COVID-19 resources on Infection control

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Discharge to designated settings / care homes: frequently asked questions

Department of Health and Social Care

These Frequently Asked Questions (FAQs) for care homes and hospitals relate to the guidance on Discharge into care homes: designated settings and accompanying Clarification note. They include question themes raised at a webinar by care homes and hospitals held on 21st January 2021. The themes covered include: hospital discharge (for those exempt from COVID-19 testing prior to discharge); designated settings; 14-day isolation period and preventing COVID-19 exposure; 90-day timeframe and testing; severe immunosuppression; COVID-19 symptoms in care home residents; new variant; vaccinations; outbreaks in care homes; and support for care homes.

Last updated on hub: 07 April 2021

A record of our own: lockdown experiences of ethnic minority prisoners

Zahid Mubarek Trust

Findings of a review of the experiences of ethnic minority prisoners, including those from Gypsy, Roma and Traveller (GRT) communities, during lockdown. The project aimed to provide a platform for ethnic minority prisoners and their families to describe the impact Covid-19 had on their lives and to consider what lessons could be learned for the future. The evidence presented in this report focusses on the findings from 87 questionnaires which were completed by prison leavers or family members of prisoners (40 interviews and 47 written submissions) and which covered conditions in 29 prisons. The findings cover: changes to the prison regime; measures to prevent the spread of Covid-19; communication; contact with families; healthcare; mental health; resettlement support; and staff-prisoner relationships and fairness. While the changes to the prison regime may have been successful in reducing the spread of Covid-19 and saving lives, they also had profound and long-lasting effects on ethnic minority prisoners and their families, with one participant describing them as a “double punishment”. Issues highlighted in this report include: not enough time out of cells; inadequate communication; inconsistent implementation of the regulations; lack of provision to support prisoners’ mental health; and resourcing and inequalities across the prison estate.

Last updated on hub: 07 April 2021

Interim infection prevention and control recommendations to prevent SARS-CoV-2 spread in nursing homes

Centers for Disease Control and Prevention

Even as nursing homes resume more normal practices and begin relaxing restrictions, nursing homes must sustain core infection prevention and control (IPC) practices and remain vigilant for SARS-CoV-2 infection among residents and healthcare personnel in order to prevent spread and protect residents and staff from severe infections, hospitalisations, and death. This guidance has been updated and organised according to IPC practices that should remain in place whether or not nursing homes are experiencing outbreaks of SARS-CoV-2. Additional guidance is included to assist nursing homes and public health authorities with resident placement and cohorting decisions when responding to SARS-CoV-2 infections and exposures.

Last updated on hub: 06 April 2021

Care homes action plan: final update: how we have supported care homes during the winter

Welsh Government

This report provides a final update on progress in relation to the actions set out in the Care homes action plan, reflecting on lessons learnt during the pandemic and next steps. It focuses on six specific areas: infection prevention and control; personal protective equipment (PPE); general and clinical support for care homes; residents’ well-being; social care workers’ well-being; and financial sustainability. Effective use of testing, PPE and infection prevention and control practices have seen a noticeable drop in the number of positive test results within care homes. The vaccination programme, whilst not removing the need to ensure these practices remain in place and are adhered to, has also been seen as providing a glimmer of light at what has been a very long tunnel. Financial sustainability of the sector remains a significant challenge. COVID-19 has had an impact on the financial position of many care providers due to the additional cost pressures surrounding additional infection prevention and control activity and staffing constraints, alongside a reduction in income.

Last updated on hub: 06 April 2021

Extra care and supported living: guidance document

Department of Health and Social Care

Guidance on regular retesting for extra care and supported living settings that meet the eligibility criteria. NHS Test and Trace is making regular COVID-19 testing available to eligible extra care and supported living settings in England. In order to be eligible for testing, extra care and supported living settings must meet both of the following criteria: a closed community with substantial facilities shared between multiple people; where most residents receive the kind of personal care that is CQC regulated (rather than help with cooking, cleaning and shopping). This guidance covers: why testing is important; what to do if you have an outbreak; the end-to-end testing process; unique organisation number; preparing your setting; registering completed tests; returning test kits; results; where to go for support; step-by-step guide for registering a test kit after completing a test.

