Publication - Advice and guidance

Coronavirus (COVID-19): clinical guidance for the management of clients accessing care at home, housing support and supported housing

Published: 6 Aug 2020
Last updated: 22 Jul 2021 - see all updates

Guidance for local authorities, Health and Social Care Partnerships (HSCPs) and registered providers, who deliver care and support to people in their own homes or provide supported accommodation including sheltered housing, extra care housing and supported living during the pandemic.

Coronavirus (COVID-19): clinical guidance for the management of clients accessing care at home, housing support and supported housing
Infection prevention and control - practical questions and concerns

Infection prevention and control – practical questions and concerns

Application of Infection Prevention and Control (IPC) within a client’s home (Care at Home) in relation to COVID-19

Introduction

This guidance has been produced in response to questions from care at home staff on the implementation of Infection Prevention and Control (IPC) for COVID-19.

National Infection Prevention and Control Manual: Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum remains the primary source of information that care at home staff should use.

The information provides generalised practical responses to situations care at home staff may encounter when providing care to clients within their own homes. Care at home providers and their staff should continue to consider their own individual circumstances when applying guidance and are responsible for and must ensure for themselves that they are meeting the requirements of the Community Health and Care Settings IPC Addendum and any other current or future legislation and guidance that may be deemed to apply to these settings. 

Face masks

When to wear masks during your shift

As there is still at present ongoing community transmission, it is recommended that staff providing direct care to individuals in the following settings should wear a Fluid Resistant (Type IIR) Surgical Mask (FRSM) at all times throughout their shift. This includes wider community care (including adult social or community care, adult residential and care home settings and domiciliary care. All guidance in relation to mask wearing is constantly reviewed and the National Infection Prevention and Control Manual: Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum will be updated pending any changes to guidance.

Changes to face masks wearing policy as we progress throughout the pandemic

The extended use of face masks for staff is a remit for Scottish Government. If the current practice were to change there would be guidance issued on this.

When worn correctly, face masks can provide protection to those around the wearer from droplet and aerosol transmission and they can also provide some protection to the wearer. They also serve a purpose in source control by reducing contamination to the environment surrounding the wearer. Face masks are one method of control and should not be a substitute for physical distancing, respiratory and hand hygiene and enhanced ventilation in indoor spaces, which all remain important.

Wearing face masks when visiting different clients (sessional use)

The advice ARHAI give is to remove face mask (along with other PPE if worn) at the end of each visit and put in a disposal bag then a bin bag and tie before leaving the person's home, where there is a safe place to do so (e.g. in a porch). We advise not to leave PPE on including face masks, out with the home or to the next visit.  If there is no safe place to take PPE off before leaving the home, we advise that PPE  including the face mask, is removed immediately on leaving home and placed in disposal bag and disposed of as local arrangements. 

Further guidance on PPE donning and doffing is available through the

National Infection Prevention and Control Manual: Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum paragraph 7.5.4

Face masks use for clients

Individuals receiving care are not required to wear a face mask/covering in their own home. However, if you are going to deliver care within 2 metres, it would be reasonable to ask your client, to put on a face covering where it can be tolerated, during the care activity. However they are not obligated to do so.  As a care professional you should be wearing an FRSM mask and asthis will provide both protection to the wearer and client, and provide source control. Therefore the focus should be on ensuring you are correctly wearing your FRSM mask and appropriate level of PPE for the task.

We encourage care at home staff to discuss mask wearing with clients prior to attending the clients home.

As a care professional you should be wearing an FRSM mask and  this will provide both protection to the wearer and client, and provide source control.

Wearing face masks in public places with clients

Care at home staff and their clients should adhere to Scottish Government guidance and legislative requirements on face covering use in public spaces. We have made face coverings mandatory in most indoor public places, indoor communal spaces including retail, restaurants, cafes, bars and public houses, and in workplaces and on public transport. People must wear a face covering unless they are exempt from doing so because of specific circumstances.

Clear face masks

Clear masks are available but do not currently meet the requirements for PPE. They may be worn as a face covering in social settings but not by health and social care providers. Clear mask options are being actively explored as we appreciate the significant challenges that this can have with individuals with a sensorial impairment.

Read more information to support lip readers and/or those with a hearing impairment.

PPE and work wear

When to use gloves

Gloves should only be used where contact with blood or body fluids is expected. COVID-19 entry points are through the mouth, nose or eyes.

Uniforms/work wear

Staff often worry about the risks of having to wear the same uniform throughout their work day. This risk of COVID-19 transmission through uniform/ work wear is likely to be extremely low provided uniforms are laundered correctly and the appropriate PPE is worn correctly.  PPE, when worn correctly, along with good hand hygiene should  protect your work wear or uniform from contamination, as well as protecting and you. If you do not have a designated  work  uniform it is still important that your work wear complies with good practices including being compatible with good hand hygiene (bare below the elbow). The work wear should also allow mobility and comfort, and importantly be able to withstand frequent decontamination laundering.

The same uniform or work wear should be worn for a maximum of one day, and should be washed after each use and a fresh uniform/ work wear used for the follow work day. Staff are not required to change uniform between clients they are visiting on the same work day. It is safe to launder uniforms or work wear at home however they should be washed separately from other household linen and it is important not overfill the machine. Wash it at the maximum temperature the fabric can tolerate, then iron or tumble dry it. Further details on safe laundering can be accessed via the National Infection Prevention and Control Manual: Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum

As a good practice staff should change as soon as possible when returning home from their work day and staff should avoid shopping or non-work activities whilst in uniform or work wear, where this is possible.

Quarantining of  PPE waste for 72 hours

Currently all PPE waste generated as part of care should be double bagged and quarantined for 72 hours prior to placing in a waste bin.

