Infection Control Spot Checks in Residential Aged Care: What Providers Need to Know

The Aged Care Quality and Safety Commission (ACQSC) is stepping up its program of infection control spot checks of residential aged care homes.

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Making a Plan and Checking it Twice: Aged Care COVID-19 Advice from the ACQSC

A second wave of COVID-19 is currently being experienced by several of our communities, particularly within Victoria and NSW, and a large percentage of cases are older people within our aged care homes. While previously only a few facilities were impacted by COVID-19, we have never experienced the number of infectious outbreaks impacting such a large number of Aged Care Homes at one time as are currently being reported across Melbourne.

Throughout the pandemic the Aged Care Quality and Safety Commission (Commission) has monitored and supported providers to develop their outbreak management plans and strategies to identify and mitigate pandemic related risks. Drawing on these experiences, the Commission has now published a specific resource for residential aged care services titled COVID-19 Are you Alert and Ready?

Prepared by the Commission’s Chief Clinical Advisor, Dr Melanie Wroth, this resource is intended to support residential aged care services to prepare for and respond to a COVID-19 outbreak. The resource sets out nine key areas that need to be addressed if an aged care provider is to effectively respond to a COVID-19 outbreak. The resource focuses particularly on the responsibilities of the management team and provides links to further information.

In this article we break the Commission’s resource down to a list of practical tasks and requirements and provide links to further resources. We also highlight some of the important things that the resource does not address.

 

The Nine Key Areas

The nine key areas suggested in the Commission’s resource are:

  1. Planning – managing the risk of exposure to the virus and the impact of isolation on consumers
  2. Screening – staff, visitors, and entrants to the Homes
  3. Infection Prevention and Control
  4. Layout of the Service
  5. Service Provision
  6. Staffing – particularly loss of staff if an outbreak were to occur
  7. Personal Protective Equipment (PPE) – requirements in the event of an outbreak
  8. Communication
  9. Consumer wellbeing

 

Summary of the Nine Key Areas with Links to Further Resources

Topic

Information Summary

Other Resources

1. Planning

  • Review regularly your outbreak management plan.
  • Know the specific risks that face your service. This includes those within your local community and ensure that these are included in your plan.
  • Ensure staff know and understand your outbreak management plan and be certain that they are able to activate it rapidly if required.
  • The Outbreak Management Team must be available at short notice 24/7 and fully understand their individual roles.
  • All team members should be familiar with your prevention strategies and outbreak management plan – review and test regularly.

2. Screening

  • Screen all staff, visitors, and entrants to the home prior to entry. It should be an essential routine.
  • Screening procedures and practices should be monitored and reviewed for effectiveness and updated as required. Reviews should refer to relevant state or territory requirements.
  • Know and understand the purpose of the screening procedures so that consumers and staff are protected, and you are effective in reducing the risk of COVID-19 transmission.
  • Ensure that restrictions to visitor access are done with care and compassion, keeping consumers and their representatives at the centre of the Home’s decision-making.
  • Even with the mildest symptoms, unwell staff must be supported to stay at home.
  • Processes for detecting symptoms among consumers should be in place and support should be given to those who are experiencing mild symptoms and atypical presentations.

3. Infection Prevention and Control

Check and regularly monitor:

  • how well the Home is meeting required infection control and prevention standards across all areas and all shifts – including physical distancing, hand hygiene practices, correct use of PPE and cleaning procedures
  • resources to support hand hygiene – ensure resources are adequate and easily accessible
  • the hygiene culture within the Home – does it support the implementing of hand hygiene, including for Consumers?
  • cleaning processes, particularly for high touch surfaces as well as any shared equipment.
 

4. Layout of the Service

Understand the layout of your service by:

  • using a floor plan of the facility to identify individual consumer locations and plan for how best to ensure consumer safety and meet particular care needs
  • assessing any identified risks so they can be managed before you need to activate your plan
  • considering how you will separate COVID-19 positive consumers from those who need protection from exposure
  • planning how you will limit staff and consumer movements between areas of the building and between buildings in an outbreak
  • identifying an isolation area where a COVID-19 positive consumer could be cared for away from other consumers.
 

