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Care Certificate Standard 15: Learning Resources Handout 1 (2 pages) Infections Background Infections are caused by microorganisms/microbes such as viruses, bacteria and fungi. The treatment for the infection depends upon what type of infection the person has e.g. antibiotics are for treating bacterial infections. Different diseases pass from one person to another by different routes e.g. you cannot be infected with a sexually transmitted disease through breathing the same air as someone infected. Different types of diseases can have different incubation periods and some people can be infectious before they know they have the disease, this applies to some well-known infections associated with childhood such as measles. Some infections come from one-to-one contact with the person or their body products directly, or indirectly or via droplets. Others can be passed on without contact with the person through touching a contaminated object which an infected person or something infected has touched. Some diseases may make a person immune for life after they have had it (e.g. measles) whereas others can be caught over and over again or carry immunity for a limited period (e.g. common cold, flu, norovirus). Main routes into the body are through: Body fluids – A body fluid such as blood, urine, faeces, pus, saliva from one person enters the body of another e.g. through cuts or other means e.g. sexual intercourse (e.g. syphilis, HIV etc.). Through saliva (e.g. glandular fever). Through contaminated substances entering the bloodstream e.g. tetanus is often contracted through wounds when handling contaminated soil. Through the air – e.g. tuberculosis, measles. Droplet infections are carried through the air through coughs and sneezes (e.g. common cold, carried through the air through coughs and sneezes (e.g. common cold, respiratory viruses. Through the skin/touch Those which people catch by directly touching the skin of someone who has a particular kind of infection such as chickenpox. Published and produced by Scils, www.scils.co.uk 2015 © | Page 1 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources Touching an infected object which someone who is infected has touched e.g. door handles, paper and cooking implements – e.g. Norovirus (winter vomiting infection). Through ingestion – Through contaminated food (e.g. salmonella) or water (e.g. cholera). Through bites or stings from other creatures – e.g. infections from dog and cat bites, (e.g. blood poisoning/sepsis) or through parasites e.g. insect bites (e.g. malaria). [Note an infection from a bite or sting is not the same as having an allergic reaction to it.] If you have a communicable disease you have a duty to follow your doctor’s advice with regards to attending or returning to work and need to flag it up with your employer. For example, some diseases may result in you not being able to handle food for a period even after you feel well. Some diseases, are classed as notifiable diseases, this means that people have a legal duty to report them and to follow the Department of Health’s regulations and advice on who, when and how to report them and on how long people should refrain from having direct contact with other people. Examples of notifiable diseases are food poisoning and many of the illnesses associated with childhood e.g. measles, mumps, scarlet fever etc. Remember your duty of care and that the people at risk with whom you work may be more prone to infection than the general population. Published and produced by Scils, www.scils.co.uk 2015 © | Page 2 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources Handout 2 (4 pages) 15.1b – Effective Hand-Hygiene General hand-hygiene procedure Quality Standards produced by the National Institute for Clinical Excellence were updated in April 2014 (QS 61) and can be found in full at: http://www.nice.org.uk/guidance/qs61 [Key points below quoted directly from this link appear in inverted commas. Some emboldening of the text has been done by us to stress particular points. The terms “healthcare worker” “clinical staff” apply, in this case, to anyone doing relevant care activities and not just to people with a healthcare worker role i.e. they apply to informal carers and social care workers too. “Patient” means any service user. NICE owns the copyright of the statements in quotation marks.] Before doing any personal care task: “Healthcare workers should ensure that their hands can be decontaminated effectively by: removing all wrist and hand jewellery; wearing short-sleeved clothing when delivering patient care; making sure that fingernails are short, clean, and free from false nails and nail polish; and covering cuts and abrasions with waterproof dressings.” Hand hygiene “Hands must be decontaminated: immediately before each episode of direct patient contact or care, including clean/aseptic procedures; immediately after each episode of direct patient contact or care; immediately after contact with body fluids, mucous membranes and non-intact skin; immediately after other activities or contact with objects and equipment in the immediate patient environment that may result in the hands contaminated; and immediately after the removal of gloves.” This includes doing this immediately After using the toilet or assisting someone else to use it. After handling incontinence products. Published and produced by Scils, www.scils.co.uk 2015 © | Page 3 Care Certificate Standard 15: Learning Resources becoming Care Certificate Standard 15: Learning Resources After any contact with your own body fluids or those of another person e.g. urine, blood, ear wax, tears, saliva, excrement etc. Before, during and after handling any food or drink. After handling raw meat or items which have had contact with raw meat. Before and after performing any personal care task. After blowing or wiping your own or someone else’s nose or after putting the hand in front of your face when coughing/sneezing. Before and after handling medicines. After handling rubbish. After coming into contact with any animal. Before and after treating a cut or wound or changing dressings. After coming