COVID-19 resources on Infection control

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A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19

BMJ Open

Objectives:The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors. Setting Long-term care facilities. Participants Residents, staff and visitors of facilities. Primary and secondary outcome measures: Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. Results: The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents.Conclusions: Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF.

Last updated on hub: 20 October 2021

Coronavirus: lessons learned to date: sixth report of the Health and Social Care Committee and Third Report of the Science and Technology Committee of Session 2021-22

House of Commons

This report sets out the findings of the joint House of Commons Health and Social Care and Science and Technology Committees inquiry into the initial UK response to the Covid-19 pandemic. The report covers the country's preparedness for a pandemic; the use of non-pharmaceutical interventions such as border controls, social distancing and lockdowns to control the pandemic; the use of test, trace and isolate strategies; the impact of the pandemic on social care; the impact of the pandemic on specific communities; and the procurement and roll-out of Covid-19 vaccines. In relation to social care the report considers: the impact of the pandemic in social care including that the emphasis on “protecting the NHS” caused specific practical problems for social care providers; discharge of patients to care homes during the first wave; Infection prevention and control; Visits in residential care settings; Underlying challenges facing the care sector and social care workforce including funding pressures.The inquiry concluded that some initiatives were examples of global best practice but others represented mistakes. Both must be reflected on to ensure that lessons are applied to better inform future responses to emergencies. Report contains 38 recommendations to the Government and public bodies, and draws on evidence from over 50 witnesses.

Last updated on hub: 18 October 2021

COVID 19 guidance resumption of day services for older persons

Health Service Executive

Practice guidance for day services on the resumption of services during COVID-19 pandemic. The purpose of guidelines is to support care that meets the needs of the person, they are not a set of rigid rules, and they should always be applied with care and compassion. Key points in the guidance include: preparedness plans prior to opening; protocols to guide service user transportation; resumption of activities in the day centre with lowest practical risk; and management of potential cases / outbreaks where identified. Includes key checklist points for facilities, vaccination, procedures, transportation, and activities in each Day Service Centre

Last updated on hub: 10 October 2021

COVID-19 contacts: guidance for health and social care staff

Welsh Government

This guidance sets out requirements for health and social care staff who come into direct contact with patients or service users. Describes the process for employers to follow to protect vulnerable people. Includes sections about: when a patient/service user facing health and social care worker has been identified as a contact via TTP or the NHS COVID-19 app; testing scheme requirements; infection prevention and control; and process governance Two annexes: fact sheet for patient/service user facing health and social care workers following identification as a COVID 19 contact and checklist for employer to complete with staff member.

Last updated on hub: 01 October 2021

Free personal protective equipment (PPE) scheme

Department of Health and Social Care

Outlines details of the scheme to provide free personal protective equipment (PPE) for all health, social care and public sector workers for COVID-19 infection control, between 1 April 2021 and 31 March 2022. The purpose of the scheme is to ensure that health and social care providers have reliable access to the PPE needed for good infection control, limiting the spread of COVID-19.

Last updated on hub: 30 September 2021

State policy responses to COVID-19 in nursing homes

Journal of Long-Term Care

Context: COVID-19 has a high case fatality rate in high-risk populations and can cause severe morbidity and high healthcare resource use. Nursing home residents are a high-risk population; they live in congregate settings, often with shared rooms, and require hands-on care. Objectives: To assess state responses to the coronavirus pandemic related to nursing homes in the first half of 2020. Methods: An in-depth examination of 12 states’ responses to the COVID-19 pandemic in nursing homes through June 2020, using publicly reported information such as government decrees, health department guidance, and news reports. Findings: No state emerged as a model of care. All states faced difficulty with limited availability of testing and Personal Protective Equipment (PPE). State-level efforts to increase pay and benefits as a strategy to enable infected staff to quickly physically separate from residents were minimal, and other separation strategies depended on the ability to obtain test results rapidly and on state rules regarding accepting discharged COVID-19 patients into nursing homes. Visitor restrictions to reduce risk were ubiquitous, though based on a slim evidence-base. Limitations: The information used was limited to that which was publicly available. Implications: Overall, the results suggest that the states that handle the ongoing pandemic in nursing homes best will be those that find ways to make sure nursing homes have the resources to follow best practices for testing, PPE, separation, and staffing. Evidence is needed on visitor restrictions and transmission, as states and their citizens would benefit from finding safe ways to relax visitor restrictions.

Last updated on hub: 25 September 2021

Analysis of social interactions and risk factors relevant to the spread of infectious diseases at hospitals and nursing homes


Ensuring the safety of healthcare workers is vital to overcome the ongoing COVID-19 pandemic. This study presents an analysis of the social interactions between the healthcare workers at hospitals and nursing homes. Using data from an automated hand hygiene system, social interactions between healthcare workers to identify transmission paths of infection in hospitals and nursing homes were inferred. A majority of social interactions occurred in medication rooms and kitchens emphasising that health-care workers should be especially aware of following the infection prevention guidelines in these places. Using epidemiology simulations of disease at the locations, this study found no need to quarantine all healthcare workers at work with a contagious colleague. Only 14.1% and 24.2% of the health-care workers in the hospitals and nursing homes are potentially infected when we disregard hand sanitization and assume the disease is very infectious. Based on the simulations, this study observed a 41% and 26% reduction in the number of infected healthcare workers at the hospital and nursing home, when it is assumed that hand sanitization reduces the spread by 20% from people to people and 99% from people to objects. The analysis and results presented here forms a basis for future research to explore the potential of a fully automated contact tracing systems.

Last updated on hub: 21 September 2021

Staying ‘Covid-safe’: proposals for embedding behaviours that protect against Covid-19 transmission in the UK

British Journal of Health Psychology

Objectives: The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England’s Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term. Methods: With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals. Results: Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives. Conclusions: Embedding ‘Covid-safe’ behaviours into people’s everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.

Last updated on hub: 01 September 2021

Beyond the control of the care home: a meta-ethnography of qualitative studies of infection prevention and control in residential and nursing homes for older people

Health Expectations

Objective: This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design: This study had a meta-ethnography design. Data Sources: Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods: A meta-ethnography was performed. Results: Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions: Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution: A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.

Last updated on hub: 01 September 2021

Ethical issues for practice and research in congregate settings during the Covid-19 pandemic: cases and commentaries

Ethics and Social Welfare

This paper comprises two cases illustrating ethical challenges experienced by people working with residents and staff in congregate settings (residential homes) during Covid-19. In congregate settings restrictions were more stringent due to residents’ vulnerability and high risks of the virus spreading. In the first case, a UK social worker recounts his proactive advocacy on behalf of a young woman living in residential care, enabling easing of some restrictions for her. In the second case, a German researcher discusses how limits on entering nursing homes resulted in postponing and then ending a participatory research project, with the researcher regretting loss of contact with a home. Following each case is a commentary from an outsider’s perspective. Both authors foreground their responsibilities to care about people facing difficult circumstances and to take action for change. This suggests that situated approaches to ethics, focussing on particular people, roles and relationships in context (such as the ethics of care and virtue ethics) are helpful in understanding the ethical challenges described. The cases illustrate the extra cognitive and practical effort required to engage in ethical reflection on the implications of new circumstances, in which taken-for-granted ways of being, thinking and acting are difficult or impossible

Last updated on hub: 24 August 2021

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