5. Service Provision

  • Consider how you will provide quality care and services to consumers if a central services staff member (such as someone working in the kitchen, or laundry) contracts COVID-19.
  • Consider risk management strategies that can be implemented to prevent cross-contamination from a range of different processes including meal provision, laundry, waste management, cleaning, maintenance, and care services (e.g. medication administration).
 

6. Staffing

If needed, where would you access extra staff to support the meeting of care and service needs of consumers?

During an outbreak, how will staff be supported to allow them to continue to work while also protecting themselves and their families?

Ensure you have maintained good staff records, that include:

  • which staff also work in other aged care or health services.
  • which staff may not be able to work during an outbreak due to personal wishes, responsibilities, or vulnerabilities
  • close contacts of any staff member who is tested as COVID-19 positive
  • rostering records that identify immediately those who have worked with a staff member just diagnosed with COVID-19, and which consumers they have cared for.

Plan and ensure you can estimate the number as well as type of workforce that would be required in an outbreak. This plan should consider:

  • orientating and supporting new staff
  • increased burden of frequent PPE changes and monitoring of consumers
  • increased effort required to restrict staff to contained areas and specific workflow needs
  • enhanced cleaning requirements and the time required
  • increased support needs of consumers
  • increased staff needed for communications to consumers, relatives, and external service providers.
 

7. Personal Protective Equipment (PPE)

  • Review and ensure you have an inventory of your current PPE stocks.
  • Assess and estimate how much PPE you will need if an outbreak were to occur. You must ensure that there is adequate stock onsite and/or readily available to enable safe and effective infection prevention and control until more protective equipment is made available from the Commonwealth stock.
  • Remember that if there is an increased use of PPE, clinical waste management services need to be contracted to meet the Home’s increased needs and provide the required disposal services.

8. Communication

It is important to:

  • communicate with staff, consumers, and families in the event of an outbreak. This should be not only initially but also through the outbreak period
  • communicate a consumer’s positive test result in a timely, sensitive, and compassionate way
  • display appropriate signage to designate specific areas in the event of an outbreak and to communicate lockdown/facility closure on outside entrances
  • determine in advance how you will manage the media. This includes their requests as well as potential for a media presence outside the facility.

 

9. Consumer wellbeing

Consumer wellbeing needs to be a focus throughout the lockdown period. The negative impact of isolation cannot be underestimated.

The outbreak plan needs to include ways to prevent deterioration or consumers from occurring. This includes ways to prevent deterioration in relation to their physical condition, mobility, strength, independent function, social connectedness,

psychological and emotional wellbeing and nutritional status.

 

Key Issues that the Commission’s Resource Does Not Address

The Commission’s resource says little about staff training and staff wellbeing.

For those of you who have had the experience of a COVID-19 outbreak or other infectious outbreak it is essential that time is invested in monitoring, reviewing, and supporting staff. This is to ensure that fundamental infection control and prevention practices are appropriately implemented.

During an outbreak, staff will need an enormous amount of energy to sustain the required practices and additional tasks. This will put immense pressure on their wellbeing. Your workforce is your most valuable resource and fundamental in your preparedness and the activation of the Home’s outbreak management plan, so it is vital that you have reliable procedures in place to monitor staff wellbeing and relieve pressure on particular staff as needed.

 

Conclusion

Do not underestimate COVID-19. Remember that this continues to be a rapidly changing area. Ensure you regularly monitor available resources and Commonwealth and State updates. Continually review your outbreak management plan and ensure that that you and your workforce are prepared if a COVID-19 outbreak does occur. Your outbreak management plan and your workforce are your best risk management strategy and your first line of defence.

 

Further Resources

 

Ruth Greene
ABOUT THE AUTHOR | Ruth Greene
As a Registered Nurse with over 30 years’ experience across the healthcare industry, Ruth has been employed in a range of management and clinical positions, and for several years worked as a consultant in residential aged care. Understanding organisational governance, risk and related quality standards has been a pivotal part of her work practices and has included maintaining and monitoring of legislative and regulatory requirements, as well as developing linked policy documents. Ruth is Principal Consultant – Aged Care, at CompliSpace.

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