need to protect yourself
from infection to avoid becoming unwell yourself, and you will want to make sure
you do not carry infection home to your family.
It is very easy to control spread of infection in residential homes and community
settings. These guidelines will give you general basic advice based on the most
up-to-date information from the specialist Public Health Team who are
responsible for infection control in the community.
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Further advice on Infection Control
If you are ever worried about infection control, or not sure about what to do, you
should ask your line manager to begin with. Where there is any doubt they can
check our policy or advice with the Public Health Team. If you are still worried or
want to check the guidance you have been given is correct – you can ring the
Public Health team direct on 0118 960 5205. Ask for the Public Health Nurse for
infection control in the community.
Universal Infection control Procedures
Universal Infection control Procedures must be used whenever you give care to
any client – whether there is an infection present or not.
These procedures, when carried out correctly, will protect you, the client, other
clients and your families from infection – including the bloodborne viruses such
as HIV and Hepatitus B, and germs such as MRSA.
Good infection control practices apply equally for all clients, and are based on the
care activities being carried out. This ensures you are always protected even if
there is an infection present that we do not know about.
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Guideline 1 – General Hygiene Guidelines
This guideline details the various Universal Infection control Procedures which
must be used whenever you are giving care to any client – whether there is an
infection present or not.
Handwashing
The most important single thing you can do to control infection is good
handwashing.
Use ordinary non-medicated soap for this. Do not use harsher soaps containing
antiseptics unless these have been ordered as essential – as these can make
your hands very chapped and dry and increase the risk of infection!
Handwashing Technique
1.
2.
3.
4.
5.
Wet hands under running water.
Apply soap.
Rub all parts vigorously without adding more water for 10 – 15 seconds.
Rinse soap off hands under running water.
Dry hands thoroughly using a clean towel. If no clean towel available use
kitchen roll or paper towels.
If there are no handwashing facilities available use anti-bacterial handgel
(provided as part of home carers equipment.) It has instructions for use on it.
Pump a big teaspoonful of the gel into the palm of your hand. Using the same
motions as you do for handwashing – rub the gel all over your hands
remembering the cracks and creases. Let the gel dry in the air – and then your
hands are considered cleansed.
Keep your hands in good condition – avoid skin contact with harsh abrasive
chemicals such as bleach – and keep your nails neat and clean. All breaks in
your skin should be covered with a waterproof plaster whenever you are at work,
and these are supplied to you for this purpose. If you use a hand cream – use
your own supply which is not shared with others. If your hands get sore or
chapped – talk to your line manager to get advice.
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You must wash your hands:
 Before and after undertaking personal care tasks – even if you were using
gloves
 Before any food preparation or feeding a client or giving medication
 After using or cleaning a lavatory or commode or undertaking any task related
to toiletting or catheters
 After taking off disposable gloves or other protective gloves – always do this
 after undertaking cleaning duties – even if you were wearing marigold type
gloves
 after unexpectedly handling any body products – which includes blood, urine,
faeces, vomit, semen, mucus, pus, saliva or sputum.
 When homecarers finish with a client and are leaving the household.
 Whenever you have been to the toilet or sneezed/blown your nose
 Before you eat, drink or smoke.
 At the end of your working day
Gloves
Disposable gloves are provided as single use items – and should be discarded
after use. They are not an alternative to handwashing – and you should always
wash your hands after removing them.
Disposable gloves MUST be worn whenever there is potential or actual contact
with blood, faeces, urine, vomit and other body fluids, and it is West Berkshire
policy that you wear them when delivering all personal care.
Disposable gloves should be changed between “clean” and “dirty” tasks.
NB: Staff should never have contact with open wounds. If a dressing is found to
be badly wrinkled or soiled the District Nurse should be called to come in and
attend to the dressing. Similarly if a new sore or wound is discovered the District
Nurse should be called. You should inform your line manager and in the case of
home carers call the Home Care duty desk.
Gloves should be removed by pulling down the hand from the wrist, and left
inside-out. You should never wash and re-use gloves. Used gloves can be
disposed of in the normal household rubbish – except where the council provides
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special bags for disposal of soiled items as “clinical waste”. (See Guideline 3
about Clinical waste.)
