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This publication is available at https://www.gov.uk/government/publications/infection-prevention-and-control-in-adult-social-care-settings/infection-prevention-and-control-resource-for-adult-social-care

This guidance applies from 4 April 2022.

This resource contains general infection prevention and control (IPC) principles to be used in combination with advice and guidance on managing specific infections. It is for those responsible for setting and maintaining standards of IPC within adult social care in England.

Adult social care is a broad term covering a wide range of activities, outside of NHS-provided services, which help people who are older, living with disability or physical or mental illness, or people with a learning disability to live independently and stay well and safe.

Preventing and reducing the transmission of infectious diseases is essential to ensuring people stay healthy. People who have contact with social care should have confidence in the cleanliness and hygiene of services and services provided. Not all the contents of this resource will be applicable to every situation or type of care and support. This resource should be used as a guide in the practice of adult social care, to ensure people receive person-centred support that follows effective IPC measures.

Antimicrobial resistance is a global problem that makes infections harder to treat with existing medicines. High standards of IPC reduce the opportunities for infections to spread and for resistance to develop.

The term ‘pathogen’ is used throughout to describe microorganisms or germs which can infect people and cause disease. Within this resource, the terms ‘people’ and ‘person’ are used to describe anyone drawing on adult social care or support. The term ‘worker’ is used to describe anyone providing adult social care or support. Unpaid carers are family and friends who provide care to loved ones. Information within this resource may be useful to unpaid carers.

IPC practices should be based on person centred care and the best available evidence and guidance – see appendix 1 (below) for further information. This document does not replace any clinical or public health advice. The information within this resource draws upon several sources including the National Institute of Health and Care Excellence (NICE), NHS, government departments and professional regulators. Providers registered with the Care Quality Commission (CQC) must comply with the regulations and consider the Code of Practice for the prevention and control of infections in the delivery of their services.

Understanding how infection is spread is crucial for effective IPC. The chain of infection contains 6 links. There are opportunities to break the chain at any link, and the more links that are broken the greater the protection.

A pathogen is the microorganism or germ that causes disease. For example, norovirus can cause diarrhoea and vomiting, or the influenza virus can cause flu.

A reservoir is where pathogens live and replicate. For example, this could be a person, the environment or food and drink.

A portal of exit is how pathogens leave the reservoir. This could be through coughs and sneezes of someone with a respiratory illness such as flu, or through the faeces or vomit of someone with gastroenteritis (diarrhoea and vomiting).

A means of transmission is how pathogens are moved from one person or place to another. This could be from one person’s hands to another person, through touching a contaminated object, through the air, or contact with blood or body fluids.

A portal of entry is how pathogens enter another person. This could be by inhalation, through mucus membranes (linings of the nose and mouth), or via a wound or invasive device such as a catheter.

Susceptible host is the person who is vulnerable to infection. This could be for a variety of factors such as age, lack of immunity, or underlying health conditions.

Table 1: examples of breaking the chain

Assessing a person’s risk of catching or spreading an infection and providing them with information about infection is essential in supporting safety.

An assessment of a person’s risk of infection should be carried out before they start using the service and should be kept under review for as long as they use the service. The assessment should contribute to the planning of the person’s care and should determine whether any extra IPC precautions are required, such as whether they need to isolate or whether workers need to wear additional personal protective equipment (PPE). The assessment should include all factors which place the person at a higher risk of catching or spreading infection and may include:

The hierarchy of controls is a system used to reduce risk at work. See the Health and Safety Executive’s (HSE) toolkit on management of risk when planning work: the right priorities for further information.

The hierarchy of control principles can be broadly interpreted for social care settings under the following headings:

These controls are ranked in the order of effectiveness. PPE is the last control in the hierarchy, used when all other controls have not reduced the risks sufficiently. To be effective, PPE must be used correctly – for example, putting it on and removing it correctly and safely. This relies on individual compliance, which is considered less reliable as a way of reducing risk.

Public health measures such as vaccination, testing and isolation help to reduce the risk of infection. Vaccination against respiratory illnesses such as flu and COVID-19 is an important measure in reducing the risk of severe disease. Measures such as not coming to work when ill, advising people to isolate while infectious and recognising and reporting infections promptly, all help to prevent infections spreading at work.

When faced with a particular risk, such as an outbreak, we may need to change what we do. This might include reducing communal activities, limiting visiting, or adding disinfection into a more frequent cleaning schedule, for example.

We may not be able to change where we work but the work environment can be made as safe as possible. For example, by improving ventilation, ensuring fixtures and fittings are in good repair and can be easily cleaned and following water safety guidelines, we reduce opportunities for pathogens to survive in the environment.

Changing the way we organise work can reduce risk. Examples include reducing the number of people in a space at any one time and minimising the movement of staff between different settings. Administrative controls such as risk assessments, training, audit, and providing clear signage and instructions also help to reduce the risk of infection at work.

