COVID-19 resources on infection control

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Evidence summary for lateral flow devices (LFD) in relation to care homes

Department of Health and Social Care

A summary of published research papers on lateral flow device (LFD) efficacy and preliminary findings from the evaluation of the Department of Health and Social Care (DHSC) care home visitor testing pilot November 2020. The summary follows the release of visitor testing guidance that supports friends and relatives to visit care home residents and provides clarity on the available evidence to support safe visiting as part of our overall approach to promote the health and wellbeing of care home residents. Friends and relatives tested immediately before their visit can demonstrate they are likely to be free of risk of transmitting COVID-19 by having an LFD negative result. Testing must be done directly before the visit takes place and must be undertaken in combination with other infection prevention and control measures.

Last updated on hub: 11 January 2021

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Citation: Burton, J. K. et al. (2020). Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK. The Lancet Healthy Longevity, 1(1), e21-e31.Background: COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. This study aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. Methods: The researchers did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. This study obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and the researchers analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. This study calculated excess deaths (both COVID-19-related and non-COVID-19-related), defined as the sum of deaths over and above the historical average in the same period over the past 5 years. Findings: Between March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital. Interpretation: The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from the findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.

Last updated on hub: 13 November 2020

Evolution and effects of COVID-19 outbreaks in care homes: a population analysis in 189 care homes in one geographical region of the UK

Lancet

Background: COVID-19 has affected care home residents internationally, but detailed information on outbreaks is scarce. This research aimed to describe the evolution of outbreaks of COVID-19 in all care homes in one large health region in Scotland. Methods: This study did a population analysis of testing, cases, and deaths in care homes in the National Health Service (NHS) Lothian health region of the UK. This study obtained data for COVID-19 testing (PCR testing of nasopharyngeal swabs for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) and deaths (COVID-19-related and non-COVID-19-related), and this study analysed data by several variables including type of care home, number of beds, and locality. Outcome measures were timing of outbreaks, number of confirmed cases of COVID-19 in care home residents, care home characteristics associated with the presence of an outbreak, and deaths of residents in both care homes and hospitals. This study calculated excess deaths (both COVID-19-related and non-COVID-19-related), which this study defined as the sum of deaths over and above the historical average in the same period over the past 5 years. Findings: Between March 10 and Aug 2, 2020, residents at 189 care homes (5843 beds) were tested for COVID-19 when symptomatic. A COVID-19 outbreak was confirmed at 69 (37%) care homes, of which 66 (96%) were care homes for older people. The size of care homes for older people was strongly associated with a COVID-19 outbreak (odds ratio per 20-bed increase 3·35, 95% CI 1·99–5·63). 907 confirmed cases of SARS-CoV-2 infection were recorded during the study period, and 432 COVID-19-related deaths. 229 (25%) COVID-19-related cases and 99 (24%) COVID-related deaths occurred in five (3%) of 189 care homes, and 441 (49%) cases and 207 (50%) deaths were in 13 (7%) care homes. 411 (95%) COVID-19-related deaths occurred in the 69 care homes with a confirmed COVID-19 outbreak, 19 (4%) deaths were in hospital, and two (<1%) were in one of the 120 care homes without a confirmed COVID-19 outbreak. At the 69 care homes with a confirmed COVID-19 outbreak, 74 excess non-COVID-19-related deaths were reported, whereas ten non-COVID-19-related excess deaths were observed in the 120 care homes without a confirmed COVID-19 outbreak. 32 fewer non-COVID-19-related deaths than expected were reported among care home residents in hospital. Interpretation: The effect of COVID-19 on care homes has been substantial but concentrated in care homes with known outbreaks. A key implication from the findings is that, if community incidence of COVID-19 increases again, many care home residents will be susceptible. Shielding care home residents from potential sources of SARS-CoV-2 infection, and ensuring rapid action to minimise outbreak size if infection is introduced, will be important for any second wave.

Last updated on hub: 09 November 2020

Evolution and impact of COVID-19 outbreaks in care homes: population analysis in 189 care homes in one geographic region

medRxiv

This article is a preprint and has not been peer-reviewed. The lead researcher is Jennifer K Burton. Method: Analysis of testing, cases and deaths using linked care-home, testing and mortality data for 189 care-homes with 5843 beds in a large Scottish Health Board up to 15/06/20. Findings: 70 (37.0%) of care-homes experienced a COVID-19 outbreak.Interpretation: The large impact on excess deaths appears to be primarily a direct effect of COVID-19, with cases and deaths are concentrated in a minority of care homes. A key implication is that there is a large pool of susceptible residents if community COVID-19 incidence increases again. Shielding residents from potential sources of infection and rapid action into minimise outbreak size where infection is introduced will be critical in any wave 2.