Non-disposable gloves – such as marigold rubber gloves – are to be used for all
household tasks and contact with cleaning agents. They are not usually
disposed of – and should be left clean and dry ready for use. You should wash
your hands after removing gloves.
If you find using gloves seems to make your hands sore – make sure you raise
this with your manager. We are able to provide alternative makes of gloves if
this is found to be necessary.
Personal Care
When giving personal care always use disposable cloths/wipes for washing the
genital area, stoma areas, and for cleaning up any incontinence or body
products. This is to ensure a wash cloth is not later used on the face
inadvertently. You should also use a disposable cloth/wipe if washing any area
of broken skin. As a general principle try to start a wash with the ‘clean’ areas of
the body such as the face, and end the wash with the “dirty” or potentially
contaminated areas such as the genital area. If disposable cloths are not
available, make sure the cloth used on the ‘dirty’ areas is easily identifiable, and
that all flannels and cloths are washed out thoroughly in hot soapy water and left
hanging to dry quickly.
Record and report any breaks in the client’s skin immediately.
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Aprons and Tabards
Disposable aprons are provided as single use items – and should be discarded
after use. Do not re-use these.
You should wear a disposable apron when you are providing personal care – to
protect your uniform or tabard from contamination. You should remove the apron
and dispose of it before doing a “clean” task such as administering medication,
food preparation or feeding a client. Used disposable aprons can be disposed of
in the normal household rubbish – except where the council provides special
bags for disposal of soiled items as “clinical waste” (See Guideline 3 about
clinical waste.)
Home Carers may have tabards made of cloth too. These are not disposable. If
you have a stripey tabard – you should only wear this in a client’s house, and
should take it off when leaving the home, replacing it when you get to the next
household.
If you have a plain green tabard, provided for doing “dirty” household tasks –
such as attending to coal fires, this should only be worn for the duration of the
task. Green tabards are no longer provided to new Home Carers – who should
use a disposable apron instead.
Disposal of Waste
Almost all waste can be disposed of in the household rubbish – even that which
is contaminated by blood or body fluids. Sanitary towels should be bagged and
put into the household bin. Tampons may be flushed down the toilet, unless the
household is not connected to mains sewers (i.e. has a septic tank) – in which
case tampons should be disposed of as for sanitary towels. Nappies should also
be disposed of into normal household waste.
Urine and faeces should be flushed down the toilet in the usual way – but be
careful when undertaking this task and wear a disposable apron and disposable
gloves.
When it has been decided that a situation requires special disposal of this sort of
waste because of an infection risk, a special waste collection will be arranged –
usually known as “clinical waste” or “infected waste” – see below.
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Clinical Waste
A clinical waste collection is usually set up by the waste department of the
council - by either the District Nurse or the Home Care office. All residential
homes have clinical waste bins which are emptied each week on contract. This
waste is collected separately from normal household waste, and is incinerated by
the contractor in special incinerators. You must not burn waste.
Special collecting bags will be provided by the waste department – these are a
distinctive colour – usually bright yellow. Before articles are placed in these bags
they should be bagged in another household bag first for safety. This is referred
to as “double bagging”. Supermarket carrier bags can be used for this purpose
providing they have no holes in them.
You will be told what needs to be discarded as clinical waste – depending on the
circumstances. This may include all materials contaminated with blood or body
fluids, including paper towels, dressings, pads, gloves and aprons. It is
expensive to dispose of clinical waste – so do not use the yellow bags
unnecessarily.
You should remember that the need for a service user to have a clinical waste
collection is a matter to be kept confidential and to be treated with sensitivity.
General Cleaning
It is rare that you need to use special cleaning products. You will usually use
ordinary household cleaning products and will use them in the usual way. Hot
soapy water cleans properly in most circumstances if used thoroughly – and is
even effective against the germ that causes HIV. If it is ever necessary to use
special products such as bleach or alcohol for cleaning you will be instructed
carefully in the use and disposal of such materials.
