Coronavirus (COVID-19) infection control for care providers
Updated: 30 September 2020
Managing infection control is essential to prevent the spread of coronavirus (COVID-19) for your setting or service. As care providers, you are likely to be providing essential care and support to people, which will often require close contact. This quick guide sets out best practice for care providers to remain safe and prevent COVID-19 from spreading.
Looking for training for your staff? See our free infection control e-learning.
How does coronavirus (COVID-19) spread?
As COVID-19 is a new disease, we are still learning about the effects of the virus and how to best prevent its spread. However, we know that COVID-19 is mainly spread through two methods:
- respiratory droplets released when someone sneezes, or coughs and sometimes exhales
- touching surfaces contaminated with respiratory droplets that can then be transferred by touching your eyes, nose or mouth.
The virus has been found in stool samples of people confirmed as suffering from COVID-19. Whilst this is not thought to be the main transmission route, all secretions (excluding sweat) and excretions (such as diarrhoea) from those suffering or suspected to be suffering from COVID-19 should be managed as being possibly infectious.
How to help prevent the spread of coronavirus (COVID-19)
As we move towards the winter, infection rates are increasing and restrictions tightening once again. It remains vital to take the following steps to help contain the spread of the virus:
- regular hand washing for 20 seconds or more
- covering your face in enclosed spaces
- keeping a distance of 2 metres (or 1 metre plus other precautions) from people you don't live with
- working from home where possible
- meeting in groups of no more than six people.
If any one person in a household develops symptoms of coronavirus, everyone in that household should self-isolate.
Advice for all
Public Health England (PHE) has advised the public to:
- always carry tissues and use them to catch a cough or sneeze, then bin the tissue, wash hands, or use a sanitiser gel
wash your hands more often than usual, for 20 seconds each time with soap and water or hand sanitiser, especially when you:
- get home or into work
- blow your nose, sneeze or cough
- eat or handle food.
- avoid touching your eyes, nose and mouth with unwashed hands
- avoid close contact with people who are unwell.
Test and trace
The NHS test and trace service aims to provide access to quick testing and to trace contacts of those with a positive result to let them know that they must self-isolate. The NHS COVID-19 app has now been launched to help with contact tracing.
Testing is available for anyone with coronavirus symptoms, and for asymptomatic health and care staff, and care home residents. The Government has issued guidance on how to refer yourself, an employee or care home staff and residents.
What can care homes do to stop the spread of coronavirus (COVID-19)?
The Government has issued guidance for adult social care, including care homes. Further detail is included in the COVID-19 winter plan.
For people living and working in care settings, infections can be serious and, in some cases, life-threatening. They can also make existing medical conditions worse. Regular contact with staff, other residents, family and friends and the shared living space all mean infection can easily be passed around. It is therefore vital to take the steps that can help prevent COVID-19 occurring and spreading.
Isolation and testing
Current guidance says that all residents being discharged from hospital or another setting, or admitted from the community, should be isolated in their own room for 14 days. If people are part way through an isolation period when they move, they should remain isolated until the 14-day period is complete.
Any resident admitted to hospital should be tested for COVID-19 prior to discharge. If the result is not yet known, they should be isolated until it is received.
As testing and tracing is crucial to an effective COVID-19 response, care homes should keep a temporary record of current and previous residents, visitors and staff.
Handwashing and hand hygiene
Frequent hand washing and good hand hygiene is an essential method to control infection in your setting. All people and staff should decontaminate their hands with alcohol-based rub when moving in and out of areas where care for suspected and confirmed cases of COVID-19 is being delivered.
Hand hygiene must be performed before every direct contact with a resident, and any contact that could result in your hands being contaminated such as touching care equipment, PPE or waste.
There are three important stages to cover when talking about suitable hand hygiene: when you need to do it, preparing to wash your hands and the best way to wash your hands.
When to wash your hands Open
There are five important moments when you should clean your hands:
- just before you provide care to a resident
- as soon as you have finished providing care to a resident
- straight after you have been exposed to any body fluids
- straight after touching the person’s surroundings (e.g. chair, door handle) if this may have contaminated your hands
- as soon as you take off protective gloves.
