The Coronavirus has highlighted the need for better infection control policies and practices to minimize the spread of diseases. In addition to health and care settings, we need to think about what we do at home – and in public. Measures for infection control during the pandemic included greater hand hygiene, social distancing, face coverings, surface cleaning and more. While we should be prepared for an increase in viruses and bacterial infections, and have better preventative measures, we need to make sure the “health cost” of the prevention strategy isn’t more damaging than the risk of infection.
So, we need a new national infection control strategy which recognises that one type of control measure doesn’t fit all sources of infection. We must gather more evidence of what actually works for each. Face coverings, for example, are more effective against flu and the common cold than Covid. Likewise, what is transmitted from touching surfaces varies between types of infection. We need to understand these differences to manage disease transmission better. But we must avoid excessive use of measures that don’t make a material difference but do substantially hinder normal life. And normal life matters.
In care homes we need a thorough overhaul of how patients are accommodated - and isolated when infection looks imminent. New protocols should be in place that recognise the challenge of having many vulnerable people in a small space with visitors and agency staff coming and going. Some of the more detailed protocols around PPE, deep cleaning, and consistency of a specific carer need to be imported from hospital settings where that has not already been done. Clearly these settings need to feel homely but must also be safe. More en-suite facilities can help but that comes at a cost. Norovirus has historically been the great scourge of care homes, and its’ transmission is different to that of respiratory diseases.
Hospitals have different challenges. Better triaging could have dampened the spread of coronavirus in hospitals. Some hospitals failed to identify infectious patients quickly enough, and therefore didn’t separate them from other patients in time to prevent the virus spread. Part of the early challenge was the lack of a reliable test. Developing that early in a future pandemic will be critical. Moving forward, triaging should be done as quickly as possible and should consider a range of communicable illnesses. That Covid was most often acquired in a hospital, means we do need to re-think how we manage that risk throughout the patient journey in hospital. That means looking again at how we use space and how we train and deploy our fabulous doctors and nurses. During the pandemic, we have seen increasing use of single-use medical equipment to aid infection control -one step in the right direction.
But we do have to get all of this in context. Sometimes we can go too far, even with the best of intentions. For example, from October, anyone working in a Care Quality Commission-registered care home in England must be fully vaccinated unless they are medically exempt. The main purpose of the vaccine is to prevent the individual from becoming seriously ill with coronavirus. Being vaccinated does not mean you cannot catch and pass on the virus. Therefore, making all staff have their vaccinations will not have a significant impact on infection control, but it will have a significant impact on the number of caring staff, already in short supply. The Government’s assessments model that 7% of around 570,000 working in care homes will not be able to work in a CQC care home. The cost to a care home of replacing each worker will equate to around £2500 each - assuming they can be found. Many care homes are already understaffed. Thank goodness this is not a requirement in the NHS.
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