You must avoid the risk of moving germs from the bath room or toilet into the
kitchen. You should use disposable cloths/wipes/paper towels whenever
possible. If you have to use a cloth – there must be separate cloths for cleaning
in the kitchen, and separate ones for cleaning in the bathroom and toilet. Always
use disposable cloths or paper towels when clearing up any blood or body fluids.
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Crockery and Cutlery
You need take no special precautions in the use of crockery or cutlery – other
than normal cleansing. Clean crockery and cutlery can be safely shared, and
should be handwashed in hot soapy water or in a dishwasher if available.
Laundry
Home care client’s washing is usually done in their own home or in a communal
laundry in some housing complexes, or occasionally the launderette, using the
various wash cycles as appropriate. Washing machines should be well
maintained. Occasionally family may take a service user’s washing to do in their
own home.
If washing of laundry takes place outside of the home or housing complex
normally, you must contact your line manager if an infection is diagnosed that
requires special precautions to be taken with laundry. Alternative arrangements
may have to be made.
There is an incontinence laundry service which can be arranged if normal
arrangements cannot cope with the amount or type of laundry.
You should wear a disposable apron when dealing with laundry, and disposable
gloves if the washing is soiled or contaminated with body products. In all but the
most serious infection situations normal washing on a hot wash (60 - 80 degrees
centigrade) will suffice. Fragile items of clothing that are not shared by others will
need to be washed out in as hot a wash as is possible without damage – check
the wash care label. Residential homes will have their own laundry systems
which will be explained to staff.
If a client is regularly incontinent this should be reported to the district nurse, who
can then arrange to assess the continence needs of the service user and provide
incontinence aids as necessary. These may include Kylie sheets, incontinence
pads, or referral to a specialist nurse.
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For more information about items soiled with blood or body fluids see Guideline 2
below.
On no account should clients’ washing be taken home, since this extends the risk
of cross-infection to your own household. Where there are difficulties you should
consult your line manager.
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Guideline 2 – Blood and Body Fluids
These precautions about blood and body fluids apply to ALL clients and are part
of Universal Infection Control precautions. Treating all blood and body fluids with
care ensures that you are safe whether there is an infection present or not.
Dealing with spillages of blood or body products
Spillages of body products must be cleaned up as soon as possible. You must
wear a disposable apron and disposable gloves. Mop up as much of the soil or
spillage with disposable paper wipes, and dispose of these into the toilet or bag
them and put the bags into the household waste.
Clean the area thoroughly with hot soapy water. Rinse the area with cool water.
Blot the area as dry as possible and leave to dry. Dispose of your apron, gloves
and used wipes, bagging these carefully and putting them into the household
waste.
It is not usually necessary for you to use a bleach solution to clean up blood and
body fluid spillages in the home. When risk assessment has identified a need to
take extra precautions to protect others within the home – you will be trained to
clear up such spillages using commercially produced spillage kits designed
specifically for the purpose.
If the area is likely to cause a hazard to others – e.g. the service user or a later
visitor may slip – do what you can to make the hazard obvious and minimise the
risk.
If an item of clothing or bedding is soiled with body products such as urine or
faeces it should be washed in the washing machine using the hot cycle
(approximately 80 degrees centigrade). Heavy soiling can be wiped away first
using disposable wipes. Dispose of your apron, gloves and used wipes, bagging
these carefully and putting them into the household waste.
In all but the most serious infection situations normal washing on a hot wash (60
- 80 degrees centigrade) will suffice. Fragile items of clothing that are not shared
by others will need to be washed out in as hot a wash as is possible without
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damage – check the wash care label. If in doubt – bag the item, and draw it to
the attention of the householder or their carer if possible – or contact your line
manager or the Home Care office. If you can you should attach a note to the
item to advise where the spillage was on the item, and what it was – to assist the
cleaning company to use the right process. Record what you have done.
If the home has a clinical waste collection you should dispose of all waste items
directly contaminated by blood or body fluids into the clinical waste – double
bagging everything. (See Guideline 1 for information about dealing with clinical
waste.)
