Infection prevention and control in care homes

Page last updated: 23 June 2022

Adult social care inspection information gathering tool: infection prevention and control

Instructions and guidance

The tool will help you collate relevant information to provide assurance that a care home has appropriate infection prevention and control measures in place.

Add in your notes and observations with evidence to support your findings. Highlight good practice and, where there are shortfalls, please support services by signposting to relevant resources.

You should pre-populate the form as much as possible from other sources before or after the site visit to reduce time spent on premises. This is particularly important when community infection rates are high and risks of infection transmission and exposure increase. Use information such as from the monitoring information, notifications and feedback.

Choose whether you are assured, somewhat assured or not assured for each topic question. This will provide a quantitative measure to understand how well the care home sector is responding to key areas of IPC practice.

For the key practice findings, you only need to record key practice and innovation that you think other services could learn from rather than what we expect providers to be doing in complying with guidance. With poor practice, we want you to highlight unexpected failings and concerns that are things that providers may not recognise but has considerable impact on safety in relation to IPC.

At the end of the form are a series of closed questions that we want you to answer (mainly) yes or no based on your assessment of the service. This will provide us with a better understanding of implementation of IPC in care homes and allow us to collate and report our findings in a timely manner.

1. Are all types of visitors prevented from catching and spreading infection?

What measures can you see in place to minimise the risk of relatives and friends, professionals and others visiting from spreading infection at the entrance and on entering the premises?
What procedures are visitors asked to follow during the visit? Do they reflect national guidance? How are they communicated to people? Do the procedures appear to be complied with by visitors?
What alternative arrangements to visiting in person are available? For example where someone is self-isolating due to a transmissible infection, or the home has an active infection outbreak?

What good looks like and guidance

What good looks like

Providers should make sure they focus on enabling visits wherever possible. Whenever visits are restricted this should be based on recognised guidance and local Health Protection Team (or equivalent) advice.

Provider is transparent in terms of sharing information and communication with friends and family about current infections so they can understand the risks, the IPC measures in place and decisions around any restrictions on visits.
People have individual risk assessments. Visitor plans are included as part of their care plan to make sure their social contact needs are met.
Visitors are not limited, unless this is absolutely necessary to ensure the safety of people, their visitors and staff. Any limits or restrictions on visits should be in accordance with national guidance and local Health Protection Team (or equivalent) advice.
All visitors are asked to refrain from entering the care home if they are unwell. Visitors should be supported to understand why they should not enter the care home if they are feeling unwell.
Visitors should follow any current national testing advice in place, including if applicable, showing proof of their negative test result prior to entry.
There is prominent signage and instructions to explain what people should do to ensure safety.
Information is easily accessible on arrival or before visits to ensure visitors follow guidance, procedures or protocols to ensure compliance with infection prevention control.
Facilities are in place to wash hands for 20 seconds or use hand sanitiser on entering and leaving the home. Accessible guidance on correct hand hygiene is available.
Visitors are supported to wear a face covering and any other recommended PPE when visiting.
Visitors are supported to wash hands before and after PPE use as recommended by guidance.
Where there are necessary restrictions to visits, alternative forms of maintaining social contact are used for friends and relatives. For example, keeping in touch using video calls, weekly newsletters to family members, visiting in communal garden or through meeting at a closed window and using a phone to communicate with. Remote consultations are also considered by other visitors such as professionals and clinical consultations

Infection prevention and control guidance

COVID-19 guidance

Support and resources

SCIE, Skills for Care, British Geriatric Society, BILD, CPA

2. How are people supported to use and access their environment safely?

Where appropriate, how does the provider support people who use the service to understand basic infection control precautions they could follow, for example hand washing or respiratory and cough hygiene?
How do staff support people to minimise close physical contact with others or maintain social distancing when needed? For example, where someone has symptoms of transmissible infection or where there is an infection outbreak in the home.
When it is advisable for people to social distance or isolate, how are people supported to minimise the impact on their well-being?
How are people supported to access other services safely, for example attend medical appointments?
What mitigation is in place where it is not always possible to minimise close physical contact or socially distance when it is recommended? For example, during an active outbreak.
Is isolation, cohorting and zoning implemented effectively where there is infection or an outbreak?

What good looks like and guidance

What good looks like

Note: the national COVID-19 response has moved from an active pandemic management stage to managing COVID-19 as part of general good IPC practice. The risk of transmission of COVID-19 as well as other community based infections remains and providers should continue to assess the risks to people using the service and follow best practice and government guidance to minimise risks to people using their service.

