- [Interviewer] Right, we're about ready. You all set, Sharon?

- Yeah. Just gonna have a sip of water. Not feeling too good today. Okay. Good to go.

- [Interviewer] Right, this is an interview with Sharon Barker for infection control. Can I have a board, please? Right, first off, Sharon, just tell us why infection prevention and control is so very important for anybody working in a care home.

- Well, I'm no expert, but I know it's essential because of the increased risks. It's something... Because... Sorry. Sorry, I'm just not feeling too good.

- [Interviewer] That's all right. We can pause.

- Actually, I think... Sorry, I'm just gonna... Sorry.

- [Crew] Are you okay? Are you all right?

- Sorry, I'm late.

- Oh, we weren't expecting to see you. I heard you weren't well yesterday.

- Yeah, I really wasn't good yesterday. Probably something the kids brought back from school. Much better today though and I didn't wanna let anyone down.

- Oh, you are a trooper, but Naomi already said you weren't expected today because of the risk of spreading it, so you best head home.

- Are you sure? I know we're a bit short staffed at the moment.

- I'll tell Naomi you popped in, but we'll get someone from the second floor to come and cover you. You head home. Oh, but can I quickly get you to sign this whilst you're here?

- If you're sure you can all manage, I'll head home. Thank you, Sharon.

- It's no problem.

- Oh, there's that filming thing coming up soon, isn't it?

- Yes, eek. I don't know what I'm gonna say. I hate being on camera. Wish me luck.

- You'll be great. Good luck. See you, Sharon.

- Feel better soon.

- Infection prevention and control practices need to be ingrained as a natural part of everything we do. It's essential to providing safe quality care. It should be automatic, but as we're about to see, it's easy for poor habits to creep in when we're busy, despite our best intentions. So let's find out exactly what we need to watch out for and why good infection prevention and control is so important for anyone working in a care home.

- Come in. Good morning, Georgina. How are you feeling today?

- Hello, not too bad, thank you. I can't complain.

- Good. I'm just gonna pop your bed up if that's okay.

- Yes.

- Is it okay if I just check to see if your dressing's all right and then Meg will be along in a few minutes to help you get dressed?

- Of course, dear. Yes.

- I'm just gonna pull your covers back if that's okay. Oh, excuse me, Georgina.

- Bless you.

- I'll just put my gloves on. These things are so fiddly. I hate putting them on really, but.

- Do you think you could pass me that glass of water, please?

- Of course. No problem.

- Thank you, dear.

- Now, how's it feeling today? Is it still sore?

- It seems a bit better now. Thank you, yes.

- Yes, it's looking much better, so we're pleased to know we don't need to bother you with changing your dressing today.

- Thank goodness. So silly of me. I must be more careful next time.

- Not at all. These things happen. Just give my hands a quick clean.

- Do you know, it's so good, so nice to be back in my own bed.

- I bet it is. We're glad to have you back. We missed you whilst you were in hospital. Now, are you quite comfy if I leave you for a few minutes until Meg arrives to help you get up?

- Yes, thank you. I'll just try and finish this before she comes.

- Lovely. I'll just put your bed back down if that's okay.

- [Georgina] Oh yes, thank you.

- There we go. It's quite fun going up and down on these beds, isn't it? Right. I shall see you soon.

- Yes. Bye-bye.

- Sharon wore personal protective equipment. She cleaned her hands, so she was obviously thinking about infection control, or was she? How many infection prevention and control issues did you spot? You can take a note of them now. Have a think about it. And later, we'll come back and take another look. But first, we need to know how infections are spread and the standard precautions we should be taking.

