COVID-19 resources on infection control

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The vulnerability of nursing home residents to the Covid-19 pandemic

International Journal of Care Coordination

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

Last updated on hub: 03 December 2020

Visits out of care homes

Department of Health and Social Care

This document sets out how care homes can support residents of working age on visits outside of the care home. Outward visits are an important part of life for many in residential care. However, spending time with others outside the care home will increase risk of exposure to COVID for the resident and potentially to other vulnerable residents on their return. These risks are usually significantly greater for older people than for those of working age. As such, visits out of care homes should only be considered for care home residents of working age. Care homes should, however, support visits out for older people in exceptional circumstances, such as to visit a friend or relative at the end of their life. This guidance explains how visits out of a care home can take place; the role of the provider in supporting outward visiting; and the need for individual risk assessments.

Last updated on hub: 03 December 2020

Reducing health inequalities associated with Covid-19

NHS Providers

This framework offers principles for a population health level approach to understanding and taking action on health inequalities which have developed or worsened as a result of the COVID-19 crisis that began in 2019/20. It focuses on what NHS acute hospital trusts and mental health and community trusts can do, working as part of an integrated health and care system. The framework is intended to help NHS provider trusts to systematically review, describe, prioritise and further develop their role in addressing health inequalities during response and recovery from the COVID-19 crisis and as part of their broader core efforts to meet the needs of their local population. The framework is designed to assist NHS provider trusts to address three main areas: the principles that should be used across the healthcare system to ensure the response to Covid-19 does not increase health inequalities; the priority actions for providers to implement, working in the context of the population and its healthcare system; the indicators that should be used to monitor the impact of Covid-19 on health inequalities. The principles for action include: supporting integrated, co-ordinated person centre care; ensuring services are accessible fo all, particularly those at risk of exclusion; health and care services should always be allocated based on healthcare need, striving in particular for equity of outcome, with a principle of proportional universalism embedded; wider determinants of health should be addressed and funded at a place-based level, harnessing available community assets; health and care staff should be valued and supported to maintain wellbeing and to enable delivery of high quality, person-centred care in all settings.

Last updated on hub: 01 December 2020

How has Covid-19 impacted on care and support at home in Scotland?

Scottish Parliament

Findings from a survey to understand the impact of Covid-19 on care at home services, and what issues the pandemic has highlighted, improved, or made worse. The survey ran from 10 August 2020 to 7 September 2020 and the Committee received over 700 responses, including 415 responses from family members of those receiving care at home and unpaid carers and 93 responses from individuals receiving care at home. Key findings include: there was a reduction of care as a result of the pandemic; care at home staff do not receive the same support or recognition as NHS staff; concern regarding safety mainly related to access to and appropriate use of PPE as well as testing and training of care staff; ensuring continuity of care was the second most important issue to respondents, with concerns around quality and consistency of care as well as the need for designated carers to reduce the number of staff entering homes; the reduction of visits, activities and respite services, and resulting loss of a routine, increased feelings of loneliness and isolation for those in receipt of care and of anxiety, depression and mental exhaustion for unpaid carers; despite a reduction in care being delivered, staff saw increased workloads, with new tasks required as a result of the pandemic such as additional staff training, increased staff meetings and increased paperwork; access to additional support and services (food and prescription deliveries, access to activities and entertainment) and access to hospital, GP services and medical equipment was critically important to respondents; it was felt that one to one communication between services and service users needed to improve. Finally, it was suggested that more needs to be done to listen to the needs of those receiving care and involve them in decision making.

Last updated on hub: 26 November 2020

The supply of personal protective equipment (PPE) during the COVID-19 pandemic

National Audit Office

This report focuses on the supply of personal protective equipment (PPE) during the pandemic. It examines: responsibilities for PPE supply in England (Part One); the emergency response to PPE shortages, focusing on the performance of national bodies in obtaining and distributing PPE to local organisations (Part Two); the experience of health and social care providers and their workforce (Part Three); and the Department of Health & Social Care’s (the Department’s) new PPE strategy (Part Four). The Government initially considered it was well-placed for managing the supply of PPE in a pandemic, with tested plans and a stockpile in place. But neither the stockpiles nor the usual PPE-buying and distribution arrangements could cope with the extraordinary demand created by the COVID-19 pandemic. As a result, government’s structures were overwhelmed in March 2020. Once government recognised the gravity of the situation it created a parallel supply chain to buy and distribute PPE. However, it took a long time for it to receive the large volumes of PPE ordered, particularly from the new suppliers, which created significant risks. There were further difficulties with distribution to providers and many front-line workers reported experiencing shortages of PPE as a result. The initial focus on the NHS meant adult social care providers felt particularly unsupported. Government has budgeted an unprecedented £15 billion of taxpayers’ money to buy PPE for England during 2020-21. It has paid very high prices given the very unusual market conditions, and hundreds of millions of pounds-worth of PPE will not be used for the original intended purpose.