Last updated on hub: 15 July 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

Exploiting isolation: offenders and victims of online child sexual abuse during the COVID-19 pandemic

European Union Agency for Law Enforcement Cooperation

This report examines activities involving the sexual abuse and exploitation of children online and related offline crimes with a particular focus on how offenders have used their time during COVID-19 confinement to increase children’s vulnerability. The findings of this report are mainly based on contributions from Member States and Europol’s partner countries and input from a number of organisations. Key findings are: there have been significant increases in activity relating to child sexual abuse and exploitation on both the surface web and dark web during the COVID-19 lockdown period; travel restrictions and other measures during the pandemic have likely prevented offenders from travelling and so have shifted their focus to the exchange of child sexual abuse material (CSAM) online; an increase in the number of offenders exchanging CSAM online during lockdown may have an impact on and stimulate demand for this type of material online beyond the lockdown; increases in detection and reporting of CSAM on the surface web during lockdown indicate the level of re-victimisation of children through the distribution of images and videos depicting them; consistent levels of activity by offenders on the dark web during lockdown reflects the ongoing organised business model that has evolved and the level of threat that it poses to children; society, including law enforcement, needs to focus on the self-generation of CSAM to ensure that children are protected from this type of exposure to harm; the increased circulation of CSAM during the COVID-19 pandemic will also increase the need for law enforcement to identify the victims depicted in it; it is critical to continue to promote preventive and educational initiatives in a coordinated and structural manner across Europe.

Last updated on hub: 06 July 2020

Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK

Journal of Interprofessional Care

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Last updated on hub: 01 November 2020

Exposed, silenced, attacked: failures to protect health and essential workers during the COVID-19 pandemic

Amnesty International UK

This report makes concrete recommendations for what governments across the world need to do to comply with their human rights obligations and adequately protect the rights of health and essential workers during the COVID-19 pandemic. In the context of their occupational health and safety, health and essential workers face shortages and difficulties accessing PPE in several countries; they also experience challenges around remuneration and compensation, high workloads and associated anxiety and stress; in several countries, instead of being supported, they are facing reprisals from the state and from their employers for speaking out about their working conditions or for criticising the authorities’ response; they are subjected to social stigma and acts of violence from members of society because of the jobs they perform. The report makes a comprehensive set of recommendations to ensure health and essential workers are adequately protected during the COVID-19 pandemic. It calls on governments to ensure that employers provide all health and essential workers with adequate PPE to protect themselves during the COVID-19 pandemic, in line with international standards; recognise COVID-19 as an occupational disease; listen to and address essential workers’ safety concerns in an appropriate manner; investigate any attacks or acts of violence against health and essential workers; carry out comprehensive, effective and independent reviews regarding states’ and other actors’ preparedness for and responses to the pandemic, and provide effective and accessible remedies where there is evidence government agencies did not adequately protect human rights; and collect and publish data by occupation in order to ensure effective protection in the future.

Last updated on hub: 20 July 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

Finding the right balance: an evidence-informed guidance document to support the re-opening of Canadian nursing homes to family caregivers and visitors during the coronavirus disease 2019 pandemic

Journal of the American Medical Directors Association

During the first few months of the coronavirus disease 2019 (COVID-19) pandemic, Canadian nursing homes implemented strict no-visitor policies to reduce the risk of introducing COVID-19 in these settings. There are now growing concerns that the risks associated with restricted access to family caregivers and visitors have started to outweigh the potential benefits associated with preventing COVID-19 infections. Many residents have sustained severe and potentially irreversible physical, functional, cognitive, and mental health declines. As Canada emerges from its first wave of the pandemic, nursing homes across the country have cautiously started to reopen these settings, yet there is broad criticism that emerging visitor policies are overly restrictive, inequitable, and potentially harmful. We reviewed the nursing home visitor policies for Canada's 10 provinces and 3 territories as well as international policies and reports on the topic to develop 10 provi-informed, data-driven, and expert-reviewed guidance for the re-opening of Canadian nursing homes to family caregivers and visitors.

Last updated on hub: 13 November 2020

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