To ensure safety, standard infection control precautions (SICPs) are to be used by all workers for all people whether infection is known to be present or not. SICPs are the basic IPC measures necessary to reduce the risk of spreading pathogens.

These basic IPC measures are:

Sources of infection include blood and other body fluids, secretions or excretions (excluding sweat), non-intact skin, or mucous membranes, and any equipment or items in the environment that could have become contaminated.

The application of SICPs is determined by assessing risk to and from people. This includes the task, level of interaction, and/or the anticipated level of exposure to blood and/or other body fluids.

Hand hygiene is a way of cleaning hands that reduces potential pathogens on the hands. To be successful, hand hygiene needs to be performed at the right time, with the right product, using the right technique and making it easy to perform.

The World Health Organization (WHO) describes ‘moments’ for workers to practice hand hygiene:

WHO hand hygiene poster – your moments for hand hygiene: residential care.

There are other situations where hand hygiene should be performed including:

The hand hygiene product should be appropriate to the situation. Alcohol-based handrub should be used, except in the following circumstances when liquid soap and water must be used:

Alcohol-based handrubs must have a minimum alcohol concentration of 60% and conform to the British Standard BS EN 1500:2013. Alcohol-based handrubs are harmful if swallowed and are flammable so their use must be risk assessed.

Alcohol-based handrubs should be applied using the correct technique which involves applying the solution, rubbing hands together vigorously ensuring solution contacts all surfaces of the hand until the solution has evaporated.

When washing hands, workers should:

Hands should be washed using the correct technique:

Best practice hand wash poster

An emollient hand cream should be applied regularly to protect skin from the drying effects of regular hand hygiene. Communal tubs of hand cream should not be used. If a particular soap or alcohol product causes skin irritation a clinician should be consulted.

Make hand hygiene safer and more effective when providing personal care:

Good respiratory hygiene reduces the transmission of respiratory infections. Being alert to people with respiratory symptoms is important as this may indicate infection.

To help reduce the spread of infection:

Catch it, bin it, kill it poster

Assess the use of PPE considering the likelihood of exposure to blood, body fluids, secretions or excretions, risks associated with the procedure and risk of transmission of pathogens to the worker.

PPE should always be used when assessed as necessary to reduce the risk of transmission of pathogens and other risks associated with care tasks. PPE is the last element of the hierarchy of controls and used only when all other controls are considered insufficient to manage the risk of infection.

If it is not removed at the right time PPE can spread infection between people and wearing unnecessary PPE impacts on worker comfort, increases costs, and has adverse environmental impacts. The use of PPE should therefore be based on a risk assessment approach. When unsure what PPE is suitable in certain situations, advice can be sought from regional IPC teams.

Store PPE close to the point of use, if possible, and in a clean, dry and covered container or dispenser. When determining where to store PPE, take into account practicality and ease of use, as well as the safety of the people you are caring for. This may include storing PPE in lidded containers or dispensers. PPE should never be stored on the floor. For workers supporting people in their own home, arrangements may include storing in a dry, clean area protected from dust – for example, in sealed containers in the person’s home (with their permission and if safe to do so) or in sealed containers in the worker’s vehicle.

PPE is single use unless identified as reusable by the manufacturer, in which case it is important the instructions for decontamination are understood and followed.

Perform hand hygiene before putting on and after taking off PPE.

Change PPE if damaged or contaminated following the correct order for putting on and taking off (donning and doffing). All used PPE must be appropriately disposed of following local procedures for disposal of infectious waste.

Quick guide for putting on and taking off standard PPE

In assessing the need for gloves and the selecting the type of glove, consider the risks to the person and the worker. For example, polythene gloves should not be used for personal care or where there is a risk of exposure to body fluids.

Gloves are not an alternative to hand hygiene, and should generally not be worn except when a specific care task requires them.

Wear gloves for care tasks involving contact with non-intact skin, or mucous membranes, and all activities where exposure to blood, body fluids secretions or excretions is anticipated – such as dressing wounds or carrying out personal care. Gloves should be worn when applying topical creams or medications which might be absorbed into the skin of the care worker applying them.

Gloves should also be worn when handling chemicals as recommended by a Control of Substances Hazardous to Health (COSHH) assessment, for example when handling cleaning products which may cause irritation. See HSE advice on carrying out COSHH assessments.

An aseptic procedure is a technique to prevent the transfer of pathogens from a contaminated area into a sterile area in the body. Wear sterile gloves for aseptic procedures and when inserting invasive devices such as urinary catheters.

Ensure gloves used for direct care are single use, fit for purpose and well fitting. Put them on immediately before the care activity, and change gloves between different care activities for the same person (for example, between continence care and oral care).

Dispose of gloves following infectious waste policy after and between caring for different people and between different care activities for the same person – for example, after helping a person to use the toilet and before helping a person to brush their teeth, and before contact with other items such as door handles. This will prevent the spread of pathogens within the environment. Do not decontaminate and reuse gloves.

