The concepts to understand here are:
- Cross infection
- Contact points
Contact points just means the places in your house where hands touch a lot, so: handles, knobs, light switches, plugs, phones, taps etc - but also more subtly: the middle part of door frames, coat hooks, the bit of the wall just where you take off your boots. Imagine your hands dipped in wet red paint, then think about going about your day in your house, just doing all the normal things you do normally. Everywhere that’s covered in paint? That’s a contact point. You leave your germs there and other people pick them up, like bees. That’s cross infection, or transmission by indirect physical contact (most transmission is more direct: hand to hand, hand to mouth).
There are ways to reduce cross infection and one of them is to try to clean up and kill the germs living on those places so vectors can’t pick them up.
So here’s an example: we have a tray on our footstool and it’s always got pens in it. It’s not “the pen place”; it’s just that carers sit on the sofa with a cup of tea and fill in all that endless paperwork they are always doing, so pens accumulate on this tray. You have to assume then that those pens are a bubbling stew of bacteria. They are fomites. So that’s a point of cross infection. I mean, let’s not go crazy about it or anything, I’m just explaining how to identify these places. What to do about this one is harder. I mean, one some level, you know, you have not be crazy? You’re trying to seal up draughts in an old house, but you have to recognise you can’t brick up the doors or the windows, right? There’s only so much you can do. But maybe I’ll get a copper tray for that footstool, and put an alcogel on it.
I work in routine cleaning of contact points into the carer’s shifts, and of course I do it myself as well. Go around and clean lightswitches, door handles, the bed rail, etc. But use a clean cloth for each zone! Do this routinely, but strategically - at the end or beginning of shifts or at handovers. See clear to zero.
(I don’t mean vectors as in vector-borne disease, which properly means things like malaria contracted from mosquitos. I mean a normal Euclidean vector.) Remember I talked about desire lines in designing out behaviour? This is a similar observation practice: figuring out where people are carrying germs from and to, and thinking up ways to interrupt that.
This is less of a thing for us now as we have full shifts, but if you have pop-ins, you know that the carer coming through your door is bringing a colony from another ill person - who may have open sores, MRSA, that weird superbug Stuart got once that smells of tacos and glows in the dark… So you need to work up a patter to get people to take their coat and shoes off at the door and wash their hands straight away. This is actually pretty easy if you put the coat hooks right there at the front door, and the shoes lined up (all the regular carers keep their own slippers in a shoe tree thing). I always say, brightly and politely - Hello, do come in, let me take your coat, you can wash your hands right there, (and then I wash my hands too) in a helpful, polite way, and most people comply. They won’t do it unprompted. District nurses won’t do coat or shoes but will wash their hands unprompted, so, you know, swings and roundabouts.
Do you need to use your lightswitches? This is actually a useful side effect of living with someone who can’t use their hands - if you start thinking differently, not “hands first” - you can find ways to reduce handling things so much as a freebie. This isn’t really advice, hahah. It’s just an observation.
This is the single biggest thing you can do for infection control obviously. I’ve mentioned it in every article. Make sure there’s always handsoap, alcogel, and a clean hand towel at the sink. I’m not gonna write any more about this because what else is there to say? It’s really hard to get people to wash their hands. You have to keep trying. They will think you are neurotic. You will have to put up with that.
So this is obviously related to zoning and vectors, but look at your house and try to set up conceptual “airlocks” within it. So this means making sure the soap and the alcogel and the hand towel are all at the sink, so people don’t walk from one room to another with dirty hands, put your dishwasher near your sink so you can put the meat knife in the washer and wash your hands as the next step, put the clinical waste where dressings are changed, etc. But it also means building in clear ends to tasks: now wash your hands.
The goal here is behaviour change: you want to create habits in context. I talked about how people are a bit like the automatic breakfast machine in designing out behaviour, and that can be a challenge, but you can make this work for you if you can create situations where people wash their hands or clean up by habit. Start with the front door and then build in more as you think of them. You’ve probably had carers who don’t even close the door when using the toilet, and certainly don’t wash their hands afterwards, I know we have, so you sometimes have to really start on the ground floor.