Preparing to wash your hands Open
To prepare for hand hygiene, it is recommended that you:
- expose your forearms so that they are bare from the elbows down
- remove all hand and wrist jewellery, a single plain metal finger ring is permitted; however, it should be removed or must be moved during hand hygiene
- ensure finger nails are clean, short and that artificial nails or nail products are not worn
- cover all cuts or abrasions with a waterproof dressing.
Washing your hands Open
When washing your hands, you should:
- do so for 20 seconds, or the time it takes to sing ‘Happy Birthday’ twice
- wet your hands with water and apply enough soap to cover your hands
- use one hand to rub the back of the other and in between fingers – do the same with the other hand
- rub hands together and clean between your fingers
- rub fingers against the back of both your palms
- rub your thumbs using the other hand – do the same with the other thumb
- rub the tips of your fingers on the palm of the other hand – do the same with the other hand
- rinse your hands with water
- dry your hands with a disposable towel
- use the disposable towel to turn the tap off.
Where running water and soap are not available, an alcohol-based hand sanitiser should be used instead. Hand sanitiser for staff should be close to where care is provided, or personal dispensers used. Hand sanitiser should be used for 20-30 seconds to decontaminate the hands.
Respiratory and cough hygiene – ‘Catch it, bin it, kill it’
To minimise transmission of COVID-19 through respiratory droplets, tissues and waste bins should be available to everyone. All staff, residents, users and visitors should:
- use disposable tissues to cover the nose and mouth when sneezing, coughing or wiping and blowing the nose
- dispose of used tissues immediately in the nearest bin
- clean hands after coughing, sneezing, using tissues, after any contact with respiratory droplets or objects contaminated with respiratory droplets
- not touch their eyes, mouth and nose
- help those people who may need help with containing their respiratory droplets such as the elderly
- provide those who are immobile with a bag close by for immediate disposal of tissues
- ensure in common areas, or during transportation, that people with symptoms wear a fluid-resistant surgical face mask to minimise dispersal of their respiratory droplets or contamination of surfaces
- clean frequently touched surfaces.
Personal protective equipment (PPE) guidelines
The current guidance for care homes can be found at COVID-19: how to work safely in care homes. Guidance has also been issued for domiciliary care at COVID-19: how to work safely in domiciliary care. These pages include videos and diagrams about putting on and taking off PPE. PPE can be ordered via the PPE portal.
The guidance explains the type of PPE required in the following circumstances:
When providing personal care which requires you to be in direct contact with the person (e.g. touching) OR you are within 2 metres of anyone who is coughing. Open
- Disposable gloves
- Disposable plastic apron
- Fluid-repellent surgical mask
- Eye protection may be needed with some clients but not all. Please refer to the PHE guidance on page 3
These principles are also suitable for extra-care housing schemes and live-in homecare. These recommendations assume that care workers are not undertaking aerosol generating procedures (AGPs).
When you need to be within 2 metres of the person, but do not need to touch them and no one within 2 metres is coughing Open
- Type II surgical mask
Disposable gloves and a plastic apron may be required for other infection prevention precautions or if the task involves anyone who is shielding.
If you are within a metre of a person with possible or confirmed COVID-19, Public Health England (PHE) recommends:
Fluid-resistant facemasks Open
Fluid-resistant facemasks can be used to reduce contact with respiratory droplets by capturing some droplets when you are providing care in close contact. Both the person displaying symptoms and staff providing care should wear facemasks, preferably.
Aprons protect staff uniform from contamination when providing direct care and during environment and equipment decontamination. Fluid-resistant gowns must be worn when disposable aprons cannot provide adequate cover from splashing and body fluids. If non-fluid-resistant gowns are used, a disposable apron should be worn underneath.
Disposable gloves Open
Disposable gloves must be worn when providing direct patient care and when exposure to blood or body fluids is likely, as well as during environment and equipment decontamination.
