Infection prevention and control
The following sections of this guidance cover operational requirements and considerations for public bodies and services to support them with infection prevention and control. Shared Care Scotland has collated case studies which illustrate how organisations have approached infection prevention and control in day services and other settings.
Staff, supported people and their families must follow the most up to date physical distancing guidance to ensure there is adequate space for physical distancing between supported people at all times.
To help with this, services may wish to consider measures for communal or busy areas such as entrance areas, corridors, kitchens, toilets etc. Services may wish to introduce measures such as one way systems, screens, barriers or distanced floor markings. This may also help avoid bottlenecks and ease travel around the setting. As well as supporting people to adhere to distancing requirements, these measures may make staff and people using the service feel more comfortable.
It may be beneficial to encourage the use of external doors to move between parts of the building where possible. This would reduce the density of use of the internal areas and also provide some movement and fresh air. Appropriate solutions will be specific to each location. Safety in all weathers and security issues would require to be considered in each location.
Signage or other communication about physical distancing measures may be needed if it differs from previous arrangements. NHS Inform has developed a communications toolkit including leaflets, posters and graphics available to print and share with staff, supported people and unpaid carers.
There may be some supported people who find it difficult to understand or practice physical distancing. It may be helpful to deploy staff who already have a relationship with that person or with specialist skills and knowledge to assist people to understand and practice physical distancing. For example, this may be required where the supported person has a cognitive impairment, autism or profound and multiple disabilities.
Physical distancing must be practiced alongside other infection control and hygiene measures such as hand washing and use of face coverings or personal protective equipment (PPE), where required.
Services may wish to consider identifying a small group of staff to allocate to supported people who have recently been shielding or are higher risk of COVID-19 due to underlying health conditions, age or other factors.
People using the service who are at higher risk, their unpaid carers and care workers should be given the opportunity to discuss and agree in advance whether additional modifications can be made to the support provided to ensure effective physical distancing is possible. This may include:
- adapting the nature of the support offered
- applying environmental changes to minimise contact such as physical barriers, markings or changing placement of equipment or seating
- exploring whether digital tools could replace the need for face-to-face discussion in some cases
In order to support NHS Scotland’s Test and Protect service, services must collect the details and visit dates of those who are accessing the setting. This includes staff, people using the service, accompanying care workers and unpaid carers or family who enter the setting. More information on this, including on registration with the Information Commissioner’s Office, the lawful basis for data processing and collection and managing data can be found in the Coronavirus (COVID-19): tourism and hospitality sector guidance. It is important that providers ensure that, where relevant, any data which they collect, process and use is done so in accordance with the GDPR or the Data Protection Act, where this legislation applies.
For full and up to date information on coronavirus symptoms and advice on what to do if someone has symptoms, see NHS Inform. The most common symptoms of coronavirus are a new:
- continuous cough
- fever/high temperature (37.8C or greater)
- loss of, or change in, sense of smell or taste (anosmia)
Some people will have more serious symptoms, including pneumonia or difficulty breathing, which might require admission to hospital.
The general coronavirus advice on NHS Inform provides additional information on when to get help from NHS 24 (111) and when to call 999.
NHS Inform has setup a free helpline (0800 028 2816) to help with any questions about coronavirus that can’t be answered on their website.
Staff, people using the service and carers who develop symptoms consistent with COVID-19 must follow the latest Test and Protect guidance, which includes staying at home, self-isolating, and contacting the NHS for advice on testing. Those who do test positive for COVID-19 and their close contacts, identified through contact tracing, will be asked to self-isolate in line with the latest advice.
If staff, supported people or carers (paid or unpaid) attending the service have been in contact with someone who has symptoms or tested positive for COVID-19, they must follow the Test and Protect guidance, as above.
If someone becomes unwell while in the setting, a ventilated space must be available for those who become symptomatic to wait in until they can safely leave. Where space allows, you should prevent contact with any other individual in the setting. Care must be taken however for the appropriate levels of supervision of and support for all individuals. Read the advice on what to do if someone is symptomatic.