It should not go straight to a waste bin or public bin as it could be handled which could result in transmission of COVID-19.   This applies to all settings, not just settings where there is a confirmed COVID-19 case. The reasoning for this is   that we are unable to determine if the person you are providing care for is positive, negative or incubating with COVID-19. Therefore those without a confirmed COVID-19 diagnosis are still  considered to be in the medium category for risk.  Please see the National Infection Prevention and Control Manual: Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum for further details.

The only exception to this is where it is known that a waste bin will not be accessed or uplifted for 72 hours.

Waste management processes in these settings are regularly discussion with SEPA, whom manage and provide the guidance for waste. As the pandemic levels reduce this may be reviewed.

Cleaning within a client's home

The NIPCM Addendum for community health and care settings, currently does not include guidance nor prescribe cleaning processes or products for any cleaning that may be required within a client’s home. The reason for this is that as care is taking place within a client’s home, the carer  is likely to have  little or no control over products available in an individual’s home. If cleaning is a requirement within your duties appropriate processes should be discussed  with your employer. Your employer is responsible for ensuring you are trained and able to perform your role safely, including safely using any chemicals or cleaning products and are responsible for provided you with  suitable personal protective equipment to complete the cleaning and utilise the identified products.

Transport to attend clients homes

Preferred method of transport to attend clients homes - car sharing or public transport

The NIPCM Addendum for Community Health & Care Settings recommends staff travel separately to clients homes and recommends staff avoid car sharing,  however there may be times that due to the location of clients homes travel via public transport or car sharing is unavoidable.   The current Scottish Government advice also states that you should not share a vehicle with anyone from another household, unless you absolutely have to and the NIPCM Addendum for Community Health & Care Settings indicates public transport as an alternative option for travel ,where social distancing can be achieved i.e. through the use of larger capacity vehicles.

This suggests that public transport is the preferred option to car sharing, however

there may be some instances were social distancing is not possible on public transport, in which case there is no preferable option asthere is still an increased risk in COVID-19 transmission.

Additionally, public transport systems may still have limited capacity and lower service provision, which may not meet your travel needs.  

As both methods of transport can result in care staff being in closer proximity to people out with their own household, and may not have appropriate ventilation, both methods of transport can pose a risk that should be mitigated. The risk can be minimised through following of appropriate guidance including mask wearing, hand sanitising, cleaning,  opening window to increase airflow, keeping the radio off (car sharing) and sitting an appropriate distance for other travellers.

Please see Transport Scotland’s  website for advice on how to travel safely (transport.gov.scot) and refer to the information within the care at home IPC webinar slides on minimising risk for car sharing.

Providing care when clients have visitors in their homes

Under the Scottish Government levels guidance, where visitors are allowed in private homes, they are not required to wear face coverings . Therefore, you may attend a house where a client has family/friends in attendance. In these instances as per the Scottish Government level guidance they do not need to wear a face mask or face covering, however as a care professional you must continue to wear your face mask. The use of face masks are  important in care settings as you are more likely to be in close proximity of multiple individuals whom may have greater vulnerability to COVID-19. FRSM masks also provide a level of protection to you, as you provide care to your clients. In a person’s own home, if you are going to deliver care within 2 metres, it would be reasonable to ask your client or if you need help from a family member/friend there friend/ family member, to put on a face covering on during your visit. However, they are not obligated to do so and  the focus should be on ensuring you are correctly wearing your FRSM mask and appropriate level of PPE for the task.

Additionally, if there are visitors in someone’s home, it would not be unreasonable that you ask they go into another room, whilst you deliver any care.

It may also be appropriate to ask that a window is opened in the room you will be providing care before you attend and during your time with the client. to increase  ventilation.

We encourage all social care professionals to discuss measures that can be taken to support care in a safe way with their clients and where appropriate clients delegated representative.

Self-auditing and record keeping

A checklist/self-audit check for to staff regarding support in the home.

Currently national guidance does not prescribe specific checklists or self-audits for care at home staff. We recommend discussing the use of such tools with your employer. ARHAI may explore the provision of such tools in the future and will update guidance where appropriate in the event a tool is developed. 

Additionally, current national guidance does not prescribed record keeping for ancillary staff. We recommend  care staff discuss and agree the approach to this with your line manager and/ or employer.

Hierarchy of controls

The Hierarchy of control is a system that’s been well used to minimise or eliminate exposure to hazards or risk.  Traditionally, a hierarchy of controls has been used as a way of determining how to implement feasible and effective control solutions. The idea behind it is that the control methods at the top (elimination) are more likely to be effective and protective than those at the bottom. Eliminating hazards and risks, might not always be possible or it can be difficult. When this happens we must work through the hierarchy and select controls that will be most effective at reducing the risk. The hierarchy of controls can be used to support the selection of appropriate mitigations of risk as identified in organisational risk assessments.

Preventing transmission

More information can be found in the NIPCM Covid 19 Community health and care settings Addendum or the Scottish Government website.

National Infection Prevention and Control Manual: Scottish COVID-19 Community Health and Care Settings Infection Prevention and Control Addendum

Certificates of completion

Staff can download the pdf certification of attendance after watching the recording of the webinar.

The certificate can be edited to include your name and the date the video was used. To do this either click on the signature pen and type in your name and drop it into the same on the certificate or create a text box and type your name in. The date can be applied via the same functionality.

More information

If after completing the webinar and reading this additional supplementary information and signposted guidance you have any questions on the practical implementation of IPC within your care at home setting, please contact us on covidcarehomessupport@gov.scot. Please be sure to outline what setting you work in within this enquiry as this will help us to answer your query.


First published: 6 Aug 2020 Last updated: 22 Jul 2021 -