Perform hand hygiene following removal of gloves, as the integrity of gloves is not guaranteed and hands may become contaminated during their removal.

The table below provides advice on when different types of gloves could be used. There is also advice from HSE on what to consider when choosing gloves.

Latex gloves are not routinely recommended due to the risk of latex allergies or sensitivities among the workforce and people receiving care. Where providers wish to use latex gloves, they should ensure they are low protein and powder free and follow the HSE advice on selecting latex gloves.

Wear plastic disposable aprons when there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions. This could include activities such as personal care or handling dirty laundry.

Use plastic disposable aprons for one procedure or one episode of care. Gowns should be worn where there is a risk of extensive splashing of body fluids and aprons would provide insufficient cover.

Dispose of aprons when contaminated, after the completion of the care activity and between care of different people.

Type IIR fluid-repellent surgical masks protect the wearer by providing a fluid repellent barrier between the wearer and the environment. They provide additional protection from respiratory droplets.

Consider wearing fluid-repellent type IIR masks where there is a risk of splashing of blood or body fluids into the worker’s nose or mouth. These should be well-fitting and cover the nose, mouth and chin and should not be touched when worn. Type IIR masks should be worn when carrying out aerosol-generating procedures (AGPs).

Fluid-resistant type IIR masks should not be worn for longer than 4 hours. They must be disposed of after the episode of care is completed, when damaged or when the mask becomes moist. Care workers should move to a safe area to remove the mask. For additional advice on the use of masks specific to COVID-19, see the COVID-19 supplement.

Respiratory protective equipment (RPE) is a type of PPE designed to protect the wearer against airborne hazards. The most commonly used RPE in social care settings is the Filtering Facepiece Class 3, also known as an FFP3.

RPE is not routinely necessary and is used in a limited number of situations where respiratory protection is needed. If someone receiving care has a pathogen which requires care workers to use RPE, their primary care provider should advise on this.

There are specific legal requirements when using RPE including fit testing and fit checking. The organisational responsibility for the risk assessment of care activity is covered by Health and Safety regulations.

RPE may be considered if there is a significant risk of exposure to infectious airborne particles that cannot be mitigated by the application of other control measures. All other control measures to reduce risk must be applied before considering RPE.

RPE may be recommended for use in social care settings when undertaking AGPs where there is a risk of infection or more broadly in response to a novel infection spread through the airborne route. A risk assessment in response to a novel airborne infection would need to consider:

On its own, RPE will not provide total protection and should only be used when a risk assessment indicates this is an appropriate action for the care task, the client, the care worker and the environment. Not many people would willingly want to wear RPE for any length of time as it can be uncomfortable to wear. HSE provides further information as to why RPE is referred to as the last resort in terms of protection.

Additional guidance will be issued if a novel infection requires routine use of RPE, but care providers may wish to consider how they would react to this need, such as how they would arrange or access fit testing for workers.

Further information on respiratory protective equipment is on HSE’s website

Consider wearing eye protection such as goggles or visors where there is a risk of blood or body fluids splashing into the worker’s eyes. Do not touch the eye protection when wearing. Decontaminate reusable eye protection in accordance with manufacturer’s instructions and store safely.

Regular spectacles do not provide sufficient protection. Visors may offer greater comfort for those who wear spectacles.

Table 3: the recommended PPE that should be used as standard precautions

For people with an infectious illness, follow the above principles and any additional advice for the specific infection.

Pathogens may be transferred between people through the use of care equipment if it is not properly stored and cleaned, including consideration to how equipment is safely transported between people’s homes, so it does not become contaminated.

Reusable care equipment must be decontaminated after each use. It must be clear who is responsible for decontaminating the equipment, the frequency, and method of decontamination which conforms with the manufacturer’s instructions.

Poorly maintained equipment can also increase the risk of infection. Care equipment should be standardised wherever possible and be stored to ensure it does not become contaminated, including during transport between people’s homes. It is easier for staff to clean and safely use equipment they are familiar with.

There are 3 categories of decontamination processes:

The choice of decontamination process for reusable care equipment depends on the assessment of risk. Risks fall broadly into 3 categories: high, medium and low.

A device designated as single use should not be re-used as this can affect safety, performance and effectiveness, exposing people to unnecessary risk. Anyone reprocessing or reusing devices designated as single use bears the full responsibility for its safety and effectiveness.

A single-use device should only be used on an individual person during a single procedure, and then safely disposed of. It is not intended to be used again, even on the same person.

These items are intended to be used by only one person for a limited number of uses. They must not be used by different individuals. Follow the manufacturer’s instructions regarding re-use and decontamination.

It is important those carrying out cleaning duties understand their responsibilities as required under the Health and Safety at Work etc Act 1974 and associated regulations including COSHH. Workers should be provided with the PPE required to safely undertake cleaning tasks. See HSE advice on carrying out COSHH assessments.

