Care homes and infection control

[MRex]

Every year there are flu and notorious outbreaks that kill a lot of elderly in care homes. I was thinking back to when my dad was in a hospital ward with flu on the immediate next door ward. Staff were wearing PPE, the ward had big signs, the cleaner put on mask/ shoes etc to go in. Dad didn't catch flu, nor did anyone on his ward that we knew of. Then thinking about the few care homes I've been in, I've never noticed anywhere set up as a kind of sanitorium for patients who get unwell. It's not that you can prevent all deaths, but with complaints about patients being discharged from hospitals with covid (or I guess who could have a negative result if they are only just infected), I would have thought each care home would have had some procedures in place for flu that would have been adapted easily.

Just what are the practices for preventing the spread of disease in care homes? Do some care homes simply not have safe practices for isolating and caring for individuals who get unwell? Is the issue that they're profit making and it isn't tightly regulated enough for them to demonstrate these procedures? Too high staff turnover with poor training? Not enough money in total? Does covid PPE and infection control need to be much stronger than that used for flu? I've read about there being a lot of agency workers going between homes, which might infect a few people but then there should be isolation, so that shouldn't affect infection of everyone else, or is the theory that one asymptomatic person has turned up and just infected 50 in one day?

In our home and many others we have been putting any residents who have tested positive in one area of the home and sealing that corridor off as best as we can. Use of PPE and strict infection control now means we have no new cases after an outbreak and we hope to keep it that way.
However it’s not always possible to cohort residents as it is their home and they may not wish to move rooms.
I think the news has over hyped the situation so that the general public imagine all care homes have unchecked infection running throughout their homes this is not the case.

Thanks @ilovebagpuss. Is that similar to your normal flu procedures then? Do you think some care homes have better practices than others? What do you do if a client doesn't "wish" to move?

My mum had dementia, she lived in a carehome for 6 years. The home was never great in cleanliness unfortunately. My mum would never have been able to cope with any restrictions regarding covid because she would wander about all the time and also go into other residents rooms thinking she knew them. Several other residents were the same.
It must be a nightmare for both staff and residents just now dealing with covid.

Usually when a home has noro virus or similar they close to admissions and non essential visitors until it's gone, it doesn't usually matter because there are other homes in the area to deal with urgent admissions (eg to free up a hospital bed or prevent a hospital admission). The difference with Covid 19 is that there is such pressure to get people out of hospital that homes haven't been able to do this.

MRex, can't comment on cases of flu but in cases in norovirus/c.difficile, resident has to stay in their room. Staff will have to barrier nurse the resident--wash hands and put on PPE before entering, perform tasks, remove PPE properly and dispose of in clinical waste in room, wash hands, leave room. One should gel or re-wash hands after leaving the room because of touching door handles etc and these should be disinfected frequently.
This should apply to flu outbreaks as well as covid. Only difference is the wearing of masks.
All care homes seem to have different ways of doing though-some better than others.
In terms of dementia, this can be nigh impossible to manage due to not being able to isolate resident if they are mobile and like to wander. Staff generally have to put a lot of time and effort into enticing the dementia resident back to their room but they don't tend to stay there.

Aren't locked barriers put up to prevent dementia patients from wandering? I seem to remember them having several different barriers in the home my granddad was at.

In the care home I worked in, the dementia ward is locked but the resident can still wander around it. Those residents who remain in their rooms have their door shut to deter mobile residents from wandering in. I don't know what locked barriers are, tbh.

Thanks. They had doors that needed to be opened with a security tag between different areas, then some kind of wooden gates separating different bedroom areas, kitchen etc. It was a long time ago, I don't remember exactly what they were like.

At a minimum they should be nursing the same way they do for a case of MRSA, my exh caught MRSA when he was in hospital for an MS attack that went round the ward, all positive patients were moved to the furthest end of the corridor, separate staff looked after patients who tested positive, barrier nursing was compulsory, visitors had to gown up with gloves & aprons, nobody was allowed past the barrier point without PPE, the doors to the other end of the ward were locked & separate entrances & toilets used. That was for a disease that wasn't airborne, surfaces were constantly cleaned & deep cleaned when a patient left. They also had an area for new patients until swab results were received who were also barrier nursed. By doing this the ward was MRSA free again within a month & practice was permanently changed that new patients were kept separate until they tested negative.

I have a lot of friends that work in a healthcare setting which is not a care home but comes under being classed as a care home for CQC etc. They have had a problem with covid, almost half the care staff have gone down with it, yet they are still admitting new patients ( non covoid) from hospitals ? I don't understand how this is allowed ?

Babyroobs, this has been going on throughout. Govt policy, in the beginning, was to move elderly patients to care homes as step down beds to free up hospital beds but without testing them beforehand.
I thought this had changed and that new residents needed two tests before admission but I guess not.
The onus is on the care home to not admit any new residents if they are in the midst of an outbreak regardless of pressure from hospital/ccg (although I don't know if this is in the policy).

www.gov.uk/government/publications/coronavirus-covid-19-adult-social-care-action-plan/covid-19-our-action-plan-for-adult-social-care

It's not only that it's 'allowed'. It's that care homes are put under immense pressure from ward managers and social workers to accept referrals from hospitals. And your contract kind of depends on you doing that to some degree (If like mine and a lot of homes you've a contract which gives the LA nomination rights-we are a not for profit housing association-it's not quite the same for excusively private homes-lots are a mix of both).

This has always been the case. Any given Friday you'll find care managers all over the country arguing With hospitals trying to discharge people unsafely back to homes and to the community care services before the weekend. This situation is just a continuation of that.

I've refused to accept anyone from hospitals into my void room at service so far. We have had 5 suspected cases in service users And up to half the staff team off at any one time in the last 8 weeks. We weren't in a position to manage a new referral, Covid positive or not. And they couldn't guarantee not. I've had flack from commissioners and my own manager. But it's a hill I'm prepared to die on. I won't risk my existing service users and I won't put more strain on my team. Fully understand why people have been forced to do so though.

Channel 4 news did a huge segment on care workers. And how they are under paid , under valued, classed as low skilled and why they cant socially distance due to the appalling places some of them live in.

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Add message | Report | Message posterHeIenaDove Thu 14-May-20 19:14:10
A care worker interviewed lives in one room with her son and they share bathroom and kitchen facilities with ten other families

A care worker was ill with Covid for 28 days and was brought a hot meal every day by Hare Krishna She has to walk an hour to get to work and same to get home because she cant afford public transport

www.channel4.com/news/charities-demand-care-home-workers-are-paid-a-living-wage

@MurrayTheMonk - You sound like an excellent manager, I hope in time your efforts are proudly appreciated, meantime a massive well done for trying to do the right thing. If this is always an issue though, then what's the answer? Is there anything like halfway hospices that manage hospital-to-care-home/ own-home? Or should there be?

The answer would be NHS and social care working together as opposed to never co operating as is The case now. It's ridiculous and sometimes a bit pathetic. The only way would be to combine the funding streams I think. Otherwise we are both pitched against one another. It would need a huge change to funding and a huge change in thinking. Could be done if there was a will to.
Social care is currently the poor relation to the NHS (which is saying something-but if there was a race to the bottom social care would win by a country mile). But there is so much overlap. It needs to be centrally funded in the main (as it once was before it was all sold off or put out to tender-so privatised by stealth if you will). Would take a huge effort to do it.

Thanks, that makes a lot of sense.