Philippa Shirtcliffe, Head of Care Quality, Quality Compliance Systems, discusses the importance of implementing infection control and pandemic policies.
You don’t have to be an avid news watcher to know that it’s a very different story in China, however. At the time of writing, on the Chinese mainland, the Coronavirus has claimed 2,626 lives, while more than 79,700 people are infected with the disease. [i]
Currently there are many more questions than answers. We simply don’t know if China is winning the fight to contain the virus to Hubei province. Certainly, a regional lockdown, which, BBC Newsnight says, has restricted the movements of 10 percent of its population, will help slow the spread of the disease down. But nobody can be certain as to whether this novel strain of Coronavirus can be stopped.
Part of the problem is that epidemiologists, the people who study diseases, understand so little about this new virus. They don’t know the severity of the virus, how easily it spreads, nor are they sure of the incubation period, which the European Centre for Disease and Control currently estimates “to be between two and 14 days”.[ii]
New research says elderly most at risk
However, that said, there’s a lot we do know, thanks to research just published by the Chinese Centre for Disease Control and Prevention (CCDC). The study, which analysed over 44,000 confirmed cases of Coronavirus, revealed that 81 percent of cases presented with mild symptoms. But it also found that the elderly and the sick – particularly those over 80 – were most at risk. [iii]
In the UK, where there are 15,545 CQC registered care homes[iv], and many more domiciliary care agencies providing specialist care to elderly clients, you’d think that the CCDC study would act as a clarion call to act.
But so far there has been very little guidance issued. In a sense, considering that the authorities don’t know whether the virus will impact on the UK, it’s understandable that social care bodies are reviewing their normal pandemic processes. But, on the other hand, the lack of communication risks sending a message to front line carers that there’s a lack of preparedness in the sector.
Better preparedness and compliance needed
With NHS 111 reporting a rise in calls from concerned members of the public, our own customer support team has seen an increase in enquiries from worried care managers seeking advice and guidance on how best to equip their service to manage the situation.
At Quality Compliance Systems (QCS) compliance is something that we take very seriously. We believe it’s important to be proactive and plan for the worst case scenario – even if it never happens.
Therefore, at QCS, as well as providing advice to thousands of care homes and domiciliary care agencies, we’ve produced an online factsheet containing a comprehensive list of policies and procedures around infection control and pandemic.
Here are the key points.
• Create an up-to-date contingency plan
Firstly, it’s crucial to stress the importance of advanced emergency preparedness planning. Every provider should have such a plan in place already of course, but that plan must be tailored towards preparing for a Coronavirus outbreak.
Secondly, providers must develop a specialist business continuity plan for the Coronavirus. With seasonal flu, claiming around 17,000 lives in the England each year[v], again, the majority of providers will already have a template on which to devise a strategy, but flu is not the Coronavirus and the programme must be up-to-date and relevant.
Within the plan, it’s important that providers appoint a Pandemic co-ordinator, who will be the Single Point of Contact (SPoC), if there’s a COVID-19 outbreak in a home or service. Moreover, it’s absolutely essential that the SPoC and everyone else in the service knows their roles and responsibilities. For example, are the contact details of key members of staff in the plan? Is the escalation process clearly mapped out, and is there a contingency plan in place to cover weekday nights and weekends?
• Re-visit Policies and Procedures
Providers should then tailor existing infection control and prevention policies ensuring that the guidance also covers a Coronavirus outbreak. When the policies and procedures are updated, the first step is to ensure that everybody in the service – including admin staff, service users and their families – understand how the updated policies will impact on the home and on them.
Secondly, front-line workers need to ensure that the new policies and procedures are actually being implemented at ground level. Therefore, have care staff spent a suitable amount of time with service users and their families discussing good infection control techniques and best practice? Do clients have easy access to hand sanitiser? Or, if not, is there a basin in close vicinity that they can easily access to wash their hands? And, lastly, do they know how to wash their hands properly?
• PPE Policies and procedures
In China, such is the demand for face masks, that there is a current shortage of them. But in the UK, where only nine people have tested positive for Coronavirus, and the risk of infection is low, there’s currently no guidance recommending that face masks be worn.
Therefore, providers do not need to issue their staff with masks. In fact, those that do, run the risk of creating a barrier between themselves and the service users they look after, which, in the long-term, could damage the person-centred culture of care that they have worked so hard to instil.