Puncture Wounds
Be careful when dealing with anything that could cut you or puncture your skin.
Wrap broken crockery or glassware etc in old newspaper before disposing of it
into the normal household waste. You should do the same with anything else
sharp which may cut another person – such as used razors. You have a duty to
protect the workers who may handle the household waste.
Any accident where the skin is punctured should be treated promptly and
carefully. Free bleeding should be encouraged, and the affected part should be
washed with soap and running water very thoroughly. You should then cover the
injury with an “island” type dressing – one which seals the affected area all
round. You must then notify your line manager or the Home Care office
immediately. Medical advice should be sought about whether anti tetanus or
other treatment is appropriate.
(note: island-type dressings are plasters with a central
gauze strip which is surrounded by sticky plaster – so that
the area is completely sealed when covered.)
Dealing with “sharps” injuries
You should not handle used hypodermic needles or other sharp instruments
which have been in contact with another person’s body fluids. These are known
as “sharps”. The person responsible for the medication is also responsible for
making arrangements for safe disposal of “sharps”, and all service users who use
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needles will be prescribed by their GP a special container to dispose of “sharps”.
This should be kept in a secure place away from children, pets and visitors.
In the event of skin being punctured by a used hypodermic or other sharp
instrument which may have been in contact with another person’s body fluids –
you must attend to the injury immediately.
Free bleeding should be encouraged, and the affected part should be washed
with soap and running water very thoroughly. You should then cover the injury
with an “island” type dressing – one which seals the affected area all round. You
must notify your line manager or the Home Care office immediately that you have
sustained a “sharps” injury. Medical advice should be sought without delay, and
your line manager or the Home Care office will arrange for you to have advice
from the Occupational Health Service as soon as possible. You will also be
required to complete an Incident Reporting Form – which your line manager will
assist with.
Spitting and Biting
Although unpleasant, spitting should cause no particular hazards. Sputum
should be treated as a body fluid when it is being cleared up. Regular spitting by
a client should be notified to your line manager or to the Home Care office – who
may need to complete a FRIAR 1 Incident Reporting Form, and arrange to
discuss with the client or family about management of future behaviour.
Biting should be treated as a sharps injury and notified and managed as above. .
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Vaccination
Vaccination may offer additional protection against Hepatitus B – a blood borne
infection. All Home Carers, short term foster carers, staff working with adults
and children with learning disabilities and those working with other high risk
groups such as those who inject drugs or have lived in large institutions long
term, are expected to have this vaccination – which you arrange via your own
GP. For more detailed information about vaccination see Guideline 9 on
Hepatitis B.
Animals
If you sustain a bite or scratch that breaks your skin from any animal or insect in
the course of your work - you should follow the advice above for a “sharps” injury,
and notify your line manager or the Home Care office immediately.
If you have to clean up animal excrement you should treat it as you would human
excrement. This must also be notified to your line manager or the Home Care
office.
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Guideline 3 – Gastro-Enteritis – Diarrhoea and/or
Vomiting or D & V
There are many conditions which can lead to diarrhoea and/or vomiting (D&V).
Not all are infectious – sometimes certain drugs or overindulgence in certain
foods or alcohol can cause it.
Some infectious causes of D & V can be very infectious indeed and will spread
rapidly between clients if hygiene practice is not excellent. In every case of
diarrhoea or vomiting you should treat all body products with great caution in
case the client you are dealing with is infectious. Good hand washing and use of
disposable gloves and aprons is vital.
Care of a client with Diarrhoea or Vomiting – D & V
Report the case to the GP immediately so that a decision can be made about
whether or not the client needs to go into hospital, and what treatment or
investigations may be needed if the client is to remain at home.
Also ensure you notify your line manager or the Home Care office – as it may be
necessary to re-arrange the work schedule or order of home carers' visits to
reduce the risk of an infection being carried to particularly vulnerable people.
Your hygiene must be scrupulous. You must adhere strictly to guidance about
when to wash your hands and the use of disposable aprons and disposable
gloves.
