Infection prevention and control in care homes

Page last updated: 23 June 2022
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Our inspectors use these questions and prompts to look at how well staff and people living in care homes are protected by infection prevention and control (IPC) - key line of enquiry S5.

The questions help us to gather information about the service's strengths. They also help us understand if there are any gaps or concerns about infection prevention and control. Where there are we aim to signpost the service to resources that could help.

Although the questions are written for care homes, we plan to adapt them to other types of service.

Adult social care inspection information gathering tool: infection prevention and control

Instructions and guidance

The tool will help you collate relevant information to provide assurance that a care home has appropriate infection prevention and control measures in place.

Add in your notes and observations with evidence to support your findings. Highlight good practice and, where there are shortfalls, please support services by signposting to relevant resources.

You should pre-populate the form as much as possible from other sources before or after the site visit to reduce time spent on premises. This is particularly important when community infection rates are high and risks of infection transmission and exposure increase. Use information such as from the monitoring information, notifications and feedback.

Choose whether you are assured, somewhat assured or not assured for each topic question. This will provide a quantitative measure to understand how well the care home sector is responding to key areas of IPC practice.

For the key practice findings, you only need to record key practice and innovation that you think other services could learn from rather than what we expect providers to be doing in complying with guidance. With poor practice, we want you to highlight unexpected failings and concerns that are things that providers may not recognise but has considerable impact on safety in relation to IPC.

At the end of the form are a series of closed questions that we want you to answer (mainly) yes or no based on your assessment of the service. This will provide us with a better understanding of implementation of IPC in care homes and allow us to collate and report our findings in a timely manner.


1. Are all types of visitors prevented from catching and spreading infection?

  • What measures can you see in place to minimise the risk of relatives and friends, professionals and others visiting from spreading infection at the entrance and on entering the premises?
  • What procedures are visitors asked to follow during the visit? Do they reflect national guidance? How are they communicated to people? Do the procedures appear to be complied with by visitors?
  • What alternative arrangements to visiting in person are available? For example where someone is self-isolating due to a transmissible infection, or the home has an active infection outbreak?
What good looks like and guidance

What good looks like

Providers should make sure they focus on enabling visits wherever possible. Whenever visits are restricted this should be based on recognised guidance and local Health Protection Team (or equivalent) advice.

  • Provider is transparent in terms of sharing information and communication with friends and family about current infections so they can understand the risks, the IPC measures in place and decisions around any restrictions on visits.
  • People have individual risk assessments. Visitor plans are included as part of their care plan to make sure their social contact needs are met.
  • Visitors are not limited, unless this is absolutely necessary to ensure the safety of people, their visitors and staff. Any limits or restrictions on visits should be in accordance with national guidance and local Health Protection Team (or equivalent) advice.
  • All visitors are asked to refrain from entering the care home if they are unwell. Visitors should be supported to understand why they should not enter the care home if they are feeling unwell.
  • Visitors should follow any current national testing advice in place, including if applicable, showing proof of their negative test result prior to entry.
  • There is prominent signage and instructions to explain what people should do to ensure safety. 
  • Information is easily accessible on arrival or before visits to ensure visitors follow guidance, procedures or protocols to ensure compliance with infection prevention control.
  • Facilities are in place to wash hands for 20 seconds or use hand sanitiser on entering and leaving the home. Accessible guidance on correct hand hygiene is available.
  • Visitors are supported to wear a face covering and any other recommended PPE when visiting.
  • Visitors are supported to wash hands before and after PPE use as recommended by guidance.
  • Where there are necessary restrictions to visits, alternative forms of maintaining social contact are used for friends and relatives. For example, keeping in touch using video calls, weekly newsletters to family members, visiting in communal garden or through meeting at a closed window and using a phone to communicate with. Remote consultations are also considered by other visitors such as professionals and clinical consultations

Infection prevention and control guidance

COVID-19 guidance

Support and resources


2. How are people supported to use and access their environment safely?

  • Where appropriate, how does the provider support people who use the service to understand basic infection control precautions they could follow, for example hand washing or respiratory and cough hygiene?
  • How do staff support people to minimise close physical contact with others or maintain social distancing when needed? For example, where someone has symptoms of transmissible infection or where there is an infection outbreak in the home.
  • When it is advisable for people to social distance or isolate, how are people supported to minimise the impact on their well-being?
  • How are people supported to access other services safely, for example attend medical appointments?
  • What mitigation is in place where it is not always possible to minimise close physical contact or socially distance when it is recommended? For example, during an active outbreak.
  • Is isolation, cohorting and zoning implemented effectively where there is infection or an outbreak?
What good looks like and guidance

