Keeping your care home healthy this winter – Part 1

This past year has given us some extreme weather: who can forget the deluge of snow that the ‘Beast from the east’ brought us in March? And then, just a couple of months later we enjoyed unprecedented heat waves throughout the long summer. Unfortunately, we don’t have a crystal ball, so who knows what the next few months will bring weather-wise? However, what we do know is that, if you work in a care home, it’s not only the weather that you will be concerned about this winter.

Without fail, wintertime is a challenging period throughout health and social care: acute admissions to A&E departments soar which affects every part of the NHS and has a resulting impact in wider areas of social and residential care.

The care home environment means that seasonal infections such as influenza (‘flu) and norovirus (‘winter vomiting bug’) can spread easily and cause havoc – both amongst residents and staff. In addition, the cold weather means that many residents will have an increased risk of falls, some of which can be life-threatening, and all will affect the resident’s quality of life. The long dark days don’t help either as some residents may be prone to seasonal depression and this can affect their ability or motivation to eat, drink or care for themselves.

Unless you move to sunnier climates there is no avoiding the challenges of the next few months. What doesn’t work though, is burying your head in the metaphorical sand and counting the days till spring. Instead, you need to have robust plans in place to help protect those in your care (including staff) and to minimise the risks that this time of year undoubtedly brings. But remember, this isn’t just a job for the managers; every staff member has a role to play in keeping your care home as healthy as possible during winter.

The key messages, which we will go through in more detail are:

• Be prepared
• Recognise and report any outbreaks
• Manage / contain outbreaks
• Liaise with multidisciplinary teams

Be prepared

There are lots of practical steps that you can take to make your care home ‘winter ready.’ You may not be able to fully eliminate the risks of ill-health over the next few months, especially when residents have a range of comorbidities, but you can lessen the impact and thus continue to operate and provide a quality care service.

Firstly, consider the following points:

• Are your residents and staff vaccinated? Both will be eligible for free annual ‘flu vaccinations from the NHS. Residents and some staff may also be eligible for the pneumococcal vaccine (this is given either as a one-off dose or every five years depending on the individual’s medical history) and / or the shingles vaccine (given as a one-off dose). Don’t forget, it’s not just your care workers you need to think about – your admin, domestic and catering staff could all be carriers of bugs too, so include them in your vaccination campaigns.
• Do all staff know about and adhere to infection control procedures? It’s well documented that many outbreaks can be prevented if the basic level of care is done well. But don’t assume that everyone knows what ‘infection control’ means. You should receive regular training, know where to find policies and lead by example. For example, according to the World Health Organisation the five stages for hand hygiene are:

1. Before touching a patient/resident
2. Before undertaking clean/aseptic procedures
3. After body fluid exposure/risk
4. After touching a patient/resident
5. After touching patient/resident surroundings

It’s your duty to follow this advice, however you also need to ensure that adequate facilities (e.g. liquid soap, disposable paper and/or alcohol-based hand gels) are always available in every room as well as communal areas.

Other important aspects of infection control include: using gloves and aprons appropriately; only using invasive devices / procedures when clinically indicated (e.g. catheters); ensuring equipment and the environment is safe and clean; ensuring adequate waste disposal and linen management systems are in place and promoting good respiratory hygiene (Catch it! Bin it! Kill it!)

The important message for you and your colleagues is that you simply can’t ‘cut corners’ with infection control – if you do you put lives at risk.

• Do you screen new residents for risk of infection? If someone has symptoms such as diarrhoea, vomiting, productive cough, night sweats, fever, breaks in the skin, and inflammation of the skin or soft tissues you may want to seek advice from the resident’s GP or public health to prevent any spread within your care home. Similarly, seek advice if someone is being transferred from another care setting where there has been a recent outbreak.
• Do all residents have up to date care plans? This should include risk assessments for falls as well as malnutrition. Remember that the home environment is an important aspect in managing risk of falls so make sure that equipment or electric cables don’t turn communal areas into an obstacle course. In the winter, residents may still want to go outside – so how can you maintain safe and clear spaces?
• Do residents have sufficient clothing to keep warm? Though you may find the centrally heated environment too hot, remember that frail and elderly residents feel the cold more easily. So, make sure they have adequate layers on. 
• Do you have clear and visible messages for visitors and relatives? You don’t want anyone entering your care home who is unwell so make sure you have posters up and inform all visitors. The same goes for staff! There’s no point being a ‘hero’ and coming in for your shift, only to spread bugs throughout the home. 
• Are your residents eating nutritious meals? Notice the emphasis on ‘eating.’ It’s not enough to offer healthy meals if the resident doesn’t eat them. Malnutrition can creep up on people, so you need to keep an eye on each residents intake as well as their weight.
• What do your residents do all day? Activities in themselves won’t stave off an infection but they can boost morale and install a sense of fun / hope. In turn, you may find that residents comply with treatments more easily, their appetite increases and, in general, have a better quality of life.

As well as looking after your residents you need to look out for your fellow colleagues. The smooth running of your care home revolves around team work, so if someone looks tired or unwell ask if they are ok or if you can help them.

Read our article ‘Looking after yourself‘ for information on coping with the demands of a job in health and social care.

Part 2 of this article is now live – have a read here