S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination
The standard of the cleanliness of the environment and the management of the care equipment is a fundamental aspect of infection prevention and control. By high standards being maintained the number of incidences of healthcare associated infections can be reduced. In turn this increases the confidence remains high in all stakeholders [people living in the home, staff, relatives, commissioners].
The area of Safe Management of the Care Environment is a vast area and an excellent example of how Infection Control and Prevention should be woven through every aspect of the care home. This section is broken down into seven [7] sections.
- Cleaning, disinfection, and sanitising
- The Domestic team
- Holding the evidence, cleaning, schedules, and records
- Deep cleaning and S shaped cleaning
- Equipment used for cleaning
- Safe management of blood/blood-stained body fluid spillages [SICP 8]
- Colour coding of cleaning equipment
Cleaning, Disinfection and Sanitising
Did you know that there is a difference between cleaning, disinfection, and sanitising?
Cleaning
Cleaning does not kill the infectious agents [germs and dirt] that causes disease and illness. This is the role of disinfection. Dirt and debris can hide the infectious agents and prevent the disinfection from reaching them. Cleaning reduces the number of the infectious agent from surfaces or objects when they are physically cleaned. Several human waste products or by products can hide an infectious agent. This can include faces, blood, vomit, wound pus, sputum, urine and other bodily fluids. Cleaning requires physical activity with water and soap [or a detergent] to physically remove the germs. This process cannot be assumed to kill the infectious agent, it will however lower the number of them and reduce their opportunity to spread [reduces the mode of transmission].
Disinfection
The role of disinfection is to kill the infectious agents that cause disease and illness. The process of disinfection cannot be assumed to be cleaning the surface or removing the infectious agent. By the disinfection process killing the infectious agent the risk of the infection spreading is reduced further.
Sanitising
This process reduces the germs [infectious agent] on a surface or object to a safe level as judge by public health standards or requirements. Sanitising can be referred to a disinfection and vice versa. Sanitisers are most often referred to in the Catering environment within the care home. Sanitisiers have a ‘contact time’. The ‘contact time’ is critical part of the using a product that sanitises as this is the time it takes for the product [the chemical] to be left on the surface before it kills the infectious agent.
For disinfection or sanitising to be effective surfaces have to be cleaned thoroughly first!
Graphic Representation using Milton
Milton Sterilizing Fluid and Tablets
Milton Antibacterial Spray
Milton Antibacterial Wipes
The Milton antibacterial wipes have a contact time of 30 seconds
The Domestic Team
The cleaning team are part of the foundations of the care home team when it comes to reducing the risk of infections spreading through the home.
The cleaning team should be allocated to zones [areas with the home] and should remain working in the allocated zone as far as possible. Refer to SICP 11, Maintaining social/physical distancing (this is the new SICP due to COVID-19) for further information on zoning.
The cleaning team are to be up to date with all Infection Control training and informed if there are concerns in the home re suspected or confirmed infections.
There should be an identified lead within the Domestic Team who is responsible for
- The ordering of cleaning materials and products
- Reviewing the rota to ensure there is sufficient cover across the home
- Reviewing the cleaning records and schedules for the home
- Supports the domestic team to stay up to date with the required Infection Control training
- Completes practical supervisions with the domestic team
- Remains abreast with any changes in cleaning materials and their use within the home
- Remains alive to changes in the Infection Control requirements to manage care homes safely
Holding the evidence, cleaning, schedules, and records
Each care home should hold a set of cleaning records or schedules. The cleaning records or schedules should cover every aspect of the care home.
The cleaning schedules should cover the following areas
- The individual areas of the home
- The allocation of responsibility through the domestic team
- Detail the name of the Domestic lead
- The schedules and the frequency of cleaning the identified areas within the plan
- The required risk assessments
- A documented record of the cleaning completed should be made within the cleaning schedules. There should be no gaps in the cleaning record. If there is a reason why cleaning as scheduled has not been completed this should be documented within the records.
- The cleaning records should match the rota detailing where staff are allocated to work within the home
- All cleaning records should be dated and signed
In events where there is a need for increased infection control and awareness, they may be additional polices and processes in place that work outside and above the documented cleaning schedule. For example, the increase in front door measures through COVID and the increase in cleaning touch points. Another example would be with there is a suspected or confirmed outbreak of Norovirus. This would require the implementation of an Enhanced Cleaning Schedule to reduce the risk of the infection being transmitted through the home as a whole or the identified area of concern.
Deep Cleaning and S Shaped Cleaning
Refer to the COVID 19_Deep Cleaning Process for details of how to reduce transmission of infections during periods of sustained transmission.