Remember to get the client to wash his/her hands after toileting and before
handling their food too.
People with D & V can quickly become very dehydrated – which can make older
people very confused and ill. The GP will need to give instruction about what
fluids to give, and when, and may prescribe sachets of sugar/salt solution to help
prevent dehydration. (You can make these up following the written instructions
on the sachets). You should follow GP instructions about fluid intake carefully
and encourage fluids when required.
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Usual routines are for clear fluids only for at least 24 hours, and then gradual
introduction of soft bland foods such as potatoes, bread and dry biscuits in small
amounts. Dairy produce, fruit and foods containing lots of roughage are usually
witheld until symptoms have stopped.
Cleaning
Many of the germs that cause D & V will end up on surfaces which, if not
regularly cleaned, can re-infect the client or cross infect you. When cleaning pay
special attention to toilet and door handles, the arms of commodes, and
anywhere that the client may have touched during toileting.
When people vomit many germs can spread in the air on very fine and tiny
droplets. Thus you also need to keep surfaces around the client clean,
especially if they may later carry food or drink.
If commercially produced kitchen and bathroom cleaners with bleach as an
ingredient are available– use these as appropriate to keep surfaces in the home
clean. Otherwise use hot soapy water and clean frequently.
Ensure all laundry is done on a hot wash (80 degrees centigrade) to ensure
germs are killed in the wash.
Longer term
If symptoms do not improve within a few days the GP should be called again.
Any blood in the vomit or bowel motions should also be reported to the GP
immediately, as should any high temperature or severe abdominal pain.
If other cases of D & V occur in the wider client group, it may become necessary
for Managers to seek advice from the Public Health team to take further
measures to reduce the spread of infection to others.
If you have Diarrhoea and/or vomitting
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If you get D & V you must report this to your line manager or the Home Care
office.
You should not handle food if you are suffering from D & V.
Staff should not return to work until 48 hours after symptoms of diarrhoea and/or
vomiting have resolved.
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Guideline 4 – MRSA (Methicillin Resistant
Staphylococcus Aureus)
We all have millions of ordinary Staphylococcus Aureus or “staph” on our skin –
and it usually does us no harm at all. If ordinary “staph” get through breaks in
the skin it can infect wounds, catheters and thus urine, pressure sores and ulcers
to cause an infection, but this can usually be treated very easily with antibiotics.
MRSA is a form of “staph” that has developed resistance to lots of antibiotics –
so it has become hard to treat when it gets inside the body and causes an
infection.
Many people pick up MRSA on their skin when they are in hospital. If they do not
have a skin break, drip, wound or catheter they may not develop an infection, but
they may still carry the germ home with them on their skin. You cannot see any
signs that they have MRSA on their skin instead of the usual, less harmful,
“staph”. That is why it is vital you always practice good hand washing – as
anyone could have MRSA without you knowing it.
Good handwashing in accordance with the general guidelines will be your best
protection against picking up MRSA yourself, and will prevent you carrying it from
person to person. Keep your hands in good condition, and cover cuts and
abrasions. Avoid the use of harsh antiseptic soaps as this will only make your
hands sore and increase the risk of you picking up MRSA.
Looking after a client with MRSA
You do not need to do anything different if you are looking after a client with
MRSA. If you follow the general guidelines for infection control (see also
Guideline 1) you will do everything possible to avoid picking up MRSA yourself.
Remember you do not have a wound or catheter where the germ could cause an
infection – but others you visit do have.
You only need to wear disposable gloves and a disposable apron when you
would normally do so – it is not necessary to wear gloves all the time, as may be
done in hospital.
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Hot soapy water kills this germ very well. Cutlery, crockery, clothing, bedding and
linen do not present a risk and should be dealt with in the normal way. All laundry
is done on a hot wash (80 degrees centigrade) to ensure germs are killed in the
wash.
MRSA can accumulate in dust – so keeping dust from accumulating by dusting
using a damp cloth will reduce the risk. Home carers should not stock pile
disposable equipment as you cannot take this on to another household if it is no
longer needed.
