SICP 1: Resident placement and assessment for infection risk (screening/triaging/testing)

S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination  

This SICP is broken down into three parts.

1. Pre-Admission for risk of infection
2. Assessment for infection post admission
3. The process of confirming whether an infection is present.

Pre – Admission

Each person who joins the care home is required to have a preadmission assessment. The pre assessment is the first opportunity to establish if the person is living with an active infection or a latent infection that at the point of admission is not causing any concerns or risks to the person or others.

A latent infection is defined as ‘the residence of an infectious agent within the body without any manifest symptoms. The incubation period of some diseases can be referred to as a period of latency in infection. This can occur in smallpox, measles and COVID-19

The pre-assessment and assessment of infection should be completed for people already living in the home that have been admitted into hospital owing to acute ill health. The completed assessment is to be used to determine the placement decision based on the identified clinical care needs of the person. 

Pre – Admission Questions to consider based on infection risk

1. Past Medical History
2. Reason for last hospital admission
3. What has the clinical presentation of the person been over the last 14 days
4. NEWS information/observations [specifically temperature, oxygen saturations and respirations]
5. Known or suspected exposure and/or increased risk of carrying an infection from the current environment.

We should therefore consider and gather further information when the person we are assessing has been or is presenting

• With diarrhoea, vomiting, unexplained rash, high temperature or respiratory symptoms
• Previously positive with a Multi-drug Resistant Organism, i.e., MRSA  
• Exposure to COVID-19 in the current setting or the previous setting if admission has been less that 14 days

COVID-19 Specific Questions

COVID19 screening questions including vaccination questions for flu and COVID-19. The vaccination information forms part of the risk assessment process on admission.

COVID-19 Testing

A negative PCR COVID-19 is required to be completed before a new admission joins the care home or an existing family member returns from a hospital admission [if the person has not gone passed the A&E department a COVID swab is unlikely to be completed before discharge from the A&E department. Refer to SICP 11. Maintaining social/physical distancing during the COVID-19 pandemic. This will explain the requirement to reduce the risk of transmission further by isolating each person for 14 days.

Breaking the Chain of Infection

Assessment of risk prior to accepting a person into the care home plays a major role in preventing infections being able to transmit through the care home.

What does this mean?

The red crosses reflect how the assessment process can identify the risk.

The blue crosses identify how if admissions are managed safely with robust infection control policies how the chain of infection can be broken post admission to a care home.