Eye protection / visor Open
Eye protection / visor should be worn when there is risk of contamination to the eyes from body fluids. This may be a surgical mask with visor, or polycarbonate safety spectacles or equivalent. Regular vision-corrective spectacles are not considered adequate eye protection.
Note: PPE is only effective when combined with: hand hygiene (cleaning your hands regularly and appropriately); respiratory hygiene and avoiding touching your face with your hands, and following standard infection prevention and control precautions.
PPE should be:
- compliant with relevant BS/EN standards
- located close to where it will be used
- stored correctly to prevent contamination, and expiry dates adhered to.
When using PPE, you should:
- ensure you have been trained in the proper use and on donning and doffing PPE – videos are available for aerosol generating procedures (AGPs) and non-AGPs
- only use each PPE item once
- change PPE between different care tasks for one person
- change PPE between care tasks for different people
- remove PPE immediately and dispose of used items correctly
- practice hand hygiene and extend to exposed forearms after removing any element of PPE.
Laundry and waste management
- Wash items as appropriate in accordance with the manufacturer’s instructions.
- Dispose of items that are heavily soiled with body fluids, such as vomit or diarrhoea, or items that cannot be washed, with the owner’s consent.
- Store personal waste (such as used tissues, incontinence pads and other items soiled with bodily fluids) and disposable cleaning cloths securely within disposable rubbish bags. Place these bags into another bag, tying securely and keep separate from other waste within the room. This should be put aside for at least 72 hours before being disposed of as normal.
- Place dirty laundry on the floor or other surfaces to prevent contamination.
- Shake dirty laundry before washing to minimise the possibility of dispersing virus through the air.
Note: According to Government guidance, you don't need to separate dirty laundry that has been in contact with an ill person from other people’s items.
Staff uniforms and clothing should be protected from contamination by PPE. For staff taking uniform home for laundering, use a plastic bag.
Natural ventilation can be an effective environmental measure to reduce the risk of spread of infections. Therefore, where safe and appropriate, the opening of windows and doors should be considered.
More information can be found on the World Health Organization (WHO) website.
Best practice management of people at high risk or with symptoms of COVID-19
Use the drop-downs below for specific advice.
People living in care homes Open
Some people living in care homes may be at risk of serious illness should they catch coronavirus. Although the period of shielding was paused at the start of August, it is vital that both care staff and residents continue to follow the main advice from the Government outlined at the start of this quick guide, including social distancing measures.
Care home residents may not present with the typical (cough/fever) symptoms of this virus and may not be able to report a loss of taste or smell. They should therefore be assessed twice daily for:
- onset of high temperature (37.8 degrees or above)
- new persistent cough.
Softer signs of ill-health should also be assessed, including:
- shortness of breath
- less alert
- new onset of confusion
- being off food and/or reduced fluid intake
- diarrhoea or vomiting.
Anyone who develops symptoms should be isolated in a single room, using a separate bathroom if possible. A test should be arranged, and full infection-control measures put in place. If this is a new outbreak and/or it has been 28 days since the last case of coronavirus, the local Health Protection Team should be informed.
Any resident exposed to a person with possible or confirmed COVID-19 should be isolated (or grouped with others in the same position if isolation is not possible) until 14 days after their last exposure. If they develop symptoms, they should be tested.
Anyone discharged from hospital or from another care setting, and all new residents should be isolated for 14 days in their own room.
Managers can use the care home portal to arrange tests for staff and residents.
Movement of staff within the care home should be restricted as far as possible. If any staff member develops symptoms, they should isolate for 10 days and be tested. Any member of staff with a symptomatic member of their household should isolate for 14 days. Staff must also not work if they are told to isolate by NHS Test and Trace.
Managers should encourage and support staff and residents to receive a flu vaccination.
People supported by home care services, including those living in extra care housing Open
Many people receiving care and support from home care services will be at risk of serious illness should they catch coronavirus. Although the period of shielding paused at the start of August, it is vital that both care staff and people using the service continue to follow the main advice from the Government outlined at the start of this quick guide. Providers should also reduce contact between members of staff where possible, and minimise the number of different people going into the homes of those considered at higher risk.
