COVID-19 resources on infection control

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Case studies

Care Home Professional

Brings together innovative examples of good practice in care homes. They case studies cover a range of topics, including responses to Covid-19; quality of care; the use of technology; social activities and entertainment; and helping residents stay connected.

Last updated on hub: 07 September 2020

What you need to know when visiting a care home (new guidance for COVID-19)

Healthwatch England

A breakdown of current guidance on visiting care homes during coronavirus. It addresses key aspects and questions, including: when to to visit a care home; what advice to expect; whether a test is required to be able to visit my relative; how to travel to the care home; what is likely to change when visiting a loved one; how many people can visit a care home at a time; what happens if there is an outbreak at the care home; and what happens if there is a local lockdown.

Last updated on hub: 03 September 2020

COVID-19 insights: impact on workforce skills

Skills for Health

Based on the Covid-19 Workforce Survey, this report explores the extent of the pandemic’s impact on the health sector employers and employees. It reveals that the pressure of working in the healthcare sector during the pandemic has led to many staff retiring or resigning. As a result, nearly half of the respondents report that their organisation is planning on increasing recruitment over the next 6 months. However, several organisations have frozen training activities which has led to skills gaps. The pandemic has brought along new ways of working which has meant that COVID-19 awareness and knowledge relating to social distancing as well as infection prevention and control have become crucial for healthcare staff. In addition, the sector has seen a change in the clinical management of patients with COVID-19 infection as well as an increase in home working and the use of PPE – however, 40.6% of respondents state that their organisation was not adequately prepared for this sudden shift in working methods. Many respondents report on issues obtaining PPE as well as inadequate IT systems and digital skills to facilitate remote working. As a result of the pandemic, 44.3% of employers report that their organisational structure will look different. To aid revised organisational structures and potential new ways of working, employers state that they would like immediate support with staff wellbeing processes, employee engagement and workforce planning.

Last updated on hub: 03 September 2020

Personal protective equipment (PPE): care workers delivering homecare during the Covid-19 response

Healthcare Safety Investigation Branch

This national intelligence report provides insight into a current safety risk that the Healthcare Safety Investigation Branch (HSIB) has identified, relating to the use of personal protective equipment (PPE) by care workers when visiting a patient at home. It documents how concerns raised by HSIB were responded to by Public Health England, the body responsible for the development of guidelines for the appropriate use of PPE. The report finds that there are multiple Covid-19 guidelines for different care sectors. PPE guidelines should be used in conjunction with other guidelines, such as infection control guidelines, so that care providers can develop protocols for care delivery. This is challenging when guidelines are updated, or new guidelines are issued and there is a risk that guidance may be missed. The report argues that there is an opportunity to introduce a document management system for guidelines to ensure that the latest information is available. This would involve the design of a usable navigation system so that all related guidelines relevant to a particular care sector are visible and can be checked for completeness.

Last updated on hub: 01 September 2020

West Midlands inquiry into COVID-19 fatalities in the BAME community

COVID-19 BAME Evidence Gathering Taskforce

Findings from the Labour Party-led COVID-19 BAME Evidence Gathering Taskforce, which was established to gather the evidence on the impact of Covid-19 on black and minority ethnic communities in the West Midlands. The report indicates that men and women in the black community have been over four times more likely to die from Covid-19 than white people (4.2 and 4.3 times respectively). Men of Bangladeshi and Pakistani origin were 3.6 times more likely to have a Covid-19 related death, while the figure for women was 3.4 times more likely. Key findings include: fear of inequitable treatment that might be received in the NHS was a deterrent for many in the BAME asking for help quickly enough; the BAME community experienced an NHS and care system that was overwhelmed, despite the heroism of our frontline NHS workers, many of whom were themselves from the BAME community; public health messages about symptoms or what to do when in need were poorly communicated to BAME communities; the voice of the BAME community has not been heard in the way the health services are designed and delivered; many BAME frontline workers had direct experience of inadequate provision of PPE with some having to make protective equipment themselves; a clear strategy for understanding the scientific evidence for the disproportionate impact of Covid-19 on the BAME community has not been communicated effectively. The report makes a number of recommendations and calls on the Government to commence a formal judge-led independent public inquiry into the Covid-19 fatalities in the BAME community and to consult with BAME communities on both the Chair and the Terms of Reference.

Last updated on hub: 01 September 2020

Expanding frontiers of risk management: care safety in nursing home during COVID-19 pandemic

International Journal for Quality in Health Care

Background: Nursing homes provide long-term care and have residential-oriented hospitalizations characterized by medical, nursing, and social-care treatments for a typically geriatric population. In the current emergency phase, the problem of infections in residential structures for the elderly is taking on considerable importance in relation to the significant prevalence rates of COVID-19. Safety improvement strategies: Prevention and control measures for SARS-CoV-2 infection in nursing homes should be planned before a possible outbreak of COVID-19 occurs and should be intensified during any exacerbation of the same. Each facility should identify a properly trained contact person—also external—for the prevention and control of infections, who can refer to a multidisciplinary support committee and who is in close contact with the local health authorities. The contact person should collaborate with professionals in order to prepare a prevention and intervention plan that considers national provisions and scientific evidence, the requirements for reporting patients with symptoms compatible with COVID-19, the indications for the management of suspected, probable or confirmed cases of COVID-19. Discussion: Adequate risk management in residential structures implies the establishment of a coordination committee with dedicated staff, the implementation of a surveillance program for the rapid recognition of the outbreaks, the identification of suitable premises and equipment, the application of universal precautions, the adaptation of care plans to reduce the possibility of contagion among residents, the protection of operators and staff training initiatives.