Services should use the aforementioned advice to develop a clear procedure for what to do should a supported person or staff member displays symptoms of COVID-19 when in the setting. Please see Health Protection Scotland’s COVID-19 guidance on contact tracing in complex settings.
Services must also contact their local Health Protection team for advice if they have an increased rate of background illness.
Services must also maintain an accurate register of absences of staff and whether these are due to suspected or confirmed COVID-19. This will enable employers to maintain records on staffing capacity in individual settings and to make judgements about whether it will be necessary to close settings temporarily due to high levels of staff absence.
The procedures for outbreak management are well established.
The infection prevention and control measures set out in this guidance will help to minimise the risk of a COVID-19 outbreak in adult day service settings.
The definition of an outbreak is 2 or more confirmed cases within 14 days within the service.
If there is a suspected or confirmed outbreak in a service (staff or supported people) the local Health Protection team must be informed immediately and, with input from the local Director of Public Health, may advise the closure of the setting to prevent further transmission.
If an outbreak is confirmed, services should work with their local Health Protection team to manage it. Actions that services may need to be involved in include (but are not restricted to):
- attendance at multi-agency incident management team meetings
- communications with supported people, carers and staff
- providing records of the building layout / attendance / groups
- implementing enhanced infection, prevention and control measures
Staff providing direct care to individuals should wear a Fluid Resistant (Type IIR) Surgical Mask at all times throughout their shift, which includes when they are in contact with their work colleagues. Any other non-clinical staff members should also wear a Fluid Resistant (Type IIR) Surgical Mask if they need to enter an area where direct care is undertaken. Where direct care is not being undertaken but where physical distancing isn’t always possible (e.g. corridors, offices and other public areas), face masks/coverings should be worn by all staff.
Health and care staff should use their professional judgement, and undertake a risk assessment, in instances where it is necessary to remove the face mask for a short period, and ensure it is safe to do so - for example, when the person they are supporting / caring for is showing signs of distress, or to communicate with a person who lip-reads.
Staff are not required to wear a face mask during mealtimes in staff restaurants but should do so when not seated at a table, such as when queueing, entering or leaving the canteen (in line with other hospitality venues). Again, carrying out physical distancing is essential during these times as is hand hygiene using alcohol rub where hand washing facilities are not available. During breaks, and where possible, consideration should be given to facilitating the use of outdoor spaces, which provide a safer alternative than enclosed indoor spaces. Alternatively, consideration should be made to the staggering of staff breaks etc.
Please see the most up to date interim guidance on the extended use of face masks for more detailed guidance and information for staff who suffer from breathing difficulties or other discomfort or distress when wearing a facemask.
Services should follow the PPE advice set out in the Health Protection Scotland information and guidance for social, community and residential care settings.
Staff, and supported people if necessary, should be supported with training in the use of PPE, where required. Health Protection Scotland has guidance which explains the correct use of PPE and can be used for training.
Day services can access PPE through their local social care PPE Hub when their normal supply routes fail. Services should contact their health and social care partnership (HSCP) to find out more about how the PPE Hubs work, if they don’t have this information already. The HSCP will be able to share the details of the local Hub. Services can also contact the NHS National Services Scotland Social Care PPE Support Centre on 0300 303 3020 to find out the details of their local Hub.
Face coverings – people attending the service
People who attend an adult day centre are not required to wear face coverings unless that service is accommodated in one of the settings in which a wearing face covering is mandatory, as set out in the guidance on face coverings.
Arrangements should be implemented for enhanced hand hygiene in the setting. There is best practice advice from the National Infection Prevention and Control Manual on hand hygiene and a video to demonstrate the correct way to wash your hands from NHS Education for Scotland (NES).
Where possible, disposable paper towels or kitchen roll should be used to dry hands. Where this is not practical, individual towels must be available, and these must be laundered after each use.
Services may wish to supply antibacterial hand gel at the entrance to the setting and in each room.