Where cleaning is the responsibility of the worker it is important all understand their responsibilities such as:

For further advice on cleanliness in care homes, see national specifications for cleaning in care homes.

Ventilation is an effective measure to reduce the risk of some respiratory infections, by diluting and dispersing the pathogens which cause them. Open windows and vents more than usual – even opening a small amount can be beneficial.

Opening high level windows is preferable to low level windows where there is a danger of creating draughts and causing discomfort. Where the room has multiple windows, it is usually possible to create a more comfortable environment by opening all windows a small amount rather than just one a large amount.

Opening windows on different sides of a room will allow greater airflow. Where possible, opening external doors can improve ventilation. However, this may present security and safety issues, so would need proper consideration and risk assessment.

In care establishments, removing window restrictors is not advised due to safety and security issues. Keeping internal doors open may increase air movement and ventilation rate. However, it is important that fire doors are not kept open, unless fitted with approved automatic closers. Internal doors should be kept closed if a client is being cared for in isolation where there is a risk of infection to others.

Where refurbishment or new builds of care with accommodation services are planned, the risk of infection should be considered in the design, alongside creating a homely environment. Considerations should include:

People are supported in a variety of different environments, and workers have differing degrees of control and responsibility for the management of laundry depending on the setting.

It is important to ensure workers have the required information in relation to laundry management that is appropriate to the setting within which they are supporting people.

The key principles for safely handling laundry are:

There are 3 categories of laundry:

Store clean linen in a clean, designated area, preferably an enclosed cupboard.

All dirty linen should be handled with care, and attention paid to the potential spread of infection. Within a care home, place used laundry in an impermeable bag immediately on removal from the bed, or before leaving the person’s room. Place the laundry receptacle as close as possible to the point of use, for immediate laundry deposit.

Handle used laundry safely by wearing a single use or washable apron to protect your clothing if necessary. Avoid:

Infectious laundry includes laundry that has been used by someone who is known or suspected to be infectious and/or linen that is contaminated with body fluids.

Seal infectious laundry in a water-soluble bag (appropriate for the washing machine used) immediately on removal from the bed, and then place this within an impermeable bag.

Place water-soluble bags containing infectious laundry directly into the washing machine without opening the bags.

Use separate containers for transporting clean laundry, and used or infectious laundry, and wash infectious laundry separately.

Clean hands between handling different categories of laundry.

Where workers are responsible for laundering the clothing of a person with an infectious illness, these should be laundered at the highest temperature possible recommended by the manufacturer. For delicate items of infectious laundry consider using a laundry bleach or alternative laundry disinfectant. Heavily soiled items should have a pre-wash cycle or sluice cycle selected where available.

Within care homes, consider processes that will help ensure dirty laundry will not contaminate clean laundry. Consider having a dirty to clean flow system in laundry rooms so clean and used laundry are physically separated and ensure hand washing facilities are available where possible to do so.

A spillage is an accidental escape of substances into the environment. Blood and body fluids may contain a high number of pathogens.

In the event of a spillage of body fluids, keep people away from the area until removed.

Spillages of blood and other body fluids may spread infection and must be cleaned immediately.

Consideration as to what is being cleaned will guide the choice of product and approach to cleaning. Chlorine releasing agents must not be used directly on a urine spill.

Use and store products safely following the manufacturer’s instructions.

Waste management is important to ensure waste does not pose a risk of injury or infection. In addition to safe working practices, appropriate management of waste has additional benefits in terms of cost and lessening the environmental impact of waste.

People are supported in a variety of different environments and workers have differing degrees of control and responsibility for the management of waste. All workers responsible for management of waste should understand how to segregate and store waste before collection or disposal according to the hazard.

There are several types of waste including recycling, household, offensive or hygiene, infectious, sharps and medicines. Where any doubt exists as to the classification of waste, the local authority or the Environment Agency should be consulted.

An assessment of how waste will be disposed of will include:

Health Technical Memorandum (HTM) 07-01 is a useful guide to assist with waste management.

In care homes typically, waste bags are colour coded. However, waste contractors may operate a different colour coding system.

Black – general or household waste.

Yellow with black stripe – offensive waste.

Yellow – infectious waste contaminated with medicines and/or chemicals.

There should be a plan to minimise the risk of exposure to potential pathogens. Examples of exposure include sharps injuries, human bites, failures in PPE, splashing of blood or body fluids into eyes. Where sharps are used a risk assessment should be carried out, and a safe system of work developed. Sharps should not be passed directly from hand to hand.

Needles must not be bent, broken, dissembled or recapped, and should be disposed of by the person generating the sharps waste into a sharps container.

Sharps containers must be located in a safe position which reduces the risk of spillage. Containers should be taken to the point of use, and the temporary closing mechanism used when not in use.

Only sharps waste should be disposed of in a sharps container, and it must not be filled above the fill line.