Last updated on hub: 31 August 2020

The Coronavirus and the risks to the elderly in long-term care

Journal of Aging and Social Policy

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.

Last updated on hub: 31 August 2020

Covid-19 infection and attributable mortality in UK long term care facilities: cohort study using active surveillance and electronic records (March-June 2020)

medRxiv

This article is a preprint and has not been peer-reviewed. The lead researcher was Peter F Dutey-Magni. Background: Rates of Covid-19 infection have declined in many countries, but outbreaks persist in residents of long-term care facilities (LTCFs) who are at high risk of severe outcomes. Epidemiological data from LTCFs are scarce. This study used population-level active surveillance to estimate incidence of, and risk factors for Covid-19, and attributable mortality in elderly residents of LTCFs. Methods: Cohort study using individual-level electronic health records from 8,713 residents and daily counts of infection for 9,339 residents and 11,604 staff across 179 UK LTCFs. This study modelled risk factors for infection and mortality using Cox proportional hazards and estimated attributable fractions. Findings: 2,075/9,339 residents developed Covid-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory confirmed infections. Confirmed infection incidence in residents and staff respectively was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days. 121/179 (67.6%) LTCFs had at least one Covid-19 infection or death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. 1,694 all-cause deaths occurred in 8,713 (19.4% [18.6%; 20.3%]) residents. 217 deaths occurred in 607 residents with confirmed infection (case-fatality rate: 35.7% [31.9%; 39.7%]). 567/1694 (33.5%) of all-cause deaths were attributable to Covid-19, 28.0% of which occurred in residents with laboratory-confirmed infection. The remainder of excess deaths occurred in asymptomatic or symptomatic residents in the context of limited testing for infection, suggesting substantial under-ascertainment. Interpretation: 1 in 5 residents had symptoms of infection during the pandemic, but many cases were not tested. Higher occupancy and lower staffing levels increase infection risk. Disease control measures should integrate active surveillance and testing with fundamental changes in staffing and care home occupancy to protect staff and residents from infection.

Last updated on hub: 31 August 2020

COVID‐19 and care homes in England: What happened and why?

Social Policy and Administration

In the context of very high mortality and infection rates, this article examines the policy response to COVID‐19 in care homes for older people in the UK, with particular focus on England in the first 10 weeks of the pandemic. The timing and content of the policy response as well as different possible explanations for what happened are considered. Undertaking a forensic analysis of policy in regard to the overall plan, monitoring and protection as well as funding and resources, the first part lays bare the slow, late and inadequate response to the risk and reality of COVID‐19 in care homes as against that in the National Health Service (NHS). A two‐pronged, multidimensional explanation is offered: structural, sectoral specificities; political and socio‐cultural factors. Amongst the relevant structural factors are the institutionalised separation from the health system, the complex system of provision and policy for adult social care, widespread market dependence. There is also the fact that logistical difficulties were exacerbated by years of austerity and resource cutting and a weak regulatory tradition of the care home sector. The effects of a series of political and cultural factors are also highlighted. As well as little mobilisation of the sector and low public commitment to and knowledge of social care, there is a pattern of Conservative government trying to divest the state of responsibilities in social care. This would support an interpretation in terms of policy avoidance as well as a possible political calculation by government that its policies towards the care sector and care homes would be less important and politically damaging than those for the NHS.

Last updated on hub: 31 August 2020

COVID-19 and the female health and care workforce: survey of health and care staff for the Health and Care Women Leaders Network, August 2020

NHS Confederation

This report sets out the findings of a survey to understand the impact the Covid-19 pandemic has had on women working across health and care services. A total of 1,308 women responded to the survey. While the overwhelming majority of respondents to the survey were white, there were some key differences in the findings in relation to participants from black and minority ethnic (BME) backgrounds. The survey found that most respondents – almost three-quarters – had reported that their job had a greater negative impact than usual on their emotional wellbeing as a result of the pandemic, and more than half had suffered a negative impact on their physical health. Staff from BME backgrounds also reported feeling traumatised by the disproportionate impact of the virus, compounded by concerns over risk assessments not being performed in a timely manner, if at all. In addition, the analysis shows that PPE availability and training have been broadly adequate, but could be stronger; managerial support has been strong, but some issues emerge over sharing concerns; struggles with work-life balance since lockdown started; some respondents had safety concerns when working from home. The report also draws out some of the positive experiences, such as opportunities for learning and the strength of support many have received from their managers. Recommendations to improve the working conditions for women in health and care services are included.

Last updated on hub: 27 August 2020

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