General information on the use of care equipment is covered in Health Protection Scotland COVID-19: Information and Guidance for Social, Community and Residential Care Settings.
Where possible, single use equipment should be used and disposed of when finished with. If this is not possible, equipment should be easy-clean and wiped down after use.
If operating group sessions, equipment should only be used by one individual per session, with routine decontamination after use following the Health Protection Scotland guidance on Decontamination of reusable non-invasive care equipment.
Soft furnishings such as throws should be removed from the area, where possible. Staff may wish to consider keeping any soft items needed for comfort and feelings of security. Where soft items are in use additional hygiene measures should be introduced such as washing after every use. Supported people can bring items for personal use if required but must be clean and in a clean bag and taken home following each session.
If premises have been closed for many weeks or if parts of the building have been out of use for a long period, the provider must undertake appropriate and thorough cleaning of the premises prior to re-opening. All cleaning should be carried out in accordance with the environmental decontamination guidance in the Health Protection Scotland COVID-19: Information and Guidance for Social, Community and Residential Care Settings.
For toilets, including changing places, services must also follow Scottish Government guidance on opening public and customer toilets during the coronavirus pandemic.
Consideration should be given to the cleaning strategy to be adopted in the setting once it re-opens. This may be an extension of the cleaning regime normally used in the setting, with table tops, chairs, doors, light switches, banisters, equipment sinks, toilets etc. being cleaned more regularly. There should be routine cleaning and disinfection of frequently touched objects and hard surfaces, this should include equipment staff use, (e.g. telephones, keyboards, door handles, and tables).
If a suspected or confirmed case of COVID-19 has been identified on the premises, services should follow the environmental decontamination Health Protection Scotland COVID-19 Information and Guidance for General (Non-Healthcare) Settings, including on the use of PPE in this situation.
Services should follow Health Protection Scotland COVID-19 Information and Guidance for General (Non-Healthcare) Settings on infection prevention and control in shared kitchen environments. Where refreshment and food preparation are undertaken, staff must adhere to food handling procedures according to local guidance and legislation. Further advice may be sought from the local environmental health department if required.
Additional advice on risk management and infection control when handling food can be found on the Food Standards Scotland website.
Where applicable, ventilation systems should be checked or adjusted to ensure they do not automatically reduce/increase ventilation levels due to differing occupancy levels.
The opening of doors and windows where is safe to do so should be encouraged to increase natural ventilation and also to reduce contact with door handles. This should not include fire doors. Further advice is available from the Health and Safety Executive.
Transport is an integral part of many day services and may include provider-owned vehicles, community transport, public transport, family or carers driving, or taxis. Transport will need to be planned in advance and it is likely that group vehicles, such as minibuses will have reduced capacity.
Protocols for the modification, cleaning and maintenance of vehicles should be implemented by all service services:
The arrangements for arrival, departure, drop off and pick up of supported people requires careful consideration to ensure that large gatherings of people can be avoided, and physical distancing maintained. Physical distancing between staff, supported people and carers must be adhered to at all times. Where possible, carers who are dropping someone off or picking them up should not enter the building.
Approaches that services should consider include the following:
- staggered and allocated arrival/ departure/ drop off/ pick up times
how to remain safe when walking, cycling and travelling in vehicles or on public transport during the coronavirus outbreak
- consideration of additional access points. This could include supported people going straight to the area in which their group is meeting, which could be indoors or outdoors, after washing their hands if no hand washing facility, antibacterial hand gel should be available.
- for those arriving by car, supported people and carers may be encouraged to park further away from the setting and then walk to avoid congestion, or alternatively use active travel routes where feasible. Car-sharing with other households should be discouraged
- encourage supported people and carers who do not use transportation provided by the service to plan their journey to and from their setting
- make arrangements in advance with the supported person and carer if it is likely that someone may be distressed about returning to the service
- encourage staff and unpaid carers to follow physical distancing when travelling to and from the service, as advised in the latest guidance on