into contact with someone with an infectious disease which can be transmitted from person to person by touch or via objects. After handling items which have been contaminated by flood water or sewage. After gardening, touching plants and handling pesticides or weed-killer (see poisoning below). When the hands look dirty. After smoking. After handling coins and banknotes. When arriving at and leaving the workplace. After handling chemicals e.g. cleaning fluids, leaking batteries, care maintenance. [This is about addressing the risk of poisoning rather than infection but is still very important.] Routine for washing hands “Effective hand washing technique involves three stages”: Stage 1 -”Preparation: wet hands under tepid running water before applying the recommended amount of liquid soap or an antimicrobial preparation.” Stage 2 - Washing and rinsing: “the hand wash solution must come into contact with all of the surfaces of the hands. The hands should be rubbed together vigorously for a minimum of 10–15 seconds, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers. Hands should be rinsed thoroughly.” Stage 3 - Drying: “use good-quality paper towels to dry the hands thoroughly.” Alcohol-based sanitizers/hand rubs “Use an alcohol-based hand rub for decontamination of hands before and after direct patient contact and clinical care, except in the following situations when soap and water must be used: Published and produced by Scils, www.scils.co.uk 2015 © | Page 4 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources when hands are visibly soiled or potentially contaminated with body fluids; and when caring for patients with vomiting or diarrhoeal illness, regardless of whether or not gloves have been worn.” “Alcohol-based hand rub should be made available at the point of care in all healthcare facilities.” Procedure for using an alcohol-based hand rub “When decontaminating hands using an alcohol-based hand rub, hands should be free of dirt and organic material, and: hand rub solution must come into contact with all surfaces of the hand; and hands should be rubbed together vigorously, paying particular attention to the tips of the fingers, the thumbs and the areas between the fingers, until the solution has evaporated and the hands are dry.” Health and safety when using hand-cleansing products “Clinical staff should be made aware of the potentially damaging effects of hand decontamination products and encouraged to use an emollient hand cream regularly to maintain the integrity of the skin. Consult the occupational health team or a general practitioner if a particular liquid soap, antiseptic hand wash or alcohol-based hand rub causes skin irritation.” If you are allergic to the hand cleaning products or to the hand-cream/emollient provided then you need to flag this up to your employer so that alternatives can be found and made available to you. Monitoring and compliance with hand hygiene “Hand hygiene resources and healthcare worker adherence to hand hygiene guidelines should be audited at regular intervals and the results should be fed back to healthcare workers to improve and sustain high levels of compliance.” “Healthcare organisations must provide regular training in risk assessment, effective hand hygiene and glove use for all healthcare workers.” “Local programmes of education, social marketing and audit and feedback should be refreshed regularly and promoted by senior managers and clinicians to maintain focus, engage staff and produce sustainable levels of compliance.” “Patients and relatives should be provided with information about the need for hand hygiene and how to keep their own hands clean.” Published and produced by Scils, www.scils.co.uk 2015 © | Page 5 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources “Patients should be offered the opportunity to clean their hands before meals; after using the toilet, commode or bedpan/urinal; and at other times as appropriate. Products available should be tailored to patient needs and may include alcohol-based hand rub, hand wipes and access to hand-wash basins.” Those instructed to wash their hands or to use a sanitizer MUST do so. Remember you are protecting other people and yourself by decontaminating your hands. If in doubt wash your hands! Use the space on the back of this page to write down any relevant details about where washing facilities and hand cleaning products are available in your work place(s). You may also find it helpful to state how you flag up the need to replenish stocks of soap etc. Published and produced by Scils, www.scils.co.uk 2015 © | Page 6 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources Handout 3 (2 pages) 15.1c, 15.1d – Some ways in which our own health or hygiene may pose risks to others Infectious diseases - Can be passed on to others by poor hygiene or by failure to recognise periods when we are infectious. There is a need not only to consult a G.P. if you have sickness, diarrhoea, or a known infection but also if you have had contact with someone who has: a)A Notifiable disease such as food poisoning - [A notifiable disease is one which needs to be reported immediately under the Health Protection (Notification) Regulations (2010) to a “Local Authority Proper Officer” this can be done via the G.P.] Or b)A disease with an incubation period such as influenza/flu. There can be very serious consequences for a pregnant woman’s unborn child if the woman has contact with anyone who may infect her with chickenpox or rubella/ German measles. This applies to women in the very early stages of pregnancy who may not be aware that they are pregnant as well as to those who already are aware that they are pregnant. If the worker is pregnant* or is seeking to become pregnant adjustments may need to be made to her work to prevent her from being put at risk of infection and/or other dangers to health. Tiredness - Can affect the way we think and behave and our ability to do our job (including driving). Parasites - Head lice, fleas, lice and scabies can be passed on from person to person but measures can be put in place to prevent this. State of mind - Stress, anxiety, depression, other mental ill health, whether work related or not and the effects of bereavement can have an impact on the way we do our job and behave towards others. They do not necessarily prevent us from earning our living or going to work but our employer might need to make adjustments in order to minimise any risks to ourselves or others.