COVID-19 Safe PPE & keeping safe (Social Care)

14/05/2020 – Advice for Home Support Staff on keeping safe during COVID-19

Introduction

This is a worrying time for everyone, for you, your families and your service users. There has been a lot of advice which has been continuously updated, on how we should keep safe both at home and at work. This can become confusing as to what is the best things to do.  This guidance brings together the latest advice for you to practice. The main change is that the decision on wearing face masks when attending to service users is no longer dependent on your judgement but must be worn on all occasions. So if you cannot keep 2 metre social distance in doing your work, then wear a mask provided.

Why this recent change to wear a mask on all visits – I thought it was my judgement to wear a mask?

Up until now the best advice from Public Health Scotland was to be aware of the signs of Covid-19, typically a fever and cough. This was updated to include any situation where you thought the service user was out of sorts from their normal self. Now that testing has been increased in the community to include people who do not have signs of the virus, some of these people have had a positive test. This means we can’t presume who has or doesn’t have the virus, so as a precaution it is thought to be safer to wear a mask on all occasions to protect yourself and our service users. It is a precautionary measure, but will offer more reassurance to you carrying out your work and to service users and families.  You will be issued with the necessary supply of these masks called fluid resistant surgical face masks (FRSM) coded as IIR masks. These should only be used by you in your work situations, they are not for personal use by yourself of family, the supply needs protected to make sure everyone has the right mask for the work they are doing.

The fluid resistant surgical face mask (FRSM) should be close fitting and fully cover your nose and mouth (1. open and hold the face mask on your hands.  2.  Place ear loop over ear and extend mask above nostrils and below chin.  3. Pinch nose pieces to ensure snug fit.) 

Do not touch the front of the mask when being worn.

How is Coronavirus or Covid-19 spread?

COVID 19 is a droplet spread virus, it is not airborne spread. This means it can only spread by person to person. The virus cannot spread itself, but depends on us to spread it, so the better we keep to the advice given, the less chance of it spreading.

There are two routes by which COVID-19 can be spread:

Directly; from close contact with an infected person (within 2 metres) where coughing or sneezing can enter the eyes, mouth, nose or airways. This risk increases the longer someone has close contact with an infected person who has symptoms.

Indirectly; by touching a surface, object or the hand of an infected person that has been contaminated with respiratory secretions and then touching own mouth, nose, or eyes. If you are not going to come within 2 metres of service users then the risk of infection is from indirectly touching surfaces not from respiratory secretions, (coughs and sneezes).

The most important part of your PPE is therefore your mask, apron and gloves and frequent washing of your hands. PPE must be worn at all times when in contact with service users or in their households.

Good hygiene practice has not changed.

To keep you safe please remember the most important part of your PPE is your apron and gloves which must be worn at all times when in contact with a service user and throughout your visit.  We recommend you put on your gloves and apron immediately after entering the service user’s home.  For those who drive, leave all your personal belongings (including jacket) in your car if possible.

Please don’t forget frequent washing of your hands (where this is not practical use hand sanitiser provided).  This is particularly important when PPE is removed – gloves (grasp the outside of glove with the opposite gloved hand; peel off.  Hold the removed glove in the remaining gloved hand.  Slide the fingers of the un-gloved hand under the remaining glove at the wrist) and then apron (unfasten or break apron ties / pull the apron away from the neck and shoulders, touching the inside of the apron only. Turn the apron inside out, fold or roll into a bundle and discard appropriately) by storing securely within disposable rubbish bags.  To dispose of the PPE:-

For any individual not displaying any symptoms or confirmed as COVID+ PPE can be placed in a disposable waste bag and disposed of with other waste as normal.

For those individuals with symptoms or confirmed as COVID+ PPE should be securely stored immediately after use within a disposable waste bag and sealed.  The bag should then be placed into a second disposable waste bag, tied securely and kept separate from other waste in the room.  At the end of each day the bag should be sealed and dated to indicate when it was sealed.  The bag should be stored in a safe area within the home for at least 72 hours before being placed in the public waste bin.

Your professional judgement is still important.

You should initially stay over 2 metres away from service user and other household members until you assess the situation. Ask if any member of the household has:

  • A new cough?
  • A temperature?
  • Do they feel unwell?
  • Have they had to take any medication that they wouldn’t normally take like paracetamol?
  • Look at the service user to see if they look like their normal self. Recent knowledge of the virus suggests a wide variety of symptoms, so if your service user is not their regular self, then it is safer to wear a mask as well as your other regular PPE.

Your knowledge of what is normal for the service user is important.

If the answer to any of these questions is yes then treat the service user as a potential case and notify your manager. Following your care delivery ensure that PPE is removed and you wash your hands thoroughly.

Should I consider wearing eye protection such as a visor or goggles?

