COVID-19 resources on infection control

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Webinar recording: Sharing voices in response to COVID-19

Social Care Institute for Excellence

This webinar was chaired by Baroness Ilora Finlay and the technical host was Prof Wayne Martin. It was about sharing voices in response to COVID-19.

Last updated on hub: 22 October 2020

Winter discharges: designated settings

Department of Health and Social Care

This letter sets out: an overview of the requirement for designated care settings for people discharged from hospital who have a COVID-19 positive status; and an instruction for local authorities to commence identifying and notifying the Care Quality Commission (CQC) of sufficient local designated accommodation and to work with CQC to assure their compliance with the infection prevention control (IPC) protocol.

Last updated on hub: 22 October 2020

The predictable crisis: why Covid-19 has hit Scotland’s care homes so hard

Common Weal

This paper considers how government in Scotland has managed the Covid-19 crisis, using what has happened at Home Farm Care Home on Skye to illustrate the issues but also, potentially, to point to the way forwards. It argues that much of the Covid-19 disaster in care homes was quite predictable and, as such, represents a failure by both care home providers and the public authorities. It then looks at these failures within the broader context of the development of the care home sector in the last 27 years, with a particular focus on how this has provided for the health of older people. It concludes with some recommendations, both for immediate action and for more fundamental reform of the sector and the role of public authorities within it. Key points include: based on quality ratings at the outset of the crisis more than one quarter of Scotland's care homes (those rated adequate or below) could have been expected to be unable properly to protect older people in the event of a pandemic; the Care Inspectorate, which has few enforcement powers, was incapable of brining care homes up to the standard required by the Covid crisis; the result is that six out of ten care homes in Scotland have had a case of Covid and about 45 per cent still have a current case (as of Monday 18 May); for the first eight weeks of the crisis the Scottish Government was adamant that the providers (and not the Scottish Government) were responsible for protecting care home residents – this effectively represented the privatisation of the responsibility for older people in care during the crisis and restricted adequate access to medical treatment; the repeated updating of guidelines created a confusing impact.

Last updated on hub: 21 October 2020

Updating ethnic contrasts in deaths involving the coronavirus (COVID-19), England and Wales: deaths occurring 2 March to 28 July 2020

The Office for National Statistics

Updated estimates of mortality involving the Covid-19 by ethnic group and investigation of the explanatory power of hospital-based comorbidity on ethnic differences, building on previous models published by the Office for National Statistics. Considering deaths up to 28 July 2020, males and females of Black and South Asian ethnic background were shown to have increased risks of death involving the Covid-19 compared with those of White ethnic background. In England and Wales, males of Black African ethnic background had the highest rate of death involving COVID-19, 2.7 times higher than males of White ethnic background; females of Black Caribbean ethnic background had the highest rate, 2.0 times higher than females of White ethnic background. All ethnic minority groups other than Chinese had a higher rate than the White ethnic population for both males and females. Looking separately at the care home population, males of Asian ethnic background and females of Black and Asian ethnic backgrounds (using broader ethnic groupings) also had a raised rate of death involving COVID-19 compared with people of White ethnic background after taking account of geography and health measures. These findings show that ethnic differences in mortality involving COVID-19 are most strongly associated with demographic and socio-economic factors, such as place of residence and occupational exposures, and cannot be explained by pre-existing health conditions using hospital data or self-reported health status.

Last updated on hub: 21 October 2020

COVID-19: information and guidance for care home settings (adults and older people)

Health Protection Scotland

This guidance for care homes provides advice about COVID-19 for those working in care home settings for adults and older people. It covers: measures to prevent spread of COVID-19 and protect people at increased risk of severe illness; providing care for residents during COVID-19 pandemic; measures to protect residents in the shielding category; measures for residents exposed to a case of COVID-19; admission of individuals to the care home; testing in the care home; care home placement for symptomatic residents; Personal Protective Equipment (PPE); care equipment; staffing, including staff cohorting and staff testing; visiting care homes; and caring for a resident who has died.

Last updated on hub: 20 October 2020

COVID-19: visiting nursing and residential care homes: summary for family and friend carers

Northern Ireland. Department of Health

Outlines the arrangements for visiting in nursing and residential care homes which apply in line with current regional surge level position (level 4 – high or rising level of transmission). This is subject to change depending on the prevalent rate of transmission and will be reviewed frequently. Local outbreaks of infection in care homes will require an additional specific local response and additional restrictions for visiting in line with Public Health Agency advice for management of the outbreak.

Last updated on hub: 20 October 2020

Infection prevention and control in care homes

Care Quality Commission

A set of questions and prompts used by CQC inspectors to assess how well staff and residents of care homes are protected by infection prevention and control, including checks for COVID-19 mitigation.