Sometimes the health service decides it is necessary to treat the client to get rid
of the MRSA – usually because they are at risk of getting the germ into a part of
their body where it could cause a serious infection, or because they may need to
go back into hospital later for more treatment. The GP may prescribe a special
skin wash and cream to apply to the skin creases (damp dark places are where
germs multiply faster). Antibiotic tablets may also be prescribed. The health
service will know when the MRSA has gone when swabs from various areas of
the body show that MRSA has not been found. MRSA can return.
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Guideline 5 - Scabies
Scabies is caused by the tiny mite Sarcoptes Scabei, which live under the skin
where they burrow horizontally – eating the skin as they go and leaving burrows
behind them littered with eggs and dung pellets. They can travel 5 mm per day.
Scabies is passed from person to person through close and prolonged
(estimated to be 10 minutes) skin-to-skin contact – e.g. holding hands. It cannot
be caught through fleeting contact.
Scabies cannot be caught in the general environment. The mite is so tiny and
fragile it cannot survive in the dry air outside the skin – so it cannot be passed on
by handling bed linen or simply being in the household.
Humans are allergic to the dung of the Scabies mite. As the dung pellets break
down and are chemically absorbed into the blood stream - an allergic reaction
begins. This causes widespread itching – not just at the site where the mites
may be – but all over the body - most especially the arms, legs, trunk, and waist,
and is most severe at night.
The client usually becomes itchy 4 – 6 weeks after getting Scabies – but this may
happen sooner if they have had Scabies before.
If the client has a very poor immune system there may be little or no itching –
which can delay diagnosis and treatment and significantly increase the number of
mites present. In these cases the scabies can be much more infectious – due to
the huge number of mites present. They are sometimes known as ‘Crusted
Scabies’.
Caring for someone with Scabies
You should report any cases of suspected Scabies to your line manager or the
Home Care office, and you may be asked to call the GP.
You should wear disposable gloves for skin contact with the client until treatment
has been applied for at least 24 hours.
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Linen and clothing need no special precautions. Contrary to common belief –
bedding, pillows and mattresses do not need to be destroyed or cleansed other
than in the normal way.
Treatment of Scabies
Treatment is by the application of a scabicide lotion to the whole body. It is not
necessary to treat the scalp if there is a healthy hair growth – as the mite cannot
burrow through dense roots, but it is necessary to treat the groin area. Lotion
should be applied to cool skin to maximise absorbtion, and should be left in place
for 24 hours. If it is washed off during care it should be re-applied. Treatment
may need to be repeated 3 – 9 days later, although some treatments only need
one dose.
Remember it is the dung which causes the body to react with a widespread itch –
and so the itch may continue for a week or so after treatment has killed all the
mites.
All people who have had close and prolonged skin-to-skin contact with the client
will need to be treated too. This may include Carers and other people they have
also had prolonged skin-to-skin contact with. The GP or district Nurse will be
able to advise on who needs treatment.
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Guideline 6 – Head lice
Head lice are small six legged wingless insects, the size of a pinhead when they
hatch and the size of a match head when full grown. They are grey or brown in
colour. Female lice lay eggs in sacs which hatch in 7 – 10 days. It takes 6 – 14
days for lice to grow to adult hood – when the reproductive cycle begins again.
Lice are the insects that can be seen moving on, or close to, the scalp. Nits are
the pearly white empty egg shells of head lice that are left stuck to hair shafts
after the eggs have hatched. Nits may still be found even after all the lice have
been cleared. Treatment should only happen if you find living, moving lice.
Head lice spread by clambering from head to head – when two heads are in
close contact. They do not jump, fly or swim, or pass on your hands from person
to person. Anyone with hair can catch them. They are difficult to spot – hiding
when the hair is routinely combed.
The only effective method of detecting head lice is by using a fine toothed
detection comb – preferably on wet conditioned hair. This may detect eggs,
empty egg cases and dead or live lice.
Caring for someone with head lice
You should report any cases of suspected head lice to your line manager or the
Home Care office, and you may be asked to call the GP.
