The potential for transmission of infection must be risk assessed prior to a resident’s arrival to the care home or before transferring to another care provider and should be continuously reviewed throughout their stay. A general respiratory screening questions checklist is also advised to be used, and this can be found within the resources section of the NIPCM.

A risk assessment will influence TBP decisions, and residents who may present a transmission risk include (but are not limited to) those:

• with symptoms such as loose stools or diarrhoea, vomiting, fever or respiratory symptoms. 
• with a known (laboratory confirmed) or suspected infectious pathogen for which appropriate duration of precautions as outlined in A-Z of pathogens are not yet complete
• known or suspected to have been previously positive with a Multi-drug-Resistant Organism (MDRO), for example MRSA, *CPE
• who have been admitted to a hospital outside Scotland in the last 12 months (including those who received dialysis)

This is not an exhaustive list, and risks need to be assessed for each resident.

*CPE should be considered if the resident meets any of the following criteria within the 12-month period before admission:

• was an inpatient in a hospital outside of Scotland
• received holiday dialysis outside of Scotland
• was a close contact of a person who has been colonised or infected with CPE.

A CPE toolkit for non-acute settings for further information and requirements. 

 

Staff should do the following if any resident displays signs and/or symptoms of infection:

• obtain advice on the resident’s clinical management from their GP and advice on appropriate IPC management from the local NHS Board IPCT or HPT 
• make resident placement decisions based on advice received or sound judgement by trained clinical staff who are involved in the resident’s management
• if transport to another care provider is required, advise the transport staff of the resident’s infectious condition. Residents should not be moved within the care home if they have signs and symptoms of infection unless essential.

Residents who are known or suspected to be infectious may require to be isolated temporarily within their own rooms, during the period of infectivity  A to Z of pathogens. Isolation decisions and assessment of infection risk (including isolation requirements) must be clearly documented in the resident notes.

Essential visits should be enabled and an explanation provided to the visitor of potential infection risks, and PPE offered. When undertaking a risk assessment, staff must also consider Anne's law and in particular:  

• resident and essential care supporters’ involvement in any IPC related precautions
• resident ability to comply with isolation and any potential impact of same

When residents who are required to isolate in their own room because of a known or suspected infection, it is important that: 

• residents remain in their rooms whilst considered infectious and the door should remain closed. If it is not possible for safety reasons then an individual risk assessment should be carried out, and any decisions or actions should be documented. The local NHS Board IPCT or HPT may be contacted for advice
• suitable discrete signage is placed on the resident's room door advising visitors not to enter the room until they have spoken to a member of staff 
• there should be as much consistency in staff allocation as possible to care for residents in isolation room areas as an additional IPC measure. This is known as ‘staff cohorting’
• resident isolation requirements should remain under continuous review considering individual risk factors and the impact on the resident. The local NHS Board IPCT or HPT may be contacted for advice in these circumstances
• infectious residents should only be transferred to other care providers if medically necessary. If the resident has an infectious agent transmitted by the air route then, if possible or tolerated, the resident should wear a fluid resistant surgical face mask during transfer. Receiving care providers and transport staff must be made aware of the necessary precautions

Note: If a resident requires isolation because of infection or in an outbreak situation, this should be individually risk assessed and documented to ensure the safety and health and wellbeing needs of the resident. Isolation must be for the minimum period specified and the resident must be monitored daily.

Residual respiratory exposure risk

If a resident vacating a room has a suspected or confirmed respiratory infection, the room may need to be left vacant for a period to ensure that any remaining potentially infectious particles are adequately cleared from the air to minimise the exposure risk to the next occupant. The clinical team should assess:

• the stage of infection, and whether the vacating resident continues to pose a transmission risk.
• the severity classification of the infection (R1, R2, or R3), and the vulnerability of the incoming resident

If entering the room during the vacancy period, health and care workers should wear appropriate PPE: a surgical mask or RPE should be used in line with the respiratory category associated with the vacating resident. Refer Appendix 15 for the mask selection algorithm. This would include when undertaking cleaning post discharge.

See Hierarchy of Controls (engineering controls) for information on the impact of ventilation on clearance times.

Ensure a minimum of 10 minutes has passed to allow the largest particles to settle on surfaces before terminal decontamination – see terminal decontamination for additional information.

For more information read the placement, isolation and cohorting literature review.