What good looks like

Note: the national COVID-19 response has moved from an active pandemic management stage to managing COVID-19 as part of general good IPC practice. The risk of transmission of COVID-19 as well as other community based infections remains and providers should continue to assess the risks to people using the service and follow best practice and government guidance to minimise risks to people using their service.  

  • People are supported to understand and follow basic IPC precautions such as hand hygiene and respiratory and cough hygiene.
  • People using the service are monitored for signs of being unwell and symptoms of transmissible infections.
  • The provider keeps people’s individual risk assessments under review and has identified which people are at particular risk of infection (for example where someone is not able to follow IPC precautions, is not fully vaccinated against respiratory illness or is immunocompromised).
  • People are supported to minimise close physical contact and social distance or isolate when when this is advisable to prevent the spread of infection.
  • Staff are provided with PPE, which meets recommended national guidance to carry out their role safely.
  • Staff wear PPE, which meets recommended national guidance and is appropriate for the care they are delivering and the level of infection risk. For example, where standard IPC precautions are being followed, personal care is being delivered or where a person is isolating due to a transmissible infection.
  • The provider makes sure they appropriately share relevant information with others around infection symptoms or risks when a person accesses another service, for example where they are due to attend a medical appointment.
  • Provider follows current national guidance and Health Protection Team (or equivalent) advice on isolating and cohorting symptomatic residents. Ideally, people should be isolated in single occupancy rooms. Where single room occupancy isn’t practical, the provider should follow national guidance and local Health Protection Team (or equivalent) advice on cohorting symptomatic residents together.
  • Residents in isolation should not attend communal areas, including shared lavatories and bathrooms. Alternative facilities are provided
  • Arrangements are in place so staff appropriately social distance during breaks when needed, for example when there are high levels of community infection or where there is an infection outbreak in the home.
  • The provider considers whether arrangements for visits out need to be modified during times of increased risk, for example during times of high community infection or during an outbreak. This will be based on dynamic risk assessment.

Infection prevention and control guidance

COVID-19 guidance

Support and resources


3. Are people admitted into the service safely?

  • How are the risks of people catching or spreading infection assessed prior to admission?
  • What measures are in place to prevent people with a known or suspected infection from spreading it when they are admitted to the service from a health or social care service or from the community?
  • What measures are in place to prevent people who potentially have an infection from spreading it when they are admitted to the service from a health or social care service or from the community?
What good looks like and guidance

What good looks like

  • The provider carries out risk assessments prior to admitting people to the service. This includes factors that place someone at a higher risk of catching or spreading infection. For example, they have symptoms of infection, have been exposed to known infection or personal factors such as vaccination status, immune status, medications that impact immune response, invasive devices such as catheters or wounds. Risk assessments should also include a person’s ability to understand and carryout IPC measures, such as hand washing. Risk assessments are kept under review.
  • Where possible the provider discusses people’s individual risk assessments with them and helps them to understand the actions that can be taken to minimise the risk of infection.
  • Risk assessments contribute to planning a person’s care and determine whether any specific IPC precautions are required. 
  • The service follows any current national COVID-19 testing guidance in place when they are admitting people to the care home.
  • Where a person admitted to the care home tests COVID-19 positive they are supported to isolate in their own room in accordance with current national guidance.
  • There are also clear procedures from point of entry into the care home that minimise risk of transmission when moving an isolating person to their room.
  • People are monitored for signs of infection as standard practice once admitted to the care home.
  • For people who lack mental capacity, the service has considered if any new measures and arrangements in relation to IPC amount to a ‘deprivation of liberty’ and take appropriate action.
  • If there is an infection outbreak in the home the provider considers whether it is appropriate to admit new people to the service. Decisions to admit people will be supported by risk assessments.