Avoid close head-to-head contact with the client.
Linen, clothing etc. should be washed in a hot wash. No other precautions are
helpful.
Treatment
There are a number of different lotions for use if live head lice are found on finetooth-combing, and these can be obtained over the pharmacy counter. Some
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require that two treatments are done 7 days apart, and others are a oneapplication product which does not require repeating. Treatment is usually
effective 24 hours after the final application.
In every case follow the instructions on the bottle as these do vary from product
to product. Care staff may be asked to apply head lice treatment.
Treatments are changed regularly to prevent head lice becoming resistant to
treatment. There are special treatments available on prescription for resistant
lice.
“Bug busting” – regular fine-tooth-combing on conditioned hair – has been
proven by recent research to be less effective at getting rid of lice than chemical
treatment. Use of Tea Tree oil is also not proven.
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Guideline 7 – Blood borne infections - HIV infection and
AIDS
HIV is a virus (a retrovirus called Human Immunodeficiency Virus), and AIDS is a
syndrome of chronic illness secondary to HIV (Acquired Immune Deficiency
Syndrome). AIDs is characterised by a very poor immune system and the
inability to fight even common infections. HIV is a disease only discovered in the
20th century.
HIV is carried in the blood and body fluids, and is transmitted via sexual contact,
intravenous drug use or by other contact where infected body fluids enter through
a skin break or through the mucous membranes of the eyes, nose, mouth etc.
87% of new infections diagnosed in 2001 were sexually transmitted.
It may take 3 months from when the infection is acquired before detectable
antibodies to HIV can be found. During this period the person is still infectious
however, and can infect others.
There are a number of drug treatments for HIV – which may slow down or even
halt the progression of the disease. To date there is no complete cure for it.
Some people respond well to drug treatment, whilst others find the same drugs
do not work well for them.
People with HIV may go on to develop AIDS later. The time scale for this is
extremely variable – and it tends to take much longer to develop AIDS if drug
treatments for HIV have begun early and have been rapidly effective.
HIV and AIDS carry a lot of social fear and stigma, and it was quickly realised
that we could not identify people with the condition in order to ensure workers
giving social and medical care were aware of the risks and could keep
themselves safe. Instead it was agreed internationally that taking certain basic
precautions with all blood and body fluids from anyone would provide
protection for everyone – and would protect against lots of other diseases too.
These precautions are known as Universal Infection Control precautions –
covered in Guidelines 1 and 2.
In Guideline 1 you will find detail of the precautions you must take with every
client to ensure you are safeguarded against contracting any blood or body-fluid
borne infection.
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In Guideline 2 you will find detail of the precautions you must take when dealing
with body fluid spillages and accidental “sharps” injuries. Following these two
sets of guidance will protect you against acquisition of HIV and AIDS in the
workplace.
Confidentiality
It is expected that all staff will treat any information about the HIV/AIDS status of
any person – staff, colleague or client – as confidential. Any breach of
confidentiality may lead to serious disciplinary action.
There must be good communication between departments to ensure prompt and
appropriate access to services. A co-ordinated approach including health
partners, and other statutory and voluntary sectors is necessary to the provision
of good and flexible services. However, a person's HIV status is medical
information which gives it a special status of confidentiality. It should be shared
on a strictly "need to know" basis. There may be times when knowledge of a
person's HIV status would enhance the service to their benefit. However, if
the service is needed to meet needs that are functional and not uniquely
related to a person's HIV status, (e.g. domiciliary care, personal care, day
and residential care, provision of equipment/ adaptations), a "need to
know" does not exist to access the service.
There is no "need to know" in order to "protect" those involved in care and
treatment of a person living with HIV disease. The general Health & Safety
practices, that should be applied when working with all clients of the
Department, are adequate to remove any risk of infection.
Any client, carer, employee of the Department, or a service provider used by the
Department might have chosen not to ascertain their HIV status. It follows that an
individual might be HIV+ without knowing, therefore, arguments for sharing HIV
information cannot be justified on the grounds of reduction of risk to others. On
the contrary, an expectation that such information would always be shared could
engender a false "sense of security" and result in lapses in good practice.
