S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination
Bacteria and viruses can be easily spread through a person coughing and sneezing. A person coughing and sneezing can transmit bacteria and viruses up to 2 meters in an open space.
There has been a national campaign called ‘Catch it, kill it, bin it’ to raise awareness across the world to the significant risks of bacteria and viruses being spread through poor respiratory hygiene.
Respiratory and cough hygiene is designed to reduce the risk of cross transmission of respiratory illness. The simple action of covering the nose and the mouth with a single use, disposable tissue when sneezing, coughing, wiping, and blowing your nose can dramatically reduce the risk of transmission of bacteria and viruses through the respiratory tract.
This SICP links directly with the SICP 1 Hand Hygiene as post blowing your nose, sneezing or coughing, effective hand washing or sanitising is immediately required
Powered by the diaphragm, abdominal and rib muscles, coughing is highly effective at clearing irritants or mucus from the lungs. Each cough expels thousands of saliva droplets at up to 160km/h (100mph). Each droplet is potentially laden with viruses or bacteria and can travel up to 2 meters.
The COVID-19 pandemic identified the high risk of transmission through the respiratory tract through speech. This has resulted in a requirement to wear face covering when inside. Within the care home setting the use of fluid repellent surgical masks [TYPE2 FRSM] is mandatory owing to the risk of transmission of COVID 19. This applies to staff and all visitors to the care home. The use of surgical face masks is covered in more depth under SICP 4 Personal Protective Equipment PPE
Social Distancing in Respiratory and Cough Hygiene
The importance and effectiveness of social distancing is explored under SICP 11, Maintaining social/physical distancing (this is the new SICP due to COVID-19). To help prevent the spread of respiratory disease, you can also avoid close contact with people who are sick. If you are ill, you should try to distance yourself from others, so you do not spread your germs. Distancing includes not being at work if you are unwell. For the people we support this is where the practice of Isolation strategies are used. Please refer to SICP 10 [Exposure and prevention management] and SICP 11 as referenced above.
Ventilation
Airborne transmission can occur through inhalation of respiratory droplets which are emitted through talking, coughing, sneezing or even breathing. Infectious droplets will settle onto the surrounding surfaces. The contaminated surfaces become a reservoir of infection.
As described above each cough expels thousands of saliva droplets at up to 160km/h (100mph). These can remain suspended in the air for some time before falling and settling on the surfaces they land on. The droplets can are also known as aerosols.
Covid -19 and norovirus are examples of infections that can be spread in this way. To reduce the risk of infections transmitting in this way we must ensure the air space is changed regularly. This requires the areas in the care home to be ventilated as much as possible.
Ventilation can be natural, opening the windows or the doors or mechanical.
Most care homes do not have a mechanical ventilation system to ensure the air space is changed regularly. The research is clear that in poorly ventilated spaces, the droplets [aerosols] are now known to linger much longer than in well-ventilated spaces, making transmission of a virus very possible.
The risk of transmission in this way will be higher within communal spaces than individual rooms – this is because while unventilated single rooms might not have great air quality, the transmission risk is lower (only between staff and one family member) compared to communal rooms such as a lounge or dining room (which have more family members and staff congregated in one place over a longer period). We therefore need to maintain ventilation in communal rooms, as well as limit occupancy and the duration of gatherings in these spaces when increase risks are identified.
Natural ventilation
It is important to understand that natural ventilation (e.g., opening doors and windows) may not provide the ventilation rate required to significantly reduce airborne transmission risk, the ventilation rate will vary according to outdoor conditions, and there no possibility of monitoring or controlling the ventilation rate through windows or doors being opened. This risk will become more significant during the colder months when door and window ventilation will be reduced to conserve heat.
Therefore, our actions are
- To ensure all areas are ventilated as much as possible through periodically opening windows and doors regardless of the weather. People are to be supported with addiitonal layers of clothing and blankets to protect them from the physical impact of windows being open in the colder months.
- In the event of a COVID -19 outbreak where multiple positive cases existed then portable, mechanical ventilation systems will be used.
Fans and Increased Risk of Transmission
We must take action to reduce anything that will generate the movement of droplets [aerosols] as far as possible. Research indicates that droplets [aerosols] can travel much further than 2 metres and can also remain suspended in the air for some time. This means we need to try to minimise the amount of forced air movement which could exacerbate this, thus increasing the risk of transmission. The instructions on the use of fans
- There is a direct instruction that fans are NOT allowed, fans are no longer accessible for all staff to access
However, in heatwaves however, this will be challenging.
- Where there are clear health and comfort consequences on people if fans are not used, air conditioning units on low fan speeds and with oscillation turned off will be used in communal areas.
- There is a risk assessment process in place for the use of fans for individual people. If the risk of using a fan is assessed as low, the air flow of the fan is to be aimed at an open window, ensuring that air does not blow across an individual directly to supporting staff or visitors. The use of fans must be considered on a case-by-case basis and risk assessed.
- Reduced vacuuming schedule for red or amber rooms (since it creates air flow through the filter and recirculation of particles, the effect of which is not known). Use dedicated carpet sweepers for red or amber zones within the home
Respiratory hygiene and the Chain of Infection
How does Respiratory and Cough hygiene fit into the Strategy of S.P.I.C.E?
Respiratory and cough hygiene is the first line of prevention in the S.P.I.C.E framework. The national campaign of ‘Catch it, kill it, bin it’ is a major preventative campaign.
By coughing, sneezing, blowing your nose into a single use tissue isolates and contains potential respiratory infection sources.
The infectious agent in these circumstances live in the mouth, nose and/or respiratory system. These areas of the human body act as the reservoir
Bacteria and viruses leave the body in this manner through the nose and the mouth; in the Chain of the Infection this is referred to as the portal of exit.
The use of a face mask reduces the risk of any virus or bacteria leaving the reservoir of the nose, mouth or respiratory tract and being left to circulate in the air space around them.
You can see on the diagram below how you can break the chain of infection by using a single use tissue and wearing the appropriate grade of face mask.