- [Narrator] There are six links in the chain of infection: the organism, the reservoir, a way out of the body, the method of transmission, a way into the body, and the person at risk. An infection or illness occurs when microorganisms multiply inside our bodies. In sufficient numbers, they can cause us harm. Microorganisms that cause infections are called pathogens or infectious agents, or sometimes just germs, and there are many different types. Bacteria like E. coli or Clostridium difficile. Viruses, which cause things like the common cold, influenza, or gastroenteritis. Fungi, such as thrush or ringworm. Parasites, which live on a host like scabies or head lice. And multi-resistant organisms, types of infectious agents that have developed a resistance to antibiotics. These infectious organisms are generally invisible to the naked eye and they're everywhere, on everything we touch, including in and on our bodies. That's the second link in the chain, the reservoir, anywhere that germs gather, a light switch, a lift button, a phone, food, water, surfaces, handrails, pets. It's why thorough cleaning is essential alongside effective procedures and correct equipment for the management of laundry, clinical waste, and spills. And you can find out more about those aspects of infection control in your ACC library. A reservoir could even be as simple as a keypad or us, so we need to think about all the places where we might harbour germs, our uniforms, the edges of our nails, or around chipped nail varnish, the tiny areas and joints in jewellery that are impossible to clean properly. That's why good practise requires us to be bare below the elbows, nails should be short, no nail varnish or false nails, no watches and no jewellery besides a plain wedding band. The next link in the chain of infection is a way out of the body, which could be via bodily fluids like faeces, urine, or blood, flakes of skin or loose hair, or simply a cough or a sneeze. So hair needs to be tied back, cuts and abrasions need to be covered with a waterproof dressing, and we must follow cough etiquette. Cover your mouth and perform hand hygiene immediately. If you don't have a tissue at hand, cough into your elbow. That way, you're also breaking the fourth link in the chain, the method of transmission. One of those methods is via droplet. Tiny droplets containing infectious agents go into the air when we cough, sneeze, or even just talk, and they settle on other people or surfaces. Next, there's airborne transmission, very small particles containing infectious agents are spread via the air and can be breathed into the body. Then there's direct contact, which is when we touch an infected person or infected blood or bodily fluids such as urine or saliva. So it's important to wear personal protective equipment when handling soiled items and hold them away from your body to avoid contaminating yourself. And finally, there's also indirect contact, when we touch a contaminated surface. Now the infectious agent just needs a way into the body and that could be via a break in the skin or mucous membranes like the mouth, eyes, or nose, or by ingesting it via contaminated food or water. To minimise the chance of infection finding its way into the body, extra precautions need to be taken around clinical procedures, as well as the handling of medical devices, such as catheters or sharps. Needle stick injuries pose a significant risk, so all sharps need to be handled and disposed of according to your organization's policies and procedures. If an infectious agent does find its way into the body, that brings us to the final link in the chain, the person at risk. We can all get infections, but people receiving care are at a significantly increased risk. They're more likely to come into contact with infectious agents when visiting healthcare settings like hospitals. They're more likely to live with invasive devices like catheters, or to have wounds like skin tears or pressure injuries. All of these provide entry points for infection. Poor mobility may also make it more difficult to maintain personal hygiene. Conditions like dementia or poor eyesight may make people less aware of infection risks. And the immune system is weakened by age, illness, and possible dehydration or malnutrition, so it's important to encourage people to drink at least 1,500 millilitres each day and to eat well. The immune system can also be compromised by some medications and treatments like chemotherapy.

- I heard a film crew is going to be visiting. Are you doing something with them?

- I am indeed. I'm filming an interview for a medical training film. Gonna be a big star, Bill.

- I'm sure you will be.

- All these factors mean people receiving care are not only at an increased risk of infection, but they also find it harder to recover. The effects can be severe, even life threatening. That's why standard precautions we take are so vital. It's why we can't afford to become complacent. We have to break that chain of infection. So how many issues did you spot in that earlier scene with Sharon and Georgina? Let's take another look.

- Good morning, Georgina. How are you feeling?

- [Martin] Hand hygiene should be performed before contact with the resident. Whenever you're handling sheets, fold them back carefully to contain any infectious particles rather than spreading them all around. Remember droplet transmission. Cover your mouth and clean your hands straight away. Hand hygiene should be performed before putting gloves on, as well as after taking them off. And if we store gloves in our pocket, they're of no use because then they're not clean gloves. If we touch something else when we're wearing gloves, then either the gloves become contaminated or they spread contamination. So again, they're of no use. Gloves should always be worn if there's a likelihood of coming into contact with bodily fluids, non-intact skin, or mucous membranes. Plastic aprons should be worn if there's a splash risk from bodily fluids. Gowns, face masks, and protective eyewear may be required in certain situations, such as if a splash risk is identified. Personal protective equipment is essential to preventing the spread of infection, but it's only effective if it's used correctly. We have to think about exactly what we touch while we're wearing gloves. We need to wear fresh gloves to attend to each person and they should be changed whenever you begin a new care-related task with that person. They should be discarded immediately after use and they are never reused. We also have to think about how we take them off. Have you ever rushed and done this? Whipping off your gloves too quickly just means we're spreading contamination. So here's how we need to do it.