If an incident occurs, such as a staff member is injured by a sharp object, or there is a risk of contamination, medical attention should be sought without delay, and there should be an immediate assessment of any exposure. Immediate actions should be taken to reduce risks, including reporting the incident to an appropriate person.

Investigation to understand the circumstances of the incident should be undertaken and any identified actions to prevent similar incidents should be taken. Sharps handling should be eliminated or reduced, and approved safety devices used where appropriate.

HSE guidance on how to deal with an exposure incident

Vaccination is an important component of good IPC. Vaccinations protect people against vaccine preventable infectious diseases, including respiratory diseases. Staying up to date with recommended vaccinations including booster and seasonal doses, helps reduce risk from these infections.  

People working in adult social care, and people receiving care, are encouraged to make sure they receive the vaccinations they are eligible for. Providers should undertake risk assessments to ensure the safety of people who receive care and workers wherever possible

The Green Book has the latest information on vaccines and vaccination procedures for vaccine preventable infectious diseases in the UK.

Antimicrobial resistance (AMR) is a global problem that impacts all countries and people.

AMR arises when pathogens evolve to survive treatment. Once standard treatments are ineffective, it is easier for infections to persist and spread. The UK’s ambition is to reduce the burden of treatment resistant infections, and improve the use of antibiotics.

Taking antibiotics when you do not need them means they are less likely to work in the future. Not all infections need antibiotics and many mild bacterial infections get better on their own. Antibiotics do not work for viral infections such as colds and flu, and most coughs and sore throats.

When there are indications a person may need antibiotics, the following should be considered:

People with non-intact skin or an invasive device (such as urinary catheter, vascular access device or enteral feeding tube) are at increased risk of infection.

Evidence-based clinical guidelines for wound management and management of invasive devices should be followed. Specific training to ensure competency is needed for those supporting people with invasive devices or wounds.

People and their family members or carers (as appropriate) should be supported in understanding and applying safe management of invasive devices or equipment, including techniques to prevent infection where this is appropriate to do so.

Decisions should be reviewed regularly by a clinician. People with invasive devices or wounds should have a documented plan of care, providing detailed guidance as to the care and management and monitoring for infection.

Accurate and complete records should be kept regarding the care and maintenance of any device.

Manufacturers’ instructions for use, storage and changing intervals must be followed.

The NICE guidance on healthcare-associated infections: prevention and control in primary and community care provides further useful information on long-term urinary catheters, enteral feeding and vascular access devices.

People have contact with multiple health and social care services. Appropriate provision of information regarding a person’s infections not only ensures they receive the appropriate care and support, but also assists others in their risk assessments to ensure that other people are protected from any risk of infection.

It is important that services and workers are aware of any infections the person has, and are aware of the signs of infection, particularly in older people – for example, fever, diarrhoea or vomiting, unexpected falls and confusion – so that the appropriate care and support can be provided and to ensure continuity of care.

Providing the information in advance of the person using a health and care service allows that service to risk assess and plan the person’s care.

It may be appropriate to delay a person attending a particular appointment if they pose a risk of spreading an infection. This decision should be made by the professional providing the service, who will also consider the urgency of the appointment and the needs of the person.

If a person is being admitted to a service it is important that their medicines, including any antibiotics, are transported with them.

Standard precautions alone may not be sufficient to prevent the spread of infection. There is a need to assess any additional measures needed when a person is suspected or known to have an infection. Additional precautions are based on:

Identifying people who have an infection, and the pathogen causing it, is essential to ensure appropriate support is provided to minimise the risk of spreading it to others.

Be alert to people experiencing symptoms of infection, or exhibiting any changes in their usual behaviour. Be curious if more than one person is experiencing similar symptoms – this may indicate spread, even where the people have no obvious links. Consider who may need to know this information, for example the health protection team, primary care network, social care providers and local infection control team.

Reducing opportunities for infection to spread can be achieved by minimising contact with the person during their infectious period.

Workers who have a confirmed or suspected infection which can be spread to others should not work until they are no longer at risk of passing on infection to others. This will require an individual assessment of the pathogen causing the infection and the individual circumstances.

People should continue to be supported while infectious, but the arrangements for their care will be different. People may be encouraged to minimise contact with others or be isolated and staff may wear different PPE equipment.

Extra precautions are categorised according to the way the pathogen spreads, noting that some pathogens are spread by multiple routes. The 3 categories are:

These categories help identify the additional precautions which may include isolation and additional PPE depending on the pathogen.

See the section on RPE above.

The aim of isolation is to prevent spread of infection to others. How this aim is achieved will differ depending on the setting the person is in.

During their infectious period, the person should be encouraged to remain in one area, usually their bedroom to reduce the risk of spread to others in their household or care home. People can find it difficult to remain isolated. Where they have the desire and feel able, opportunities to access outside space should be provided. Consideration should be given to distancing measures and restricting mixing with people susceptible to infection, depending on the pathogen causing the infection.

