Hallmark Carehomes
How we manage infection outbreaks at Hallmark

12 February 2020

How we manage infection outbreaks at Hallmark

Julie Rayner, our Care Quality, Governance and Compliance Director explains what we do to ensure residents, who are being nursed in isolation due to an infectious illness, have their emotional and psychological needs met.

Traditionally, when a care home has an outbreak of diarrhoea and vomiting, residents are isolated (nursed in their rooms) and visiting is stopped. Whilst isolation is an important aspect of infection prevention and control, isolating an older person from their loved ones; particularly if they are living with dementia, have life limiting conditions or rely on their families for emotional and physical support can have a significant detrimental psychological effect on their well-being.

We have recently implemented a policy that protects residents, visitors and team members from an infectious outbreak, minimises the risk of cross infection but also supports on-going visiting in line with John’s Campaign. John’s Campaign is a campaign for extended visiting rights for family carers of residents with dementia in the United Kingdom and as part of our dementia strategy all of our homes have signed up to show families that our aim is not to substitute their role but instead work in partnership together. We have extended that commitment to ensure that we have robust processes in place to ensure residents who are living with dementia can continue to benefit from their families support even when there is an infectious outbreak within the home.

To support this commitment, a clear process has been developed to ensure contagious infections can be safely and effectively managed through the appropriate application of robust infection prevention and control processes. We have also put measures in place to guarantee that residents, who are being barrier nursed continue to receive a high standard of care and support which will include the consideration and meeting of their emotional, psychological and physical needs. Moreover, as part of our relationship-centred approach, residents, their families and team members will be immediately informed and receive information and support to alleviate any concerns they may have in respect of the infection and the infection control processes we have implemented to reduce the risk of cross contamination.

It is important to note that barrier nursing in a care home environment is not always easy and we are fortunate at Hallmark that our homes have single person occupancy, which means that residents can be cared for in their own rooms and have access to their own toilet facilities. However, this isn’t always the case when caring for couples who may choose to share a room and residents living with dementia. In these instances, a robust management plan will be created and implemented which identifies and addresses all identified risks. During an infectious outbreak, our homes establish an “infection prevention and control team” which includes the homes Infection Control Lead, the General Manager and the Clinical Lead. Internal advice, support and guidance is obtained from the Hallmark IPC Lead and the regional clinical specialists. We will also work closely with external agencies such as the local environmental health team, Public Health and GP’s.

During a period where the home is managing an outbreak and residents are being nursed in their rooms; consideration will be given to the provision of social input and activities for the resident(s) in isolation (if their condition allows). The activity co-ordinator will continue to provide input; however, equipment should not be removed from the room and anything taken into the room will require disinfecting once barrier nursing has ceased.

Care of residents who are being barrier nursed will be delivered by team members who are generally fit and healthy as they are protected by their body’s normal non-specific defence system and therefore would be safe to treat residents who present an infection. Team members who are immuno-deficient, either through illness or therapy or suffering from an open skin condition, will not care for residents who present with an infectious illness.

Moreover, resident’s with chickenpox, shingles (herpes zoster) or measles will not be looked after by team members who cannot confirm that they have had either the disease or the appropriate vaccination or who are pregnant or who suspect they may be pregnant.

Children and other susceptible visitors will be discouraged from visiting whilst an infection is active. However, the team will ensure the reason for this advice is fully explained and that residents, relatives and friends understand the concept and reasoning behind John’s Campaign and why we will continue to support family and friends visiting residents living with dementia.

Moreover, should a resident’s condition deteriorate whilst the outbreak is active (either physically or emotionally), consideration will be given to applying the John’s Campaign Protocol even if the resident is not living with dementia.

It shouldn’t come as a shock, that good hygiene and cleanliness is fundamental to the effective management of an infectious outbreak and there are a number of steps team members, residents and visitors must take to ensure that the infection is contained. This includes but is not limited to a daily chlorine cleaning of the environment, signage, clearly defining the entrance and exit from the home and to and from the infected communities within the home, providing and signposting to hand washing facilities, reminding people of the correct handwashing procedure, the provision of PPE, positioning clinical waste bins both inside and outside the infected room(s), and the provision of an infected linen bag.

In order to implement our policy, all team members have been provided with relevant infection control training which is part of the Hallmark Care Homes mandatory training programme and this will be refreshed on an annual basis. This training includes a specific session on the management of an outbreak of gastroenteritis and the implementation of John’s Campaign.

An assessment of the resident’s condition will be made on a daily basis to ascertain the need to continue barrier nursing and barrier nursing will cease when the risk of infection has gone. Following this, and on completion of isolation the room and the resident’s belongings will be deep cleaned using an appropriate disinfecting solution.

Hallmark Care Homes has a responsibility to inform and educate others regarding the management of infectious outbreaks. It is important to determine whether the actions we perform can be considered to be in the residents’ best interests. Only by making people aware of our policy and how we manage infectious outbreaks of diarrhoea and vomiting within our homes, whilst still supporting residents emotional and psychological needs can we help to secure a future, where the integrity and the care of each resident is held above all else.

If you have any questions regarding Hallmark Care Homes management of gastroenteritis policy, please contact Julie Rayner directly at Julie.Rayner@HallmarkCareHomes.co.uk.

Click here to find your nearest Hallmark care home.