It is very unlikely that any member of staff would be asked to carry out a task that required the use of eye protection. However if you are in close contact with a person showing symptoms or has a positive diagnosis and has a persistent cough or sneezing, you should wear eye protection or discuss with your Manager.

Some of my service users are ‘Shielding’ is there anything I should do differently?

There are about 9000 people in North Lanarkshire who are part of the shielding group, these are individuals with specific underlying health conditions that make them very vulnerable to the effect of Covid-19 should they get it. There are about 400 service users of Home Support who are part of the shielding group, so it is not every service user. Your Manager will inform you if one of your service users are part of the group or if the service user informs you that they have received a formal shielding letter then you should wear your apron, gloves and your provided face mask, whether you can keep at two metre distance or not.

Your schedule will highlight if one of your service users are part of the group.  For every service user who is part of the group you will notice the task code SHI (service user on shielded list) as a task code for every visit.

What else can I do to keep safe?

There are a few additional measures that we would wish you to undertake to help keep you safe:-

If you are calling ahead, ask if anyone in the household has symptoms or any concerns about symptoms.

Leave all your personal belongings including jacket in your car if possible.  If not possible remove upon entering house and leave in the entry hall.

Put on your apron and gloves immediately after entering a service user’s home. Perform hand washing before and after all contact with the service user, following removal of protective clothing and cleaning of equipment and the environment.

How do I practice Social Distancing while at work?

We must follow government advice on social distancing to reduce the spread of coronavirus, both in our personal lives and at work.  We need to think about the various work situations we can find ourselves in to take all practical measures to achieve social distancing and anticipate how we can reduce the amount of time we are working within the 2 metre social distancing.  Some tasks make this impossible which is why we use PPE.

Everyone should be trying to follow these measures as much as is practicable:-

You must ensure 2 metres (6 feet) apart from anyone outside of your household.

You should not meet in groups of more than 2, including when staff take breaks or whilst collecting PPE from your local office.

Staff working with service users should remain at a safe protected distance where possible, however, this is not feasible for activities that bring you into close personal contact, such as washing and bathing, personal hygiene etc.  Safe working procedures and aprons, gloves and fluid resistant face masks should be used in these situations.

I work alongside another Home Support Worker – can we travel together because we are working together?

In our personal lives we can travel together with the other people living in our same household if they are not showing signs of the virus, but we are not to mix with other households including sharing a car with anyone from another household. As workers you belong to different households and social distancing of two metres should be the norm for two workers traveling to the same service user.

This is why we are changing work routines so that where work can be anticipated that would involve car sharing such as the regular scheduling of two workers working together, then alternatives should be found such as additional pool cars or larger vehicles. This is particularly true for the overnight teams who could spend significant periods together in the same vehicle.

There will be times when a driver and non-driver in the same car is seen as the only practical solution after all other avenues have been explored. All staff should maintain distance from each other while waiting to board and disembark from vehicles.  Hand sanitiser should be used before entering and leaving the car. Drivers will be provided with cleaning materials to allow driving controls and vehicle door handles, grab rails, steady rails etc. to be cleaned at intervals through the day.   In these instances the non-driver should sit in the back seat with the back windows slightly open. The driver should not turn round to speak to the passenger even if the car is stationary. If either worker felt more comfortable they can also wear a face mask.

Once you reach the person’s house, when you are part of a two worker team that have travelled together, it is even more important that you put on your PPE before approaching the service user to reduce any chance of cross contamination.

As in all situations you should also be thinking about how to reduce the time for breaking the social distancing. So if any preparation can be done out with the social distancing area, such as laying out clothes, preparing the bathroom area, or dispensing medication (where appropriate), then this should be done. As workers you can still engage with the service user and sense check the situation. Please note: Drivers who are using a pool car must also ensure the vehicle is taken to the valeting centre for the daily clean.

Can I ask for a test?

NHS Lanarkshire can test Health and Social Care Staff members isolating from the workplace, due to symptoms or a symptomatic household member.  This testing of staff is being offered through Salus following a self-referral or a referral from your Home Support Manager/Out of Hours Manager.

If you experience symptoms you can now refer yourself for a test by going online at: https://covid19staffscreening.salus.co.uk.

This will allow you to access a test to confirm if you have COVID-19 or not.

A full copy of the procedure for completing a self-referral is available here.

You will be expected to be available to take calls from Salus to confirm arrangements with regards to your test appointment, and to be able to make your own way to the testing location at Law, Glasgow

Airport or Ravenscraig Sports Facility.  When you arrive you will require to remain in your car when you attend the test station.

Results will be communicated once received and assessed by an Occupational Health Physician – within 24 to 48 hours.  Your Manager will contact you when they have received the results of your test to discuss next steps – i.e. any negative results for you and your family should result in you returning to work as soon as possible.