Extra cleaning of isolation areas should be considered. Ideally this area will have its own toilet and washing facilities – where this is not possible, consider a routine for use and cleaning communal or shared facilities. Consideration should be given to any additional PPE.

Workers need to be aware of the person’s infection and how they should be supported. Workers should be aware of signs of infection in their clients, for example fever, diarrhoea or vomiting, and the more atypical signs in older people such as unexpected falls and confusion. Ensure people’s nutrition and hydration are maintained, and additional checks by staff may be required.

Arrangements should consider the additional time required to provide psychological support. The person should be involved in the decision regarding isolation, and a plan to address psychological isolation formulated. Consideration should be given to capacity and understanding of the need to isolate. People may become disorientated and anxious, and need reassurance and to be provided with information.

In residential settings, people should be supported to continue seeing their friends and family wherever possible. This could include enabling visits to take place within the person’s private room and providing visitors with information and support to comply with any additional IPC measures such as increased handwashing or the use of additional PPE.

Consideration should be given to having a smaller number of workers dedicated to supporting the person during their infectious period.

The decision to stop isolation should be assessed and decided based on individual factors. For example, those who are immunocompromised may shed pathogens for a longer period. Advice from clinicians or infection control teams should be sought as necessary.

It is important to recognise potential outbreaks promptly, and to implement control measures as soon as possible, to prevent further cases. An outbreak is defined as 2 or more linked cases of the same (confirmed or suspected) infection occurring around the same time and associated with the service or location.

It is important to identify people with signs and symptoms of illness even if they have not yet reported feeling unwell. This may include staff.

An outbreak management plan should be in place, detailing the actions that should be taken in the event of an outbreak.

Inform others of the outbreak or suspected outbreak and obtain any support and advice. This may include:

Once an outbreak has been identified, the care providers should review their outbreak plan to ensure the control measures are appropriate for the pathogen causing the outbreak, those at risk, and the management of the environment.

Workers must follow professional advice from health protection teams or infection control teams to control the outbreak and support those infected, ensuring any recommended specimens are collected as directed and without delay.

Workers should receive information regarding the outbreak, including signs and symptoms of infection, who is affected, and the necessary controls.

Increased monitoring of infection control practices should be implemented to ensure high standards of infection control practice are being maintained to bring the outbreak under control.

Enhanced monitoring of signs and symptoms of all people should be implemented to quickly identify potential spread. Any suspected or new cases should be encouraged to isolate for the duration of their infectious period and referred for clinical review as appropriate.

Workers should be alert to any deterioration in the person’s condition and refer for clinical advice as appropriate.

Workers should be excluded from work if experiencing signs or symptoms of infection. Staffing requirements should be reviewed including contingency planning.

Cleaning arrangements should be reviewed and amended as necessary, considering the efficacy of the products used and frequency. Waste management procedures should also be reviewed if larger quantities are expected to be generated.

Sufficient stocks of PPE, hand hygiene products, and paper products such as tissues and toilet tissue should be available and conveniently located.

Consider the use of shared areas, and whether distancing measures need to be increased.

Consider whether arrangements for visits in and out need to be modified following a risk assessment, and whether it is appropriate to admit new people to the service during the outbreak. Contact with relatives and friends is fundamental to care home residents’ health and wellbeing. The right to private and family life is a human right protected in law (Article 8 of the European Convention on Human Rights).

There should be a clear decision on when the outbreak is over and when additional infection control measures are no longer needed. Other professionals, such as health protection teams or outbreak management teams may be involved in this decision.

Consider reviewing the outbreak to identify areas of outbreak management which went well, what was challenging and what has been learnt to inform future practice. Review the outbreak management plan in light of this learning.

Guidance on specimen collection, supplies of containers, and transport requirements should be obtained from the local laboratory supplying the diagnostic service. This should be done with consent of the person, and in line with relevant guidance.

All specimens should be safely contained in an approved leak proof container, which should be provided by the healthcare provider requesting the test. This should be enclosed in another container, commonly a sealable polythene bag. The request form should be placed in the side pocket of the polythene bag, and should not be secured with clips or staples as these may puncture the bag.

Care should be taken to ensure the outside of the container and the bag remains free from contamination with blood and other body fluids.

The request form should be completed fully along with the label on the specimen container. This includes the person’s identifier, date and time the sample was taken, the test required and relevant clinical details.

Specimens to be sent by post must be in an approved Post Office container surrounded by absorbent material. The specimen must be sent by first class post.

Specimens should be transported directly to the testing laboratory as soon as collected. Where this is not possible, appropriate arrangements for storage must be made to ensure the viability of the sample.

Creating a culture where everyone is empowered to speak up and be receptive to feedback about IPC behaviours has positive impacts on safety. Organisations with strong visible leadership, and exemplary role modelling from managers and team leaders, usually achieve excellence in IPC.