- [Narrator] Start by removing your gloves. Use one gloved hand to pinch and hold the outside of the glove of the other hand near the wrist area. Carefully peel the glove downwards away from the wrist, turning the glove inside out as you go. Remove the glove from your hand, holding it with the gloved hand. With your ungloved hand, slide your fingers under the wrist of the remaining glove. Do not touch the outer surface of the glove. Then peel downwards away from the wrist, again turning the glove inside out and enclosing the other glove as you go. Remove the glove completely and immediately dispose of the gloves in an appropriate waste disposal bin. Then perform hand hygiene. If your hands are visibly soiled or contaminated with body substances, wash hands with soap and water. In the absence of visible soiling, you can use an alcohol-based hand rub. Then with clean hands, remove your gown. Untie or break the ties at the neck and back. Touching only the inside of the gown, pull from the neck and shoulders, then arms turning inside out as the gown is removed. Roll the gown into a bundle and discard in an appropriate waste disposal bin, then perform hand hygiene. If wearing an apron, remove by untying or breaking the ties at the neck and back. Touching only the inside of the apron, pull from the neck down, allowing the apron to fold down on itself, turning it inside out as the apron is removed. Fold or roll the apron into a bundle and discard in an appropriate waste disposal bin, then perform hand hygiene. Now remove your protective eyewear or goggles only touching the back or sides of the goggles and dispose of them in an appropriate waste disposal bin. If wearing a face shield, only touch the back or sides of the headband to remove. Some goggles, face shields, and protective eyewear can be cleaned and disinfected for reuse. Refer to your organization's policies and procedures. Perform hand hygiene. Do not remove your face mask until you have left the person's room. Now remove the face mask. With clean hands, untie or break ties at the back of your head. Remove the mask by only handling the ties, then discard it in an appropriate waste disposal bin. Finally, perform hand hygiene using an alcohol-based hand rub or washing with soap and water if your hands are visibly soiled.

- You might think hand hygiene is a pretty repetitive business, but that's because everything we do involves our hands. They're reservoirs and they transmit germs, so hand hygiene is the single most important aspect of good infection prevention and control. Sure, Sharon performed hand hygiene. She obviously meant well, but did she do it at the right times? No. Did she follow the correct steps? No. So did it help prevent the spread of infection? No.

- [Narrator] Hand hygiene needs to be performed at the right times according to the World Health Organization's Five Moments of Hand Hygiene. Before touching a resident. Before a clean aseptic task. After body fluid exposure risk. After touching a resident. After touching a resident's surroundings. For a full list of all the times when you need to perform hand hygiene, refer to your learning resources.

- I'm sure we've all seen those hand washing posters about and here's the simple reason why we have to follow them. Imagine all that glowing is from the infectious agents on your hands, the germs you've just picked up in the course of going about your day. Pretty obvious which hands were washed correctly, isn't it? So if ever you're busy or in a rush and maybe you're tempted to cut a few corners, just think of all those potential germs. They may not cause you any harm, but for a person at increased risk, they could be the start of something serious. So take those few extra seconds, be aware and wash with care.

- [Narrator] Wet your hands thoroughly under tepid running water before applying soap. You need enough soap to cover all of the surfaces of the hands. Then rub vigorously using the following steps. Palm to palm, right palm over the back of the left hand with fingers interlaced and vice versa. Palm to palm with fingers interlaced, backs of fingers to opposing palms with fingers interlocked. Rotational rubbing of left thumb clasped in right palm and vice versa. Then rub the fingertips of your right hand rotationally in the palm of the left hand and vice versa to really get into those tricky nail and cuticle areas. Rinse hands thoroughly and dry thoroughly with clean paper towels. Any residual moisture provides the perfect environment for bacteria to multiply. Remember, as soon as you touch anything else, your hands become contaminated again. Taps and bins are reservoirs for germs, so try to use your elbow or a paper towel to switch off taps and avoid touching bins. All this regular washing can make the skin dry out, so use good quality mild soap and moisturise regularly.