* Employers need to recognise that they have a responsibility towards their employees and that sometimes difficulties in their private life as well as from work need to be accounted for e.g. bereavement or the effects of a divorce or workplace bullying can all have an impact on the person’s performance and outputs. Published and produced by Scils, www.scils.co.uk 2015 © | Page 7 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources Our own physical long-term health conditions, allergies and any disabilities. These may not prevent us from doing our job but we may need to flag these up in relation to risk assessment and our individual needs with regards to the tasks we do, the equipment we may need and the procedures we need to follow in order to prevent ourselves and others being damaged. * For example, someone with a back condition may put themselves and others at risk if they do not have their related work tasks properly risk assessed and managed. Smoking – Only where a specific contract of employment states that employees can smoke are they allowed to smoke (established by case law). Most workplaces do not permit it. Smoking is banned in public places such as restaurants because of the risks it poses to people’s health. Carelessness when smoking may also be a fire risk. [The law and policy on this varies in Scotland, Wales and England.] Use and misuse of medicines, drugs and other substances – Some prescribed medication and some substances which people misuse (e.g. alcohol) can have an impact on how we function. The consumption of alcohol is usually banned from workplaces for this reason. If you take medication which may have an impact you need to flag this up e.g. some medication can make people drowsy. Note that items showing * relate to where the Equality Act 2010 applies with regards to our employers having a duty not to discriminate against us and to make reasonable adjustments to enable us to do our job. Published and produced by Scils, www.scils.co.uk 2015 © | Page 8 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources Handout 4 15:.1d and 15.1e. List common types of personal protective clothing, equipment and procedures and how and when to use them. Produce one copy for each participant. Item of personal protective clothing When to use it How to use it Relevant procedures I must follow and how and when I need to apply them Item of protective equipment When to use it How to use it Relevant procedures I must follow and how and when I need to apply them Published and produced by Scils, www.scils.co.uk 2015 © | Page 9 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources Handout 5 (2 pages) PowerPoint 1 15.1e Principles for the safe handling of infected and/or soiled linen and clinical waste. Clinical waste is any waste which consists either wholly or partially of: Human or animal tissue. Body fluid and excretions – such as blood, urine, saliva, faeces, vomit. Pharmaceutical products – such as medicines and associated equipment e.g. that which has been used to dispense or administer it. “Sharps” – e.g. hypodermic needles, razors other sharp items which could pose a risk. There are regulations about the particular containers used for sharps and standards which these should meet. The containers should be sealed and not reopened when full and should be separated from other waste for collection. Dressings and swabs – such as sanitary towels, incontinence pads, bandages, etc. Plasters, cotton wool, etc. Contaminated packaging e.g. packaging which was used for gathering laboratory samples. This waste is disposed of using specific procedures, for example, it might need to be put in a yellow bag and collected separately from ordinary rubbish, or it might need incinerating. Wrongly disposing of waste, which has not been properly disinfected, which is related to a notifiable disease can result in the person who disposed of it in this incorrect way being prosecuted and fined. Offensive/Hygiene Waste According to the HSE, clinical waste, is not the same as “offensive/hygiene waste”. http://www.hse.gov.uk/biosafety/blood-borne-viruses/non-clinicalsetting.htm Published and produced by Scils, www.scils.co.uk 2015 © | Page 10 Care Certificate Standard 15: Learning Resources Care Certificate Standard 15: Learning Resources The following applies to domestic settings only. (It, along with * above, is defined by the Public Health (Control of Diseases) Act 1984). Offensive/hygiene waste is waste from a non-clinical setting which: Is not from a person/animal with an infection. and Has been deemed to fall into this category as result of a risk assessment which has taken place. Offensive/hygiene waste must not: Be dangerous to move or handle. Include any human or animal body parts, organs or blood products. but It will still need to be separated from other products. May be disposed of with other rubbish without any additional “treatment” to it. [Babies’ nappies, plasters from minor cuts and some incontinence pads, used in a person’s home, may fall into this category]. As some waste materials could be classed as either clinical waste or offensive/hygiene waste the risk assessment is key to determining the category into which it falls. The care setting is also significant to the definition. This waste may be put in ordinary rubbish bins if it is in small quantities but if larger quantities are generated or they are produced over a long period of time it may need bagging in yellow bags with a black stripe: “Tiger Bags” and to be stored in a specific and secure place until it is specially collected. Tiger bags have to show the post-code of the address where they have been used. Local authorities vary in the rules they require people to follow and in the way in which such waste is collected. Published and produced by Scils, www.scils.co.uk 2015 © | Page 11 Care Certificate Standard 15: Learning Resources