Is there support for looking after my general health and wellbeing?

It’s important now, more so than ever to look after yourself.  We need to check on each other, share worries/how we are feeling, talk about successes/positive things and ensure that as a team we pull together.

There are many things we can do to support and manage our wellbeing during these times.  Find out all the support available to you during the COVID 19 outbreak at https://northlangov.webex.com/webappng/sites/northlangov/dashboard?siteurl=northlangov

You will find the best mental wellness supports (Looking after your mental wellness) and there is advice on your money management during these times (Coronavirus and your money).

Have a look at the Self Care section.  The Psychological Services team in NHS Lanarkshire have supported us with two guides on Managing Anxiety in the Coronavirus Pandemic and Self Care for Colleagues Looking after Clients – Patients with Coronavirus.  You can find a copy of these documents on the link and a copy will be posted out to you.   You will also find details of Time for Talking (0800 970 3980) which is a helpline for general advice and guidance and can also offer you psychological guidance and emotional support.

Lastly

If you believe a service user is displaying symptoms of COVID-19, please inform your Home Support Manager/Out of Hours Manager to ensure appropriate support for the service user including testing, and to have continuity of practice in wearing PPE as well as a continued supply of masks arranged for you and your colleagues.

Every worker still has a personal responsibility as a citizen as well as an employee to think about the general safety messages to keep themselves and others safe.

Thank you for your compassion and efforts to deliver supports to our services users during these unprecedented times.

A personal message from Chief Officer Ross McGuffie, Health & Social Care North Lanarkshire

Our staff this week have been nothing short of exceptional and you have all risen to every challenge you have faced. I have never been prouder of the commitment, compassion, flexibility and care shown by you all. Your drive to continue to deliver services really is exceptional.

We know the coming weeks and months will more than likely only get harder and it is more important than ever that we all stick together as a team to work our way through the challenge.

We continue to be guided by national policy, however it is our responsibility to come up with the answers that allow us to best meet our needs and those of our people right across North Lanarkshire.

Regarding PPE, I understand that this is a very anxious time for people. I can assure you that we are following the same Health protection Scotland (HPS) guidance across all community services and there is no hierarchy in availability of equipment within the partnership.

PPE should be worn for consultations involving acute respiratory infection or influenza-like illness. This is in line with HPS’s National Infection Prevention and Control Manual.

PPE is not required for those patients who are not displaying any symptoms.

We have also today received updated guidance on the ordering of PPE for social care staff, including independent sector providers, personal assistants and unpaid carers. The new process will allow us to take control of the local distribution of PPE, which will ensure much simpler access for all social care staff in the area.

We are acutely aware of the vital need to keep our staff safe while they do such important roles. As part of this, we have issued media releases and there is ongoing social media activity on the subject. People across North Lanarkshire are being reminded that they must proactively inform visiting community health and social care staff if they are showing signs of having COVID-19.

We are stressing patients or service users should inform their health and social care professional if they have COVID-19 related symptoms by telephone ahead of the visit.

This vitally important information will allow necessary steps to be put in place to protect the health of our workforce while helping to reduce the potential spread of the virus to other patients and service users.

COVID-19 is presenting domiciliary/Care at Home services in the area with increasingly significant capacity challenges. We have also asked families and carers of those currently in receipt of home care to help where possible and in line with national guidance and are reviewing home visiting requirements of other domiciliary services to maximise capacity.

As you know, on Monday evening the Scottish Government announced an effective ‘lockdown’ in a bid to flatten the curve of Covid-19 spread and protect the NHS and essential services. The First Minister confirmed medical reasons or caring for a vulnerable person was a permissible reason to leave home.

As a result, we’re urging people to take a single-person approach when caring for vulnerable friends and relatives.

We continue to work towards ensuring that all hospital patients whose discharge has been delayed are able to leave hospital as soon as they are medically fit to do so. This move is designed to minimise their potential exposure to COVID-19. It will also contribute towards creating vital extra capacity to help NHS Lanarkshire accommodate people requiring intensive care treatment. We have made huge progress on this over the last two weeks and I’d like to thank all staff involved for the tremendous effort.

We have never faced, and hopefully will never face again, the enormous challenge in front of us. We need your extensive knowledge, experience, skills and resources to support the people of North Lanarkshire.

Again, I’d urge you all to take the time to read advice which will be regularly issued by our NHS and NLC communications colleagues.

My thanks to you all, once again, for your amazing work, flexibility and professionalism.

Ross

Below you will find poster guidance information on safe PPE.

pdf
COVID-19 Safe PPE Poster
Size: 3.33 mb
Date modified: 27-03-2020
Updated on 18th May 2020

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