People are supported to understand and follow basic IPC precautions such as hand hygiene and respiratory and cough hygiene.
People using the service are monitored for signs of being unwell and symptoms of transmissible infections.
The provider keeps people’s individual risk assessments under review and has identified which people are at particular risk of infection (for example where someone is not able to follow IPC precautions, is not fully vaccinated against respiratory illness or is immunocompromised).
People are supported to minimise close physical contact and social distance or isolate when when this is advisable to prevent the spread of infection.
Staff are provided with PPE, which meets recommended national guidance to carry out their role safely.
Staff wear PPE, which meets recommended national guidance and is appropriate for the care they are delivering and the level of infection risk. For example, where standard IPC precautions are being followed, personal care is being delivered or where a person is isolating due to a transmissible infection.
The provider makes sure they appropriately share relevant information with others around infection symptoms or risks when a person accesses another service, for example where they are due to attend a medical appointment.
Provider follows current national guidance and Health Protection Team (or equivalent) advice on isolating and cohorting symptomatic residents. Ideally, people should be isolated in single occupancy rooms. Where single room occupancy isn’t practical, the provider should follow national guidance and local Health Protection Team (or equivalent) advice on cohorting symptomatic residents together.
Residents in isolation should not attend communal areas, including shared lavatories and bathrooms. Alternative facilities are provided
Arrangements are in place so staff appropriately social distance during breaks when needed, for example when there are high levels of community infection or where there is an infection outbreak in the home.
The provider considers whether arrangements for visits out need to be modified during times of increased risk, for example during times of high community infection or during an outbreak. This will be based on dynamic risk assessment.

Infection prevention and control guidance

COVID-19 guidance

Support and resources

SCIE, Skills for Care, British Geriatric Society, BILD, CPA

3. Are people admitted into the service safely?

How are the risks of people catching or spreading infection assessed prior to admission?
What measures are in place to prevent people with a known or suspected infection from spreading it when they are admitted to the service from a health or social care service or from the community?
What measures are in place to prevent people who potentially have an infection from spreading it when they are admitted to the service from a health or social care service or from the community?

What good looks like and guidance

What good looks like

The provider carries out risk assessments prior to admitting people to the service. This includes factors that place someone at a higher risk of catching or spreading infection. For example, they have symptoms of infection, have been exposed to known infection or personal factors such as vaccination status, immune status, medications that impact immune response, invasive devices such as catheters or wounds. Risk assessments should also include a person’s ability to understand and carryout IPC measures, such as hand washing. Risk assessments are kept under review.
Where possible the provider discusses people’s individual risk assessments with them and helps them to understand the actions that can be taken to minimise the risk of infection.
Risk assessments contribute to planning a person’s care and determine whether any specific IPC precautions are required.
The service follows any current national COVID-19 testing guidance in place when they are admitting people to the care home.
Where a person admitted to the care home tests COVID-19 positive they are supported to isolate in their own room in accordance with current national guidance.
There are also clear procedures from point of entry into the care home that minimise risk of transmission when moving an isolating person to their room.
People are monitored for signs of infection as standard practice once admitted to the care home.
For people who lack mental capacity, the service has considered if any new measures and arrangements in relation to IPC amount to a ‘deprivation of liberty’ and take appropriate action.
If there is an infection outbreak in the home the provider considers whether it is appropriate to admit new people to the service. Decisions to admit people will be supported by risk assessments.

Infection prevention and control guidance

COVID-19 guidance

Support and resources

SCIE, Skills for Care, British Geriatric Society, BILD, CPA

4. Does the service use PPE effectively to safeguard staff and people using services?

Have staff been appropriately trained in PPE use for their particular role and level of infection transmission risk?
When, where and how are staff donning and doffing PPE? How is PPE disposed of after use?
Do the levels of PPE used comply with national guidance?
Are PPE stocks stored appropriately? Are they accessible where they are needed?
People using the service may be fearful or anxious seeing staff wear PPE. What measures are in place to support communication and reassurance? (For example people who are deaf, autistic people, people with a learning disability, people with dementia.)

What good looks like and guidance

What good looks like

Staff have received appropriate training in PPE use. This should include the recommended PPE that should be worn depending on the task being carried out and the level of infection risk, sessional and individual use, correct donning and doffing and safe disposal of used PPE.
Use of PPE is in accordance with national guidelines and is appropriate to the role of individual staff and level of transmission risk. For example, where standard IPC precautions are being taken, or enhanced precautions when someone being cared for has a suspected of confirmed infection.
Signage on donning and doffing PPE and handwashing is visible in all required areas, including for visitors.
Staff observed to put on and take off PPE as per guidelines.
Staff observed to follow good hand and respiratory hygiene practices using appropriate products.
Disposal of used PPE prevents cross-contamination and follows guidance, in particular single use items and how PPE is disposed of safely.
The provider has assessed the impact on residents of how PPE may cause barriers to effective communication or fear and anxiety for residents, for example people who have a hearing impairment or autistic people, people with a learning disability or people with dementia. The provider has a risk assessment and plans in place to mitigate these concerns.
The provider has addressed issues where PPE may not fit appropriately because of staff gender or other protected characteristics