COVID-19: infection control in community settings

With the increasing prevalence of COVID-19, it is more important than ever to ensure that we maintain effective infection control. COVID-19 is not thought to be completely airborne but can be transmitted through droplets, direct contact people’s secretions, and touching surfaces that have been infected through human transmission.

Key facts (World Health Organisation)

A single cough can produce up to 3000 droplets
These droplets can land on other people, clothing, surfaces around them
People the catch COVID-19 by touching these objects or surfaces then touching their eyes, nose or mouth
People can catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets
There is emerging evidence that the virus also shed for longer in faecal matter – although the research suggests that this transmission is low, if you do not wash your hands after visiting the toilet you could contaminate anything you touch
The risk of catching COVID-19 from someone with no symptoms at all is very low

Safe ways of working for all health and care workers

Staff should know what PPE they should wear for each setting – please review this chart devised by NHS England for further specific guidance
Staff should have access to the PPE that protects them for the appropriate setting and context – we know this can be a problem and we urge you to discuss it with each individual setting or call us
Gloves and aprons are subject to single-use with disposal after each patient contact
Hand hygiene should be practised and extended to exposed forearms after removing any element of PPE

Use of PPE

It is always vital to wear PPE when completing any care interventions in the community environment, however as we try to fight the spread of COVID-19, it is essential that PPE is worn. The level of PPE will be determined depending on the environment. For non-symptom displaying service users, gloves and aprons are required for any patient care. Ensure that you wash your hands for at least 20 seconds, in warm water and with soap, before and after applying PPE.

PPE should be put in the hallway or reception area of the home.

If neither the individual nor the care worker has symptoms of COVID-19 then no personal protective equipment is required above and beyond normal good hygiene practices. Unless the patient is shielding (conditions that require shielding can be found here) then gloves, surgical mask and apron must be worn at all times for their protection.

The recommended PPE required to be worn where a possible or confirmed case has been identified is: disposable gloves, disposable apron and fluid resistant surgical face mask and potentially eye protection. Where a service user is coughing and there is a risk of splashing the use of a visor should be considered and risk assessed.

Aerosol Generating Procedures

The current AGPs in the community setting are:

Tracheostomy procedures – insertion, removal or open suction
Non-invasive ventilation (BiPAP or CPAP)
Ventilation via a tracheostomy
Cough Assist

Further information on the PPE requirements can be found here.

Hand washing

Hand hygiene is essential before and after all contact with the service user being cared for, following removal of protective clothing and cleaning of equipment and the environment. Wash hands with soap and water using the technique shown in the diagram below. Washing effectively with soap and water is sufficient, if possible, use a disposable paper towel to dry hands and place in waste. Paper towels are not always available in the community setting, and therefore it is essential that a hand towel is made available for workers only and this is changed on a daily basis and washed in a washing machine under an appropriate temperature. Recommendations do continue to state that an alcohol-based hand rub can be used if hands are not visibly dirty or soiled, but hand washing is the top recommendation.

Use of clothing at work

Do not travel to work in the clothes that you will be wearing during your shift
If possible, change into your ‘work clothes’ on commencement of shift
Use different footwear when at work – this will prevent you potentially spreading the virus outside of the work environment
Prior to leaving the shift, change back into travelling clothes, place work clothes and footwear into a plastic bag
When home, wash your clothes immediately at 90 degrees
Avoid shaking your clothes out prior to putting them into the washing machine

Tips to reduce the risk when completing care

Leave all jewellery at home, wear clothing where your forearms and hands can be left free and easier to clean
Always wash your hands before and after any care intervention
Try if possible, to group cares together to minimise the exposure
Try if possible, to complete all care from the side and avoid facing your service user head on
Maintain a safe distance with the service user in between care interventions

Environmental decontamination

It is possible for the virus to survive in the environment so environmental cleaning is essential. The amount of virus contamination on surfaces is likely to decrease significantly after 72 hours
Always wear gloves and aprons to clean your service user’s environment
Place cleaning clothes (disposable) in a sealed plastic bag and do not put in the main stream bin for 3 days. For any non-disposable clothes, wash in the washing machine after use
Ensure the service user’s environment dust free and clean every day

Waste management

Disposal of PPE and personal waste should be placed securely within disposable bags. When full, the disposable bag should be placed in a second bin bag and tied. These bags should be stored before being put out for collection. Other household waste can be disposed as normal.

Occupational exposure

There is a risk that you will be exposed to a service user with COVID-19. All staff should remain vigilant for any new respiratory symptoms during the incubation period, which can be up to 14 days following last exposure to a confirmed case, and should NOT work if you have a fever or cough. If you develop a fever or cough, contact 111 or your GP for further advice and self-isolate.

Reducing the spread of infection in your home

Just because you are not caring for service users in hospital does not mean that you will be free from the potential spread of infection. This section gives you guidance on infection prevention, not only in the service users home but also your own home so you can remain fit and well and continue to provide support.

When at home you should

Wash your hands with soap and water often and for at least 20 seconds
Use hand sanitiser gel if soap and water is not available
Cover your mouth and nose with a tissue or your sleeve (not your hand) when you cough or sneeze
Put used tissues in the bin straight away and always wash your hands afterwards
Clean objects and surfaces you touch often (like door handles, kettles and phones) using your regular cleaning products

Cleaning and washing

Use your usual household products, such as detergents and bleach when you clean your home
Put used tissues and disposable cleaning clothes in rubbish bags, place the bag in a second bag and tie it securely – wait for 3 days before putting it in your outside bin – dispose of other household waste as normal
Wash your laundry in the washing machine in the usual way. Laundry has been in contact with an ill person can be washed with other people’s items. Do not shake dirty laundry as this may spread the virus in the air (However we would suggest that you wash your uniform/work clothes separately in as high temperature as possible)
If you do not have a washing machine – wait for 3 days after your stay at home has ended before taking your laundry to a launderette

Stay up to date with the latest NHS COVID-19 guidance here.