Last updated on hub: 20 October 2020

Face-to-face DoLS assessments strongly discouraged in high-risk Covid areas

Community Care

A brief overview of current guidance relating to face-to-face Deprivation of Liberty Safeguards (DoLS) assessments, highlighting that practitioners should only carry out face-to-face assessments “in exceptional circumstances” in areas covered by tier 2 and 3 Covid-19 restrictions. Updated guidance also says that people without relevant capacity are unlikely to be committing offence if they breach self-isolation regulations.

Last updated on hub: 20 October 2020

Increased risk of SARS-CoV-2 infection in staff working across different care homes: enhanced CoVID-19 outbreak investigations in London care Homes

Journal of Infection

Background: Care homes have been disproportionately affected by the COVID-19 pandemic and continue to suffer large outbreaks even when community infection rates are declining, thus representing important pockets of transmission. We assessed occupational risk factors for SARS-CoV-2 infection among staff in six care homes experiencing a COVID-19 outbreak during the peak of the pandemic in London, England. Methods: Care home staff were tested for SARS-COV-2 infection by RT-PCR and asked to report any symptoms, their contact with residents and if they worked in different care homes. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. Results: In total, 53 (21%) of 254 staff were SARS-CoV-2 positive but only 12/53 (23%) were symptomatic. Among staff working in a single care home, SARS-CoV-2 positivity was 15% (2/13), 16% (7/45) and 18% (30/169) in those reporting no, occasional and regular contact with residents. In contrast, staff working across different care homes (14/27, 52%) had a 3.0-fold (95% CI, 1.9–4.8; P<0.001) higher risk of SARS-CoV-2 positivity than staff working in single care homes (39/227, 17%). WGS identified SARS-CoV-2 clusters involving staff only, including some that included staff working across different care homes. Conclusions: SARS-CoV-2 positivity was significantly higher among staff working across different care homes than those who were working in the same care home. We found local clusters of SARS-CoV-2 infection between staff only, including those with minimal resident contact. Infection control should be extended for all contact, including those between staff, whilst on care home premises.

Last updated on hub: 19 October 2020

Supporting individuals with intellectual and developmental disability during the first 100 days of the COVID‐19 outbreak in the USA

Journal of Intellectual Disability Research

Background: It is unknown how the novel Coronavirus SARS‐CoV‐2, the cause of the current acute respiratory illness COVID‐19 pandemic that has infected millions of people, affects people with intellectual and developmental disability (IDD). The aim of this study is to describe how individuals with IDD have been affected in the first 100 days of the COVID‐19 pandemic. Methods: Shortly after the first COVID‐19 case was reported in the USA, the organisation in this study, which provides continuous support for over 11 000 individuals with IDD, assembled an outbreak committee composed of senior leaders from across the health care organisation. The committee led the development and deployment of a comprehensive COVID‐19 prevention and suppression strategy, utilising current evidence‐based practice, while surveilling the global and local situation daily. This study implemented enhanced infection control procedures across 2400 homes, which were communicated to employees using multi‐faceted channels including an electronic resource library, mobile and web applications, paper postings in locations, live webinars and direct mail. Custom‐built software applications were used to track patient, client and employee cases and exposures, and this study leveraged current public health recommendations to identify cases and to suppress transmission, which included the use of personal protective equipment. A COVID‐19 case was defined as a positive nucleic acid test for SARS‐CoV‐2 RNA. Results: In the 100‐day period between 20 January 2020 and 30 April 2020, this study provided continuous support for 11 540 individuals with IDD. Sixty‐four per cent of the individuals were in residential, community settings, and 36% were in intermediate care facilities. The average age of the cohort was 46 ± 12 years, and 60% were male. One hundred twenty‐two individuals with IDD were placed in quarantine for exhibiting symptoms and signs of acute infection such as fever or cough. Sixty‐six individuals tested positive for SARS‐CoV‐2, and their average age was 50. The positive individuals were located in 30 different homes (1.3% of total) across 14 states. Fifteen homes have had single cases, and 15 have had more than one case. Fifteen COVID‐19‐positive individuals were hospitalised. As of 30 April, seven of the individuals hospitalised have been discharged back to home and are recovering. Five remain hospitalised, with three improving and two remaining in intensive care and on mechanical ventilation. There have been three deaths. This study found that among COVID‐19‐positive individuals with IDD, a higher number of chronic medical conditions and male sex were characteristics associated with a greater likelihood of hospitalisation. Conclusions: In the first 100 days of the COVID‐19 outbreak in the USA, this study observed that people with IDD living in congregate care settings can benefit from a coordinated approach to infection control, case identification and cohorting, as evidenced by the low relative case rate reported. Male individuals with higher numbers of chronic medical conditions were more likely to be hospitalised, while most younger, less chronically ill individuals recovered spontaneously at home.

Last updated on hub: 19 October 2020

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