In regulated services, registered persons have legal obligations in relation to the prevention and control of infections as detailed in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

CQC must take the code of practice on the prevention and control of infections into account when making regulatory decisions. By following the code, services will be able to show how they meet regulatory requirements as well as implementing best practice.

In each regulated care service there should be an identified lead with the knowledge and skills who takes responsibility for IPC.

Arrangements for IPC should include:

An annual statement should be produced by registered services which includes:

Promoting IPC is effective in supporting high standards in IPC. Several resources are nationally available to support promotion, such as Skills for Care’s Every Action Counts toolkit.

IPC champions have been advocates for promoting good infection control practices and driving local initiatives. Champions networks have been developed locally, nationally and within provider organisations.

Training and education are essential to protect people from the risks of infection, along with maintaining competence in applying the principles of IPC. Each care service should have a policy which sets out the training required and the frequency, along with how ongoing competency will be assured.

Usual topics included in IPC training include:

A number of organisations provide support and advice for IPC training and education, both nationally and regionally. Commissioners and the local integrated care system will have details of local arrangements. Nationally, Skills for Care and the Social Care Institute for Excellence provide resources.

Social care is delivered in multiple different environments, including people’s own homes, and workwear should be appropriate to the relevant environment. All workwear and uniforms should be clean and appropriate for the role and environment.

When providing direct, hands-on care, workers should be ‘bare below the elbows’ (see earlier section on hand hygiene for details). Long hair should be tied up and off the collar. If wearing a head scarf, it should be unadorned and tied neatly. Lanyards and neckties should not be worn during personal care.

Workers should wear clean clothes at the start of each shift, and change immediately if clothes become visibly soiled or contaminated. To enable this, workers may wish to consider storing spare, clean clothing at their workplace or in their vehicle.

To avoid risk of injury, workers should not carry pens, scissors or other hard or sharp objects in the pockets.

All elements of the laundry process contribute to the removal of infectious agents from fabrics. The washing process includes use of detergent, agitation and rinsing.

Uniforms and workwear should be washed at the hottest temperature the fabric will tolerate. Heavily soiled items should be washed separately to eliminate the risk of cross contamination.

Residents’ contact with relatives and friends is fundamental to wellbeing. Further details regarding visiting arrangements during the COVID-19 pandemic are included in the supplement.

‘Your moments for hand hygiene’ poster

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes hand hygiene, hand hygiene products and skincare

Hand hygiene: why, how and when?

COVID-19: infection prevention and control (IPC) guidance – handrub technique poster and hand wash technique poster.

Catch it, bin it, kill it

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes cough etiquette

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes aprons, gloves and face protection.

COVID-19: personal protective equipment use for non-aerosol generating procedures – includes guide to putting on and taking off PPE.

Single-use medical devices: implications and consequences of re-use

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes management of patient care equipment

National Resource for Infection Control (NRIC): national specifications for cleanliness: care homes

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes safe management of the care environment, and linen)

NICE care home quick guides

NICE, Healthcare-associated infections: prevention and control in primary and community care

NHS England, HTM 01-04: decontamination of linen for health and social care

HSE, COSHH essentials for service and retail publications, (including SR4 – manual cleaning and disinfecting surfaces)

NHS England, Health Building Note 00-09: infection control in the built environment

The Academy of Medical Sciences, COVID-19: looking ahead to winter 2021-22 and beyond

The Chartered Institution of Building Services Engineers, Emerging from lockdown

NHS England, HTM 03-01: specialised ventilation for healthcare buildings

HSE, Ventilation and air conditioning during the coronavirus (COVID-19) pandemic

Royal Academy of Engineering, Infection resilient environments

NICE, Indoor air quality at home

WHO guidelines for indoor air quality: selected pollutants

WHO guidelines for indoor air quality: dampness and mould

WHO, Natural ventilation for infection control in healthcare settings

HSE, Identifying poorly ventilated areas by using CO2 monitors

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes management of blood and body fluid spillages in health and care settings

National Infection Prevention and Control Manual: standard infection control precautions literature reviews – includes safe disposal of waste literature review

NHS England, HTM 07-01: management and disposal of healthcare waste

Classify different types of waste: healthcare and related wastes

HSE, Blood-borne viruses in the workplace: guidance for employers and employees

HSE, How to deal with an exposure incident

National Infection Prevention and Control Manual, Appendix 10: best practice – management of occupational exposure incidents

NHS England, Uniforms and workwear: guidance for NHS employers

Immunisation against infectious disease: the Green Book

Immunisation of healthcare and laboratory staff: the green book, chapter 12

UK 5-year action plan for antimicrobial resistance 2019 to 2024

UK 20-year vision for antimicrobial resistance

Code of practice on the prevention and control of infections

CQC, Guidance for providers on meeting the regulations

Skills for Care, Infection prevention and control

NICE, Helping to prevent infection: a quick guide for managers and staff in care homes

Skills for Care, Care certificate

Social Care Institute for Excellence, Infection control e-learning course

NICE, Healthcare-associated infections: prevention and control in primary and community care

NICE, Moving between hospital and home, including care homes

NICE, Transition between inpatient hospital settings and community or care home settings for adults with social care needs

Providers of health and care services providing regulated activities and registered with the CQC are required to comply with regulations associated with preventing and controlling the spread of infection and ensuring the cleanliness of premises and equipment where care is delivered.