In addition to periods where transmission risk is high then all bedrooms and communal areas are deep cleaning monthly. This is to be documented within the cleaning schedule for the home.
S Shaped Cleaning
This method of cleaning is designed not to re infect the equipment or surface being cleaned. The process of cleaning and the disinfection is required to ensure infectious agents are removed and cleaned from the area or surface being cleaned.
All Domestic team members are expected to be trained in S Shaped cleaning process. This should be undertaken within a practical, documented supervision.
Cleaning in a S Shape
A Commode
A Profiling Bed and Mattress
Equipment Used for Cleaning
There should be separate equipment for each area of the care home.
Equipment should be fit for purpose and not broken or damaged.
The appropriate PPE is to be worn to reflect the level of risk in the zone which is being cleaned.
Cloths should be disposable single use only or strict evidence regime for how single use cloths are washed post use.
There must be a dedicated area for all cleaning equipment to be stored. Cleaning equipment is required to be stored dry. This includes mop buckets being rinsed, disinfected, and dried before being left.
All re-usable mop heads are to be laundered daily. Any staining that cannot be removed on the mop head should lead to their replacement.
Cleaning products should be stored in their original containers.
If cleaning products are decanted to dilute, then the container used must be clearly labelled detailing the name of the product.
Each toilet should have its own toilet brush.
The toilet brush is to be changed when the brush is visible stained or damaged.
Seat coverings, cushions should be removable to enable inspection of the inside of the cushion/material
Wheelchairs should be cleaned regularly, including footplates and lap straps Table and chairs are to be cleaned regularly post use, there must also be a visual inspection of the underneath of table tops and the arms of the chairs
Ventilation
There should be maximum ventilation in any area being cleaned within the care home. This is to offer further protection around transmission and to ensure the air circulation is good to reduce the build up of toxicity from the cleaning chemical being used.
Best Practice Approaches to Cleaning
Isolation Zones
The risk of transmission increases if equipment is transferred between people that are in isolation owing to potential exposure, an unidentified infection source or an actual infection confirmed.
People who are in isolation have dedicated medical equipment and in Blue Light Care dedicated moving and handling equipment wherever possible. Refer to SICP 11, Maintaining social/physical distancing (this is the new SICP due to COVID-19)
Individual Slings
Each person who requires the use of a hoist is required to have their own individual sling. A hoist sling can act as a reservoir and act as major source of transmission between people living in the home if shared.
Each individual sling is to be
- Labelled clearly for their use only, marked with initials and/or room number
- Be detailed in the maintenance log book
- The type of sling, make model and colour to be detailed in their moving and handling plan
New Admissions or Acute Changes in Need: Hoist Slings
A person newly admitted to the care home may not come with an individual sling. A moving and handling assessment is required to be completed on admission and the sling type identified and sourced. If a sling needs to be ordered from the supplier, then the home should use the appropriate fitting sling from the ‘spare sling box’ until the personal one is received. The temporary sling can only be for the sole use of the newly admitted person.
The same process as outlined above applies for a person living in the care home that as an acute change in physical need and is assessed as requiring the use of a hoist and a sling.
Assurance Process – Infection Control Audit
The Infection Control audit that is completed both internally and externally covers single use equipment, equipment dedicated to different zones and equipment that is transferred between zones.
An audit of individual slings within the home is an essential part of the assurance process to ensure the implementation of Infection Prevention and Control is working efficiently. The audit of individual slings is also to assure that slings are in good working order and fit for purpose.
Refer to SICP 8, Safe Management of Blood and Body Fluids
Colour Coding of Equipment
The colour coding of equipment within the care home reduces the risk of equipment being used in multiple areas. This reduces the risk of transmission between areas. This reflects the face that cleaning equipment and materials can act as a mode of transmission between areas within the home.
This directive comes from the National Patient Safety Agency. These are the different colours used within the care home.
The following table demonstrates where the colour coded items are to be used within the care home.
Equipment Provision The Domestic lead should be aware of who to contact if there are concerns re equipment and how to replace this in a timely manner
Safe Management of the Cleaning Environment and Equipment and the Chain of Infection
How does the use the Safe Management of the Cleaning Environment and the Management of Equipment fit into the Strategy of S.P.I.C.E? The process and systems in place around the Safe Management of the Cleaning Environment and Equipment are focused on prevention of transmission. Isolating and containing the infectious agents within the reservoirs and eliminating them using the methods outlined. Through effective cleaning strategies and systems as outlined above the mode of transmission that infectious agents use can be significantly reduced.