Last updated on hub: 26 November 2020

Rapid learning review of domiciliary care in Northern Ireland

Northern Ireland. Department of Health

This rapid learning review has collated and considered any learning about domiciliary care issues during the Covid-19 pandemic in Northern Ireland in order to inform current and future planning as the pandemic continues. The review focused on four themes: service user and carer experience; service provision; workforce experience; and infection prevention and control. Work stream leads were appointed for each theme and they undertook a wide engagement with a range of stakeholders and using a variety of methods for collecting data. In addition, a workforce and management survey was carried out to seek feedback on three of the four themes. These were workforce, service provision/business continuity and infection prevention and control. A rapid literature review was also commissioned to add to the evidence from stakeholders. The evidence from the literature review was broadly consistent with the messages from the stakeholder engagement with common themes and lessons learned identified. The review highlighted some of the challenges domiciliary care staff faced such as PPE, training, testing and lack of adequate support. Staff felt overlooked and that domiciliary care did not get the recognition it deserved. The review has also highlighted the wider systemic issues that affect domiciliary care, including pay, terms and conditions of the workforce. Domiciliary care service users and their family carers reported feeling forgotten about and afraid to use domiciliary care because of fear of infection during the earlier stages of the pandemic. For many others, however, domiciliary care was the only service that continued for them. Both situations placed service users and carers under very significant pressure.

Last updated on hub: 26 November 2020

A testing service for homecare workers in England

Department of Health and Social Care

Sets out how homecare agencies in England can order regular tests for their homecare (domiciliary care) staff. NHS Test and Trace is making weekly Covid-19 testing available to all homecare workers in Care Quality Commission (CQC)-registered domiciliary care organisations. The guidance prescribes that agency managers should order tests every 28 days for their homecare workers; four tests are delivered for each homecare worker to the agency, for a 28 day testing cycle; each homecare worker should be given four test kits every 28 days; every 7 days a care worker should take a test, register it online, and return it by post between Thursday and Sunday. Homecare workers will receive their results in 2 to 4 days by email and text message (SMS). This approach aims to: identify homecare workers who currently have Covid-19 so they are able to self-isolate if their result is positive; protects those receiving care from infection passed to them by homecare workers who are confirmed positive; and prevents and controls the spread of the virus by identifying asymptomatic cases.

Last updated on hub: 25 November 2020

Proposal to regulate to stop movement of staff between care settings

Department of Health and Social Care

This consultation seeks views from the adult social care sector on the proposal to stop staff movement between different care settings and between health and care settings is critical to minimise the risk of infection of COVID-19. The findings of a study on the impact of coronavirus in care homes in England indicated one of the common factors in care homes with higher levels of infection among staff was the extent to which those homes employed staff who worked across multiple sites. The requirement would apply to Care Quality Commission (CQC) registered residential and nursing care home providers in England. These providers would be required not to use staff to provide nursing or personal care who are carrying on, or who have carried on within the previous 14 days, a regulated activity in another setting and/or for another health or social care provider subject to certain exceptions. The consultation closes on Wednesday 25 November 2020.

Last updated on hub: 25 November 2020

How care homes managed infection prevention and control during the coronavirus pandemic 2020

Care Quality Commission

Effective infection prevention and control (IPC) is essential to protect people from COVID-19. This report sets out the learning relating to IPC from CQC inspections across 440 care home in August and at the beginning of September 2020. Inspectors looked at assurance overall and across 8 questions: Are all types of visitors prevented from catching and spreading infection? Are shielding and social distancing rules complied with? Are people admitted into the service safely? Does the service use PPE effectively to safeguard staff and people using services? Is there adequate access and take up of testing for staff and people using services? Do the layout of premises, use of space and hygiene practice promote safety? Do staff training, practices and deployment show the service can prevent and/or manage outbreaks? Is the IPC policy up-to-date and implemented effectively to prevent and control infection? Across the 440 care homes, the inspectors found: a high level of assurance in the 8 questions; assurance in all 8 questions at 288 of the 440; the 2 areas with the most gaps in assurance were effective use of personal protective equipment (PPE) and having up-to-date policies.

Last updated on hub: 25 November 2020

Coronavirus: support for rough sleepers (England)

House of Commons Library

This briefing paper outlines the measures taken in England to support rough sleepers, and those at risk of rough sleeping, during the coronavirus (Covid-19) outbreak. It discusses the impact of these measures and stakeholder comment. Contents include: Contents: support for rough sleepers; impact of measures to support rough sleepers; government policies in Scotland, Wales and Northern Ireland; background information on rough sleeping and homelessness in the UK. Rough sleepers are vulnerable to coronavirus (Covid-19); they are more likely to have underlying health conditions than the wider population and to face difficulties in following public health advice on self-isolation, social distancing and hygiene. They can also face barriers in accessing public health information and healthcare. Shared facilities used by rough sleepers – such as day centres, hostels and night shelters – increase the risk of transmission of the virus. The Covid-19 outbreak in spring 2020 prompted an unprecedented public health response from the UK Government, local authorities and the voluntary sector to protect the rough sleeping population.

Last updated on hub: 25 November 2020

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