• Managing sickness and absence
In preparation for an outbreak, an epidemic, or, in the worst-case scenario, a pandemic, care providers must have robust policies and procedures in place around staff sickness. In the wake of a pandemic, staff shortages could be considerable, and so Registered Managers need to ensure that permanent staff have the right knowledge and training in place to cover for carers who fall ill.
At the same time, managers need to be able to communicate with sick staff and ensure that they are tested for COVID-19 quickly and effectively. Depending on the test result, Registered Managers need to take appropriate measures to ensure that service users and staff are safe.
Finally, Registered Managers need to also take into account the fact that a serious outbreak of Coronavirus might mean staff having to take days off to look after their loved ones. So it’s imperative that care providers also develop an ‘Unable to attend work policy’ too.
• Develop a flexible working plan
While the government judges the risk of infection in the UK to be low, if there’s a pandemic, ministers might decide to introduce an absolute travel ban across the UK or, at the very least, in affected regions. This of course will have implications, not just for care homes, but also for domiciliary care providers, who may make hundreds of visits to different homes every week. In the event of such a ban, Registered Managers, need to have put flexible working plans in place. They need to identify staff members that can work in different locations if their normal place of work is impacted by a travel ban. Most importantly, however, they need to ensure that care workers fully understand the situation and have adequate time to make preparations.
• Annual leave requests
At the same time, if there is a pandemic, Registered Managers will need to develop policies and procedures around holiday. It may be that at the peak of a pandemic, all leave has to be postponed. If so, a range of policies need to be developed that ensure that staff don’t lose out on leave when a pandemic is over. The problem with this approach of course is that many carers will have accrued several weeks of holiday. Either, the policy needs to allow them to buy annual leave days back from the provider, or it needs to enable them to carry that leave forward.
• Reporting an unexpected death
Hopefully, it won’t happen, but in the event of a Coronavirus outbreak, Registered Managers and their staff, need to be fully prepared if a service user passes away unexpectedly. While the cause of death may not be due to COVID-19, it is important that Care Home staff can answer three questions, namely: Who’s going to manage the situation? Who needs to be notified and how should the team respond?
It’s vital too that all providers have updated their compassionate leave policies so that they are in line with the Parental Bereavement (Leave and Pay) Act 2018, also known as ‘Jack’s Law’ which, when it comes into force in April, will grant parents dealing with the death of a child under the age of 18, the right to take two weeks paid leave.
Should we experience a pandemic, providers need to ensure that not only are they able to offer a bereaved staff member the support that they need, but can also make contingency plans.
• Reporting concerns
Finally, an infection control and pandemic plan must provide managers, care workers, service users and family members with an opportunity to raise concerns about the service. A whistleblowing policy needs to be developed and rolled-out before a pandemic occurs, as staff need to be fully aware what constitutes malpractice is this area. If staff have safeguarding concerns, they need to know who to speak to, how to report the incident, and need to be assured that if they do blow the whistle, they won’t suffer any adverse consequences at the hands of their employer.
If you want to find out more about how you can best prepare for the worst-case scenario, then why not download a copy of QCS’s Infection Control and Pandemic factsheet?
If your care practice is in England, click here.
If it’s in Wales, click here.
If it’s in Scotland, click here.
Philippa started her nursing career 30 years ago in Leeds. For the last 20 years she has worked in social care, starting out as an Area Manager managing several home care branches and extra care schemes.
Prior to joining QCS, Philippa was responsible for Safeguarding and Whistleblowing within one of the largest providers of Health and Social Care in the UK. In addition to this role she had further responsibility for creating, developing and embedding the company’s policies and procedures nationally.
Philippa has retained her Nursing Registration and holds an Extended Diploma in Health and Social Care Management. She is passionate about the delivery of safe, reliable quality care and uses her knowledge and experience to ensure policies and procedures are evidence-based and a useful tool to make a manager’s life easier.
[i] BBC news
Coronavirus: Largest study suggests elderly and sick are most at risk
February, 18, 2020
[ii] European Centre for Disease and Control
Q&A on COVID-19
[iii] BBC news
Coronavirus: Largest study suggests elderly and sick are most at risk
February, 18, 2020
[iv] Information accurate at the time of writing.
[v] ITV News
How does the Wuhan coronavirus compare to seasonal flu?
February, 6th, 2020