The code of practice on the prevention and control of infections and related guidance provides a framework to assist registered providers develop and maintain high levels of infection prevention. The code supplements the legal requirements set out in regulation.

The local authority must act jointly with the Secretary of State to appoint a director of public health who acts as an officer for the local authority. The local authority may also be required to exercise any of the public health functions of the Secretary of State, should regulations be imposed.

The local authority must take such steps it considers appropriate for improving the health of people in its area. These steps may include providing services or facilities of the prevention, diagnosis or treatment of illness. Commissioning organisations may wish to assure themselves that the services they commission meet the expected standards of IPC.

The Director of Public Health is accountable for the delivery of their local authority’s public health duties, and is a statutory chief officer of their authority. The role is wide ranging, and has both statutory and non-statutory responsibilities.

The Director of Public Health provides advice and expertise to the local authority and public on a range of health issues, from outbreaks of disease and emergency preparedness through to improving the health of local populations.

UKHSA is responsible for protecting every member of every community from the impact of infectious disease, and providing intellectual, scientific and operational leadership at national and local level, as well as on the global stage, to make the nation’s health secure. Local health protection teams provide specialist public health advice and operational support.

There is a provision contained in the Health and Social Care Act 2008 for the Secretary of State to issue and keep under review a code of practice relating to the prevention and control of infections. The Secretary of State must, by regulations, impose requirements which they consider necessary to ensure registered care providers cause no avoidable harm to persons for whom the services are provided.

The Secretary of State must act jointly with each local authority to appoint a director of public health.

CQC’s statutory objective is to protect and promote the health, safety and welfare of people who use health and social care services. In performing its functions, the commission must have regard to such aspects of government policy as the Secretary of State may direct.

CQC must have regard to any code of practice relating to health care associated infections when making decisions. In registering a service provider to carry out regulated activities, CQC must be satisfied that the provider can comply with the requirements of the regulations. Once registered, service providers are required to comply with the regulations. Health and Social Care Act 2008: code of practice on the prevention and control of infections

The regulations require service providers to assess the risk of, and prevent, detect and control the spread of infection. They further require any equipment and premises be kept clean, and that cleaning be done in line with current legislation and guidance.

If visible blood is present, treat as high risk.

Antimicrobial: a drug that selectively destroys or inhibits the growth of microorganisms. Sometimes referred to as an ‘antimicrobial agent’. Examples include antibiotics (also known as antibacterials) antiviral and antifungal agents.

Antibiotic resistant bacteria: bacteria with the ability to resist the effects of an antibiotic to which they were once sensitive.

Antimicrobial resistance (AMR): occurs when the microorganisms that cause disease (including bacteria, viruses, fungi and parasites) cease to be affected by the drugs we use to kill them and treat the disease.

Cleaning: a process that physically removes contamination but does not necessarily destroy micro-organisms.

Decontamination: a process which removes or destroys contamination and thereby prevents micro-organisms or other contaminants reaching a susceptible site in sufficient quantities to initiate infection or any other harmful response. Three processes of decontamination are commonly used: cleaning, disinfection and sterilisation.

Disinfection: a process used to reduce the number of viable micro-organisms, but which may not necessarily inactivate some bacterial agents, such as certain viruses and bacterial spores.

Alcohol-based handrub: a preparation applied to the hands to reduce the number of viable microorganisms. This guideline refers to handrubs compliant with British standards (BS EN1500: standard for efficacy of hygienic handrubs using a reference of 60% isopropyl alcohol).

Impermeable bag: bags that a liquid does not leak or pass through at any time during their use or during the washing process.

Pathogen or pathogenic: an infectious agent (bug or germ), a microorganism such as a virus, bacterium, or fungus that causes disease in its host.

Personal protective equipment (PPE): equipment that is intended to be worn or held by a person to protect them from risks to their health and safety while at work. Examples include gloves, aprons and eye and face protection.

Reuse: another episode of use, or repeated episodes of use, of a medical device, which has undergone some form of reprocessing between each episode.

Single use: a medical device intended to be used on an individual person during a single procedure, and then discarded. It is not intended to be reprocessed and used on another person.

Standard infection control precautions (SICPs): the basic infection prevention and control measures necessary to reduce the risk of transmitting infectious agents from both recognised and unrecognised sources of infection.

Sterilisation: a process used to make an object free from all viable micro-organisms including viruses and bacterial spores.

Water-soluble bags (sometimes referred to as ‘alginate’ bags) are:

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