Care workers must follow the guidance on use of PPE, including how to safely put it on and take it off. If a care worker develops symptoms of COVID-19, they must self-isolate and take a test.
Providers should assume that anyone newly receiving support from their service may have COVID-19 for the first 14 days and care workers should use PPE as advised for caring for someone with the virus. If a person being supported by the service is discharged from hospital and the result of their COVID-19 test is not known, assume that the test may be positive for 14 days (or until the result is received) and use PPE as advised.
If a person develops symptoms, they should be supported to contact NHS 111 by telephone or online. Care workers should also inform their manager.
People who receive direct payments Open
Guidance has been issued for people receiving direct payments and personal assistants.
Direct payments should continue as before, and local authorities and CCGs should provide support to ensure people stay safe.
Everyone with symptoms, including personal assistants (PAs), is eligible for testing. Tests can be delivered to the person’s own home. Specific guidance has been issued that invites PAs to register for coronavirus testing where they are self-isolating due to experiencing coronavirus-like symptoms or because a member of their household has symptoms.
It is essential that the correct PPE is used by PAs. Local authorities and CCGs will help source PPE if it proves difficult to get hold of.
Restricting visitors to care homes is one way to help reduce the spread of COVID-19, and the current guidance emphasises that alternatives to in-person visiting should still be considered wherever possible. Care homes can currently enable limited visits, based on a continuous risk assessment that considers:
- current government guidance
- the COVID-19 winter plan
- the suitability of visiting in their local area (provided by the director of public health)
- infection rates within the care home.
Wherever possible, visits to any resident should be limited to a single constant visitor. Two constant visitors is the maximum.
Each care home should establish a visiting policy, including details about how the risk of infection will be minimised. The policy should also consider whether residents needs make them particularly vulnerable or make visits particularly important. Details of the policy should be communicated clearly to all potential visitors. The guidance recommends that:
- Visits should be booked in advance and visitors should be encouraged to walk or drive to the care home.
- A temporary record of visitors (including address and telephone number) and who each visitor interacts with should be maintained for test and trace purposes.
- Screening for symptoms should take place before visitors enter the care home.
- Visitors should have no contact with other residents and minimal contact with care staff
- Visitors should be supervised at all times to make sure measures to reduce the spread of infection, including social distancing, are kept to.
- Visitors should be reminded to wash their hands for 20 seconds or use hand sanitiser on entering and leaving the care home. They should also catch coughs and sneezes in tissues, and clean their hands after disposing of the tissue.
- Visitors should be asked to avoid bringing any gifts that cannot be easily sanitised.
The local director of public health will provide a regular assessment of whether visiting care homes is likely to be appropriate, and will impose restrictions if local rates of infection start to rise. In ‘areas of intervention’ all visits should stop immediately, except in circumstances such as end of life.
Visitors and personal protective equipment (PPE)
In most situations, visitors will only need to wear a face covering. They should be advised to clean their hands before and after putting it on and taking it off.
If the visitor is likely to need to be in close personal contact with the resident, they should wear appropriate PPE.
Occasionally (for example at the end of life) a resident with COVID-19 may be visited. In this instance, additional PPE (an apron and gloves) should be considered.
To minimise the risk of infection further, consider the following steps:
- Enabling visits to take place outdoors.
- Using plastic or glass barriers between residents and visitors.
- Having designated visiting rooms that are well-ventilated.
- Decontaminating any areas used by visitors several times a day.
Read more about infection control and COVID-19
- NICE Coronavirus guidance
- NHS Coronavirus website
- Official guidance issued jointly by the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS) and Public Health England as official guidance.
- Hand decontamination (NICE)
- How to wash your hands (NHS)
- Guide to donning PPE (PHE)
- Guidance on shielding vulnerable groups (PHE)
- Helping to prevent infection: A quick guide for managers and staff in care homes (NICE/SCIE)
Support from SCIE
SCIE's COVID-19 hub contains more relevant information including safeguarding, Mental Capacity Act and infection control. It can be used when working and supporting people who are isolated or vulnerable through COVID-19, and can also be shared with community groups.