Last updated on hub: 06 April 2021

Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey

Lancet Healthy Longevity

Background: Outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have occurred in long-term care facilities (LTCFs) worldwide, but the reasons why some facilities are particularly vulnerable to outbreaks are poorly understood. This study aimed to identify factors associated with SARS-CoV-2 infection and outbreaks among staff and residents in LTCFs. Methods: This study did a national cross-sectional survey of all LTCFs providing dementia care or care to adults aged 65 years or older in England between May 26 and June 19, 2020. The survey collected data from managers of eligible LTCFs on LTCF characteristics, staffing factors, the use of disease control measures, and the number of confirmed cases of infection among staff and residents in each LTCF. Survey responses were linked to individual-level SARS-CoV-2 RT-PCR test results obtained through the national testing programme in England between April 30 and June 13, 2020. The primary outcome was the weighted period prevalence of confirmed SARS-CoV-2 infections in residents and staff reported via the survey. Multivariable logistic regression models were fitted to identify factors associated with infection in staff and residents, an outbreak (defined as at least one case of SARS-CoV-2 infection in a resident or staff member), and a large outbreak (defined as LTCFs with more than a third of the total number of residents and staff combined testing positive, or with >20 residents and staff combined testing positive) using data from the survey and from the linked survey–test dataset. Findings: 9081 eligible wLTCFs were identified, of which 5126 (56·4%) participated in the survey, providing data on 160 033 residents and 248 594 staff members. The weighted period prevalence of infection was 10·5% (95% CI 9·9–11·1) in residents and 3·8% (3·4–4·2) in staff members. 2724 (53·1%) LTCFs reported outbreaks, and 469 (9·1%) LTCFs reported large outbreaks. The odds of SARS-CoV-2 infection in residents (adjusted odds ratio [aOR] 0·80 [95% CI 0·75–0·86], p<0·0001) and staff (0·70 [0·65–0·77], p<0·0001), and of large outbreaks (0·59 [0·38–0·93], p=0·024) were significantly lower in LTCFs that paid staff statutory sick pay compared with those that did not. Each one unit increase in the staff-to-bed ratio was associated with a reduced odds of infection in residents (0·82 [0·78–0·87], p<0·0001) and staff (0·63 [0·59–0·68], p<0·0001. The odds of infection in residents (1·30 [1·23–1·37], p<0·0001) and staff (1·20 [1·13–1·29], p<0·0001), and of outbreaks (2·56 [1·94–3·49], p<0·0001) were significantly higher in LTCFs in which staff often or always cared for both infected or uninfected residents compared with those that cohorted staff with either infected or uninfected residents. Significantly increased odds of infection in residents (1·01 [1·01–1·01], p<0·0001) and staff (1·00 [1·00–1·01], p=0·0005), and of outbreaks (1·08 [1·05–1·10], p<0·0001) were associated with each one unit increase in the number of new admissions to the LTCF relative to baseline (March 1, 2020). The odds of infection in residents (1·19 [1·12–1·26], p<0·0001) and staff (1·19 [1·10–1·29], p<0·0001), and of large outbreaks (1·65 [1·07–2·54], p=0·024) were significantly higher in LTCFs that were for profit versus those that were not for profit. Frequent employment of agency nurses or carers was associated with a significantly increased odds of infection in residents (aOR 1·65 [1·56–1·74], p<0·0001) and staff (1·85 [1·72–1·98], p<0·0001), and of outbreaks (2·33 [1·72–3·16], p<0·0001) and large outbreaks (2·42 [1·67–3·51], p<0·0001) compared with no employment of agency nurses or carers. Compared with LTCFs that did not report difficulties in isolating residents, those that did had significantly higher odds of infection in residents (1·33 [1·28–1·38], p<0·0001) and staff (1·48 [1·41–1·56], p<0·0001), and of outbreaks (1·84 [1·48–2·30], p<0·0001) and large outbreaks (1·62 [1·24–2·11], p=0·0004). Interpretation: Half of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures.

Last updated on hub: 31 March 2021

Factors associated with SARS-CoV-2 infection and outbreaks in long-term care facilities in England: a national cross-sectional survey