Other information
See the HIV Confidentiality Policy for further guidance and case examples.
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The HIV and AIDS Policy gives further detailed advice about the legal position in
relation to HIV/AIDS and guidance for staff working with specific client groups,
together with useful local and national contact numbers and addresses.
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Guideline 8 – Blood borne infections – Hepatitis B and
other forms of Hepatitis
Hepatitis is a serious disease of the liver caused by a number of different viruses.
These are named after the first letters of the alphabet – A, B, C, D, E and G. The
virus causing Hepatitis B is known as Hepatitis B virus, or HBV; that causing
Hepatitis A is known as HBA, etc.
Hepatitis B is the most serious of these diseases. Hepatitis A and C are more
common than Hepatitis B, but much less serious. The other types of Hepatitis
are less common in Britain. All of these infections are carried in the blood and
can be transmitted via blood or body products.
HBV is passed through exposure to infected body fluids – mainly blood and blood
products. HBV is spread like HIV – the virus which causes AIDS – but HBV is
much more infectious, needing only a tiny fraction of a drop of blood to transmit
the disease. Thus it can be caught from sharing a toothbrush or kissing when
there is bleeding of the gums. Obvious risks are from sharps injuries, uncovered
scratches and cuts which come into contact with infected body fluids, bites and
wounds if an infected person becomes violent.
HBV is not passed through casual contact or through the air, and so is not
passed through shaking hands, breathing, coughing, sneezing or using the same
toilet seat.
Symptoms of HBV
Symptoms are usually flu-like and include: Fatigue, loss of appetite, mild fever,
aching muscles and joints, nausea, vomiting, diarrhoea, changed sense of taste
and smell, tenderness in the upper abdomen.
Some people may also have yellowing of the skin and whites of their eyes
(jaundice), itching skin, darkened urine, light coloured faeces.
Many people have no symptoms, but are still infectious. As many as one half of
all people with HBV have no symptoms.
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Symptoms appear gradually, if at all. They may appear 6 weeks to 6 months
after exposure, and may last weeks or months. An infected person can infect
others for about 4 – 6 weeks before symptoms appear, and for an unknown time
after.
About 1 in 10 people with HBV become a chronic carrier – which is especially
common among those who have shown no symptoms. Chronic carriers are
permanently infectious, and may suffer serious liver damage including cirrhosis
and cancer of the liver.
Protection against HBV
In Guideline 1 you will find detail of the precautions you must take with every
client to ensure you are safeguarded against contracting any blood or body-fluid
borne infection.
In Guideline 2 you will find detail of the precautions you must take when dealing
with body fluid spillages and accidental “sharps” injuries. Following these two
sets of guidance will protect you against acquisition of HBV in the workplace.
Departmental Policy on HBV – Information and Vaccination
It is the policy of West Berkshire Council that staff should be fully informed in the
work setting where risk of contracting Hepatitus B is increased. These are
determined as staff working with adults and children with learning disabilities, and
those working with other high risk groups of service users such as those who
inject drugs or those who have lived in large institutions long term. We also
recommend that all Home Carers are vaccinated against HBV.
Staff should request vaccination from their GP. If a prescription charge is made
this will be re-imbursed by the department on receipt of a re-imbursement slip.
Vaccine is safe and effective – and there is no risk of HIV or HBV from the
vaccine. A series of 3 injections in the arm are given at your GP surgery over a
course of 6 months, followed by periodic blood tests and booster shots as
needed. A booster is usually recommended after 5 years.
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We keep records about the immunisation status of staff, but it is your
responsibility to ensure your vaccinations are kept up to date. All staff records
are kept secure as confidential records.
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This information and guidelines have been drawn up from:
The Guidance on Infection Control for Community Care in Thames Valley –
written jointly by the health protection teams in Public Health in Berkshire,
Oxfordshire and Buckinghamshire. Guidance dated November 2002.
Additionally the draft information and guidelines benefited from the advice and
input from the Consultant In Communicable Disease Control for Berkshire.
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