Infection prevention and control guidance

COVID-19 guidance

Support and resources


4. Does the service use PPE effectively to safeguard staff and people using services?

  • Have staff been appropriately trained in PPE use for their particular role and level of infection transmission risk?
  • When, where and how are staff donning and doffing PPE? How is PPE disposed of after use?
  • Do the levels of PPE used comply with national guidance?
  • Are PPE stocks stored appropriately? Are they accessible where they are needed?
  • People using the service may be fearful or anxious seeing staff wear PPE. What measures are in place to support communication and reassurance? (For example people who are deaf, autistic people, people with a learning disability, people with dementia.)
What good looks like and guidance

What good looks like

  • Staff have received appropriate training in PPE use. This should include the recommended PPE that should be worn depending on the task being carried out and the level of infection risk, sessional and individual use, correct donning and doffing and safe disposal of used PPE.
  • Use of PPE is in accordance with national guidelines and is appropriate to the role of individual staff and level of transmission risk. For example, where standard IPC precautions are being taken, or enhanced precautions when someone being cared for has a suspected of confirmed infection.
  • Signage on donning and doffing PPE and handwashing is visible in all required areas, including for visitors.
  • Staff observed to put on and take off PPE as per guidelines.
  • Staff observed to follow good hand and respiratory hygiene practices using appropriate products.
  • Disposal of used PPE prevents cross-contamination and follows guidance, in particular single use items and how PPE is disposed of safely.
  • The provider has assessed the impact on residents of how PPE may cause barriers to effective communication or fear and anxiety for residents, for example people who have a hearing impairment or autistic people, people with a learning disability or people with dementia. The provider has a risk assessment and plans in place to mitigate these concerns.
  • The provider has addressed issues where PPE may not fit appropriately because of staff gender or other protected characteristics

Infection prevention and control

COVID-19 guidance

Support and resources


5. How does the service respond to people with symptoms of transmissible infections?

  • What does the service do if someone has symptoms of an infection, for example a respiratory or gastrointestinal infection?
  • How do staff and people using the service access COVID-19 testing in accordance with current national guidance?
  • What does the service do if a resident or staff member has a positive COVID-19 test?
  • What does the service do if people or staff refuse a COVID-19 test? And understand why they refuse?
  • How does the provider assure itself that staff understand and meet relevant recommendations (testing and isolation) when they have a confirmed COVID-19 infection?
  • How does the service support people to take medicines as prescribed to treat specific infections? For example, anti-viral or antibiotic medication?
  • How are people supported to retain or return to their usual levels of ability during or following a period of isolation?
What good looks like and guidance

What good looks like

  • Services have a good understanding of the signs and symptoms of transmissible infections, including respiratory or gastrointestinal infections in the people they care for.
  • Where an infection is suspected the provider takes appropriate steps to seek clinical advice and provides reasonable support to a person to access recommended diagnostic testing.
  • Where people are unable to verbally communicate, services have a good understanding of how to identify when someone feels unwell.
  • COVID-19 testing for staff and residents has been conducted in line with current government guidance, including any outbreak testing.
  • Care home managers know how to access COVID-19 testing kits.
  • Where people are prescribed anti-viral medication, they are supported to access it and take it as prescribed.
  • Where people are prescribed anti-biotic medication, they are supported to access it and take it as prescribed, including completing the full course.
  • Risk assessments have been carried out on people using services and staff belonging to higher risk groups and actions have been taken to reduce the risks.
  • People are supported as much as possible to retain their usual levels of ability during isolation and to return to their usual levels of ability following a period of isolation.

Infection prevention and control guidance

COVID-19 guidance

Support and resources


6. Does the layout of premises, use of space and hygiene practice promote safety?

  • Do the premises look clean and hygienic? How is cleaning scheduled and sustained? What cleaning products are used?
  • How has the layout and facilities of the premises been changed to support IPC and good ventilation?
  • How have communal indoor and outdoor spaces been optimised to use safely?
  • How does the provider ensure communal equipment used to deliver care is clean, hygienic and used appropriately to minimise the risk of infection transmission?
  • Are cleaning, disinfection and waste disposal measures appropriately applied, for example safe management of blood and bodily fluids, safe disposal of clinical or hazardous waste?
  • Have the IPC measures resulted in any other environmental risks arising, for example fire safety and evacuation risks or falls risks?
What good looks like and guidance