Lancet Healthy Longevity

Background: Outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have occurred in long-term care facilities (LTCFs) worldwide, but the reasons why some facilities are particularly vulnerable to outbreaks are poorly understood. This study aimed to identify factors associated with SARS-CoV-2 infection and outbreaks among staff and residents in LTCFs. Methods: This study did a national cross-sectional survey of all LTCFs providing dementia care or care to adults aged 65 years or older in England between May 26 and June 19, 2020. The survey collected data from managers of eligible LTCFs on LTCF characteristics, staffing factors, the use of disease control measures, and the number of confirmed cases of infection among staff and residents in each LTCF. Survey responses were linked to individual-level SARS-CoV-2 RT-PCR test results obtained through the national testing programme in England between April 30 and June 13, 2020. The primary outcome was the weighted period prevalence of confirmed SARS-CoV-2 infections in residents and staff reported via the survey. Multivariable logistic regression models were fitted to identify factors associated with infection in staff and residents, an outbreak (defined as at least one case of SARS-CoV-2 infection in a resident or staff member), and a large outbreak (defined as LTCFs with more than a third of the total number of residents and staff combined testing positive, or with >20 residents and staff combined testing positive) using data from the survey and from the linked survey–test dataset. Findings: 9081 eligible wLTCFs were identified, of which 5126 (56·4%) participated in the survey, providing data on 160 033 residents and 248 594 staff members. The weighted period prevalence of infection was 10·5% (95% CI 9·9–11·1) in residents and 3·8% (3·4–4·2) in staff members. 2724 (53·1%) LTCFs reported outbreaks, and 469 (9·1%) LTCFs reported large outbreaks. The odds of SARS-CoV-2 infection in residents (adjusted odds ratio [aOR] 0·80 [95% CI 0·75–0·86], p<0·0001) and staff (0·70 [0·65–0·77], p<0·0001), and of large outbreaks (0·59 [0·38–0·93], p=0·024) were significantly lower in LTCFs that paid staff statutory sick pay compared with those that did not. Each one unit increase in the staff-to-bed ratio was associated with a reduced odds of infection in residents (0·82 [0·78–0·87], p<0·0001) and staff (0·63 [0·59–0·68], p<0·0001. The odds of infection in residents (1·30 [1·23–1·37], p<0·0001) and staff (1·20 [1·13–1·29], p<0·0001), and of outbreaks (2·56 [1·94–3·49], p<0·0001) were significantly higher in LTCFs in which staff often or always cared for both infected or uninfected residents compared with those that cohorted staff with either infected or uninfected residents. Significantly increased odds of infection in residents (1·01 [1·01–1·01], p<0·0001) and staff (1·00 [1·00–1·01], p=0·0005), and of outbreaks (1·08 [1·05–1·10], p<0·0001) were associated with each one unit increase in the number of new admissions to the LTCF relative to baseline (March 1, 2020). The odds of infection in residents (1·19 [1·12–1·26], p<0·0001) and staff (1·19 [1·10–1·29], p<0·0001), and of large outbreaks (1·65 [1·07–2·54], p=0·024) were significantly higher in LTCFs that were for profit versus those that were not for profit. Frequent employment of agency nurses or carers was associated with a significantly increased odds of infection in residents (aOR 1·65 [1·56–1·74], p<0·0001) and staff (1·85 [1·72–1·98], p<0·0001), and of outbreaks (2·33 [1·72–3·16], p<0·0001) and large outbreaks (2·42 [1·67–3·51], p<0·0001) compared with no employment of agency nurses or carers. Compared with LTCFs that did not report difficulties in isolating residents, those that did had significantly higher odds of infection in residents (1·33 [1·28–1·38], p<0·0001) and staff (1·48 [1·41–1·56], p<0·0001), and of outbreaks (1·84 [1·48–2·30], p<0·0001) and large outbreaks (1·62 [1·24–2·11], p=0·0004). Interpretation: Half of LTCFs had no cases of SARS-CoV-2 infection in the first wave of the pandemic. Reduced transmission from staff is associated with adequate sick pay, minimal use of agency staff, an increased staff-to-bed ratio, and staff cohorting with either infected or uninfected residents. Increased transmission from residents is associated with an increased number of new admissions to the facility and poor compliance with isolation procedures.

Last updated on hub: 31 March 2021

Adult Social Care Infection Control and Testing Fund Ring-Fenced Grant 2021

Department of Health and Social Care

Sets out the measures that the new Infection Control and Testing Fund will support, including distribution of funds, conditions on funds and reporting requirements. The Adult Social Care Infection Control Fund was first introduced in May 2020. It was extended in October 2020 and, by March 2021 had provided over £1.1 billion of ring-fenced funding to support adult social care providers in England for infection prevention and control (IPC). The Rapid Testing Fund was introduced in January 2021 to support additional lateral flow testing of staff in care homes, and enable indoors, close contact visiting where possible. The new Infection Control and Testing Fund has consolidated these funding streams, with an extra £341 million of funding until June 2021. The purpose of this fund is to support adult social care providers to: reduce the rate of COVID-19 transmission within and between care settings through effective IPC practices and increase uptake of staff vaccination; and conduct rapid testing of staff and visitors in care homes, high risk supported living and extra care settings, to enable close contact visiting where possible. This brings the total ring-fenced funding for infection prevention and control to almost £1.35 billion and support for lateral flow testing to £288 million in care settings.

Last updated on hub: 31 March 2021

Working together on infection control and joint support

West London Alliance

As part of a wider joint approach, West London Alliance local authorities and North West London Health have established a joint response to care homes to support the significantly increased need for infection control advice and expertise to protect residents and staff. Local authority commissioners are the key interface with all care homes in NWL, liaising with them daily to understand their situation and their individual needs. Commissioners are providing support where they can, providing staff and PPE, and co-ordinating additional support. The full case study can be found in the Department for Health and Social Care action plan which is linked to this item and was published on 15 April 2020.

Last updated on hub: 31 March 2021

System approach to tackling COVID-19 in the care sector

Nottinghamshire County Council

Nottinghamshire County Council have worked rapidly to put in place a range of policies and support measures to support the Care Sector across Nottinghamshire. This includes working together to ensure a shared view of service capacity and pressures, and enabling urgent deliveries of personal protective equipment (PPE). Contact was made at an early stage to support people who receive a Direct Payment and those who work as a Personal Assistant have in place emergency plans and can access PPE. The full case study can be found in the Department for Health and Social Care action plan which is linked to this item and was published on 15 April 2020.

Last updated on hub: 31 March 2021

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