Indicators of Compliance with Regulation 27: Infection Control

Are you ready for HIQA’s new inspection programme on Regulation 27 Infection Control?

Overview

Over the last number of years, providers of long-term care have had to implement enhanced measures of infection control to reduce risks to residents and support safe and effective care.

We note from HIQA’s Assessment Judgement Framework for Regulation 27 Infection Control, that Infection Prevention and Control (IPC) continues to be a central focus for HIQA. In this document, HIQA detail that they will be commencing a new inspection programme that will focus specifically on Regulation 27 Infection Control. The inspection programme, which begins in October 2021, will assess how the registered provider has implemented the National Standards for infection prevention and control in community services (2018).

HIQA will be focusing on nine standards around infection prevention and control, and inspections will take place under both dimensions, capability and capacity and quality and safety. For each of these standards, lines of enquiry have been provided by HIQA to assist the Registered Provider in assessing their compliance. This Assessment Judgement Framework places significant increase in the areas of focus for infection control.

In this blog we detail the standards HIQA will focus on during an inspection against Regulation 27 and highlight some of the key indicators of compliance under each standard.

Capacity and Capability Dimension – Indicators of Compliance for Infection Control

Theme 5 – Leadership, Governance and Management

Under Theme 5 Leadership, Governance and Management, HIQA will be focusing on the following standards:

Standard 5.1 The service has clear governance arrangements in place to ensure the sustainable delivery of safe and effective infection prevention and control and antimicrobial stewardship.

Standard 5.2 There are clear management arrangements in place to ensure the delivery of safe and effective infection prevention and control and antimicrobial stewardship within the service

Indicators of Compliance under Theme 5

• IPC is prioritised by the provider and by the highest level of management.
• The provider has clear governance and management structures in place which help to minimise the risk to residents of acquiring preventable healthcare-associated infections.
• There are structures in place to measure and oversee performance in IPC.
• The RP has a nominated person or persons with the appropriate knowledge and skills to lead on, manage and ensure good IPC practices.
• All managers and employees consider IPC as central to their role and as an integral component of providing safe and effective care and support for people living in the centre.
• Staff should have access to external expertise in infection prevention and control precautions and practices, where required.
• The provider has in place contingency and outbreak management based on the National Standards, and having regard to guidance from the Health Service Executive (HSE), Health Protection Surveillance Centre (HPSC) and Government, as well as best available evidence.
• The plans are specific to the centre, and staff are supported to access, understand and implement them.
• The centre will have a defined escalation pathway which is known to all staff and implemented promptly when required.
• The provider has arrangements in place to ensure after any outbreak that there is a comprehensive investigation, the findings recorded, corrective actions are implemented and learning is shared between all staff and, if appropriate, to all residents and their families.

Theme 6 – Workforce

Under Theme 6 Workforce, HIQA will be focusing on the following standards:

Standard 6.1 Service providers plan, organise and manage their workforce to meet the services’ infection prevention and control needs.

Standard 6.2 Service providers ensure their workforce has the competencies, training and support to enable safe and effective infection

Indicators of Compliance under Theme 6

• The RP has contingency plans in place to ensure staffing levels are maintained to meet its infection prevention and control needs.
• The RP has clearly described the minimum infection prevention and control training requirements, which are mandatory for different roles at all levels of the organisation, using the national Core Infection Prevention and Control Knowledge and Skills Framework Document to guide them.
• The frequency of training and updates are defined and recorded, including the scope of training provided.

Quality and Safety Dimension – Indicators of Compliance for Infection Control

Under the Quality and Safety Dimensions, HIQA will be focusing on the following standards:

Theme 1 – Person centred care and support

Standard 1.1 People are provided with appropriate information and are involved in decisions about their care to prevent, control and manage healthcare associated infections and antimicrobial resistance.

Theme 2 – Effective care and support

Standard 2.1 Infection prevention and control is part of the routine delivery of care to protect people from preventable healthcare-associated infections

Standard 2.2 Care is provided in a clean and safe environment that minimises the risk of transmitting a healthcare-associated infection.

Standard 2.3 Equipment is decontaminated and maintained to minimise the risk of transmitting a healthcare-associated infection.

Theme 3 – Safe care and support

Standard 3.4 Outbreaks of infection are identified, managed, controlled and documented in a timely and effective manner.

Indicators of Compliance under Theme 1, 2, 3

• Staff maintain and respect the rights of all residents and ensure they are supported to continue to access care and support in a timely manner during an outbreak and at all other times.
• Information is available that is clearly visible and easily understood, directing residents to whom they can contact if they have any concerns about their care, infection prevention and control, and general hygiene in the centre.
• There are clear and transparent decision-making processes, including referral pathways, to facilitate residents’ access to healthcare services. Residents, if they wish, have access to an advocate of their choice during discussions about their care.
• Any restriction is informed by public health advice, national guidance and best practice.
• IPC audit schedules are comprehensive and implemented.
• IPC audits are completed on time, easily accessible and communicated to staff. Where corrective actions are required, there is evidence that these have been actioned and/or completed.
• The physical environment is clean, well maintained, free of clutter, bright and clean, and well-maintained equipment is stored securely.
• The provider has a scheduled refurbishment plan for the upkeep of the centre and the centre is comfortable and can be effectively cleaned.
• There are a variety of systems in place to ensure that environmental and equipment cleaning standards are met.
• All reusable equipment is safely and effectively decontaminated.
• Waste, including healthcare risk waste, is managed in line with national guidelines and legislation.

For more information on the Assessment Judgement Framework see the HIQA website:

• Guidance on the assessment of Regulation 27 – Infection Control
• Assessment judgment framework for Regulation 27 – Infection control

HCI Supports

1. IPC Audit

HCI can conduct an independent audit of your nursing home’s current system of IPC against HIQA’s National Standards for infection prevention and control in community services 2018. HCI’s report will provide and executive summary of areas good practice and a line listing of areas for improvement. This audit establishes the current baseline of the resident system of IPC and forms a strategy for improvement.

2. IPC Education and Training

HCI can support your nursing home through the delivery of IPC Education and Training that is based on best practice, regulatory requirements and up to date public health guidance. Our training programmes can be online via webinar to your staff. Staff will receive a certificate of attendance on completion of the training course.

3. IPC Policies and Procedures

HCI have a dedicated Best Practice Team who keep up to date with all regulations, standards and new guidance. Our team do the hard work for you and incorporate all guidance into our policies and procedures. Specific policies relating to COVID-19 and IPC can be purchased on hcicaretools.com.

Conclusion

Infection prevention and control is now as important as ever. Registered Providers must ensure that their service is complying with the National Standards for infection prevention and control in community services (2018).

HCI is a provider of professional services in relation to resident safety, quality improvement, and regulatory compliance. Our experts can help you ensure your organisation is implementing best practice and regulatory compliant infection prevention and control measures. We can provide you with support through training, audits, policies and procedures and practical preparation guidance for a HIQA inspection.