- If you use alcohol rub for hand hygiene, you need to follow the exact same steps as hand washing. This ensures that every surface of your hands is covered. Otherwise, it isn't effective. Alcohol hand rub is the preferred method for hand hygiene, except when hands are visibly dirty or if there's a potential for the spread of alcohol-resistant organisms like Clostridium difficile spores or other pathogens that cause diarrhoea such as Norovirus.

- Hi, Bill. Here's your tea.

- That's grand, thanks.

- I wonder where Georgina is.

- Yes, she normally comes down for afternoon tea, doesn't she? Tell me, is that film crew still here? I was very curious as to what they were up to. Sharon said it was an interview or something?

- I think they left a little while ago. Poor Sharon had to leave before they finished filming her bit. She wasn't feeling very well.

- Oh, that's a shame. Tell you what, I'm not feeling too wonderful myself.

- Oh really?

- Could you help me back to my room please?

- Of course, let's have a word with the nurse as well, shall we?

- If we don't follow standard precautions and someone becomes ill or there's an infectious outbreak, we can't rewind the clock to fix things, so we need to be thinking about infection prevention and control all the time. We need to take action to break the chain of infection at the first and every opportunity. If Sharon could rewind the clock, what might she have done differently? What was her first mistake?

- Hello?

- Oh, well, hi, Ben. It's Sharon. How are you feeling? I heard you weren't very well yesterday.

- Oh yeah, really wasn't good yesterday. Much better today though. Sorry, I'm late. I am on my way in. Didn't wanna let anyone down.

- Oh, thanks Ben, but actually that's why I'm calling. I wanted to catch you before you arrived. I wanted to remind you that you need to stay off for at least 48 hours after the last symptom you had. So sorry I couldn't call earlier this morning.

- Oh, that's okay. Are you sure? I know we're a bit short staffed at the moment. I don't wanna cause you any problems.

- Oh, it's no problem. We'd have bigger issues to fix if you passed any bugs around. You stay home, rest up and we can arrange cover.

- Okay, thanks Sharon. Bye.

- Bye. Good morning, Georgina. How are you feeling today?

- Fine, thank you. I can't complain.

- Oh, good. Is it okay if I just take a look to check your dressing, then Meg will be along in a few minutes to help you get dressed?

- Ah, it's fine.

- I'll just close the curtains. Just give my hands a clean.

- Got to be so thorough, haven't you, these days?

- Is it okay if I just take your covers back? Thank you.

- Oh, excuse me, Georgina.

- Bless you, my dear.

- Excuse me. I'll just clean my hands again.

- Another one?

- Yes. Got to make sure we're germ-free. Right, I'll just put my gloves on.

- They look very awkward.

- Yes, they can be a little bit fiddly. Could you pass me my glass of water, please? I'll pass it to you in just one second. I'm gonna check your dressing, then I'll take my gloves off and then I'll pass it over, if that's okay. How's it feeling today? Is it sore? In fact, you'll be pleased to know we don't need to change your dressing today. Oh, good. I really must be more careful. It was so silly of me.

- No, not at all. These things happen. I'll just clean my hands again and then hand you over your water. You must be parched by now.

- I am parched.

- There you are.

- Thank you my dear.

- My pleasure. I'm gonna pop your bed back down for you.

- [Interviewer] You're doing really well, Sharon. Now just one last question. What final message would you give people about infection prevention and control?

- We have to protect ourselves and our residents. Infectious agents are constantly around us, so infection prevention is the responsibility of every single member of staff. We cannot afford to forget our standard precautions or take shortcuts.

- [Interviewer] Great job, Sharon. All right, everyone. We're all finished.

- It doesn't take much to break the chain of infection. Likewise, it doesn't take much for infectious agents to spread with just a few little lapses in concentration. In reality, we can't rewind the clock if we forget our standard precautions. Staff can bounce back from infections, but the people we care for might not. So remember to think infection prevention and control in everything you do and get it right first time every time.