What good looks like

  • All areas are uncluttered, and surfaces and equipment are in a good state of repair so cleaning can take place effectively.
  • There is a designated lead for cleaning and decontamination within the service. Staff understand their roles and responsibilities around cleaning, this includes:
    • whose responsibility it is for cleaning different areas of the environment
    • the frequency of cleaning the different areas of the environment, including equipment and high touch areas, eg. light switches, keyboards, door handles
    • the method of cleaning, including the products to use
    • the method, frequency and responsibility for cleaning equipment which includes reference to the manufacturer’s guidance for cleaning
    • the training required for cleaning
    • how cleaning standards will be monitored
    • arrangements for cleaning outside of usual frequencies
    • arrangements to prevent cross contamination – for example colour coding of cleaning materials
    • how to safely dispose of items such as cleaning cloths and gloves.
  • Records and checks of cleaning show compliance with the cleaning schedule.
  • Rooms which are designated for specific activities such as for visitors, shared bathroom and toilet facilities, or where people are isolating are subject to regular enhanced cleaning
  • Communal areas such as outdoor spaces and garden areas are used creatively to help with IPC, particularly when there are high levels of community infection or when there is an outbreak at the home.
  • Where plastic or glass barriers are used to help prevent infection they do not restrict people’s access and mobility.
  • Where there are multiple entrances, they are used to manage the flow of people to minimise contact.
  • Environmental measures such as effective ventilation have been implemented.
  • Process in place to ensure personal items, toiletries are not mixed up or shared across residents.
  • Evidence of liaison with cleaning staff to review processes are in line with national guidance on cleaning of areas where possible exposure to suspected infections, including COVID-19, and to include risks to cleaning staff.
  • Designated room for storage and managing laundry. Laundry processes follow national guidance and correctly manage clean, used and infectious laundry to minimise risk of infection.
  • There are effective waste management processes in place to protect people from infection or injury. Processes follow national guidance.

Infection prevention and control guidance

COVID-19 guidance


7. Do staff training, practices and deployment show the service can prevent transmission of infection and manage outbreaks?

  • What recent IPC training has been given to support staff to provide safer care?
  • If agency staff are used, how is their understanding, competence and compliance with IPC measures assured?
  • How does the provider ensure that non-communal equipment used to deliver care is clean, hygienic and used appropriately to minimise the risk of infection transmission? For example, single use items or equipment intended to be used by a single person?
  • Has the service experienced any infection outbreaks, if so, was there any learning from this?
  • How is staff wellbeing supported, including becoming unwell, sick leave and returning to work safely?
  • How is the Registered Manager supported in their role to manage IPC risks effectively?
  • How does the provider support staff or volunteers deployed at the service to access recommended vaccinations?
  • When required to minimise infection transmission, how is staff movement in and between care homes minimised, when advised by the local Health Protection Team (or equivalent)? For example, in response to high community levels of COVID-19 or outbreaks of infectious disease within the home. If agency staff are used, how is their compliance with IPC measures and not working between other services assured?
What good looks like and guidance

What good looks like

  • Staff have undertaken IPC training that is appropriate for their role and they are competent in their IPC responsibilities. Staff have access to nationally recognised IPC guidance.
  • Where agency staff are used, the provider has assured themselves they are appropriately trained and competent with IPC for their role. 
  • Staff are trained and know how to immediately instigate full infection control measures to care for a resident with symptoms to avoid an infection spreading to other residents and staff members.
  • There are outbreak management plans in place. Staff understand what action to take when an infection outbreak is suspected or identified.
  • All staff in high risk groups have been risk assessed, and adjustments have been made.
  • Provider supports and encourages staff to access recommended vaccinations. This includes:
    • Supporting staff to access national guidance on recommended vaccination programmes
    • Providing reasonable support to enable staff to access recommended vaccinations.
  • During periods of increased infection risk the provider considers whether changes to staff rotas, shift patterns, breaktime arrangements and handovers are needed. For example, handovers are done virtually, utilising messaging apps such as WhatsApp when needed.
  • When recommended by national guidance or Health protection Team (or equivalent) advice, staff movement in and between care homes is minimised.
  • In larger settings, 'cohorting' staff to individual groups of patients or floors/wings is practiced when this is required.
  • The service has been trained to use equipment such as pulse oximeters and well evaluated tools such as RESTORE2 and NEWS2. They have also accessed specific equipment such as pulse oximeters, to help determine whether a resident is unwell.

Infection prevention and control

COVID-19 guidance

Support and resources


To complete after site visit

8. Is IPC policy up to date and implemented effectively to prevent and control infection?

  • Are infection risks to people thoroughly assessed, reviewed and managed?
  • What action has been taken to consider and reduce any impact to people and staff who may be disproportionately at risk of transmissible community infections?
  • How does the provider support people using the service to have access to recommended vaccinations?
  • What changes have been made following the most recent IPC audit?
  • What contingency planning is in place to address possible infection outbreaks and winter pressures?
What good looks like and guidance

What good looks like

Note: This section is likely to be a summation of the findings above and whether it accords with the service’s current IPC policy and implementation of current national guidance.

  • There is a designated IPC lead who is sufficiently knowledgeable to fill this role. Evidence of effectiveness includes knowledge of current guidance, dissemination to staff and others, liaising with relevant agencies, communication and transparency with people using services and their family and friends.
  • The provider produces an annual statement for residential settings which includes:
    • Outbreaks of infection and actions taken
    • Audits and subsequent actions
    • Training and education received
    • Reviews and updates of policies, procedures and guidance
    • Risk assessments undertaken for prevention and control of infection

Note: the recommendation for providers to produce an annual statement was introduced in DHSC Guidance: Infection prevention and control: resource for adult social care (4 April 2022). It will therefore take some time for this to be adopted by providers.

  • IPC policy is up to date in line with national guidance, including code of practice 10 criteria, has been audited to reflect best practice.
  • Staff know how to instigate full infection control measures in a timely manner to care for residents with symptoms of transmissible infections to avoid infections spreading to other residents and staff.
  • The service demonstrates a good understanding of when and how to access local IPC resources (for example local Health Protection Team or Infection Control Nurse) when they need advice and support. 
  • Care home managers have contacted their local Health Protection Team in a timely way (and in line with guidance) if they suspect their care home has a new infection outbreak.
  • The provider supports people using the service and staff to access appropriate vaccinations, including Influenza and COVID-19 vaccinations and boosters.
  • People know how to raise any concerns or complaints around IPC practice if they think it is unsafe or not effective without fear or discrimination. There is evidence of responsive action taken when concerns have been raised.
  • All equipment used to support the monitoring of residents meets infection control and decontamination standards and guidance/code of practice
  • In compliance with the code of practice, there is a decontamination policy in place that overs what to do if there is a spillage of blood or body fluids
  • Where a person’s usual care and treatment arrangements have changed (in response to IPC risks) to ensure safety, that may amount to a ‘deprivation of liberty’, appropriate guidelines have been followed.
  • There is a focus on enabling safe visits wherever possible. Whenever visits are restricted this should be based on national guidance and local Health Protection Team (or equivalent) advice.
  • Where a resident has passed away with suspected or confirmed COVID-19, national guidance on handling the person’s body is followed.

Infection prevention and control guidance

COVID-19 guidance

Support and resources

 

Additional mandatory questions

  1. Does the service have sufficient and adequate supply of PPE that meets current demand and foreseen outbreaks?
  2. Are staff using PPE correctly and in accordance with current guidance? 
  3. Has the service undertaken appropriate PPE training?
  4. Does the service know where to go for advice should there be an outbreak – which authorities and what their role and responsibilities are?
  5. Is the service participating in the testing programme that is currently provided for residents and staff members?
  6. Do staff in the service understand the principles of isolation, cohorting and zoning appropriately?
  7. Has the service implemented isolation, cohorting and zoning appropriately?
  8. Is the service facilitating visits to people living at the home in accordance with current guidance?
  9. Has the service adequately taken measures to protect clinically vulnerable groups and those at higher risk because of their protected characteristics (ethnic minority background, physical and learning disabilities)?
  10. Has the service got a named clinical lead as assigned by the Primary Care Network?
  11. What position/profession is your named clinical lead? For example GP
  12. Do they conduct a home/ward round?
  13. What clinical support has been provided direct into the care home, by whom, and what has been its impact?
  14. Is support being provided for staff to access recommended vaccinations?