COVID-19 resources on infection control

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International examples of measures to prevent and manage COVID-19 outbreaks in residential care and nursing home settings

International Long-term Care Policy Network

This document provides examples of policy and practice measures that have been adopted internationally to prevent COVID-19 infections in care homes and to mitigate their impact. The evidence shows that: while both the characteristics of the population in care homes and the difficulties of physical distancing in communal living mean that care home residents are at high risk of dying from COVID-19, these deaths are not inevitable; countries with low-levels of infection in the population typically also have low shares of infections in care homes; the response to COVID-19 in care homes needs to be coordinated across all relevant government departments and levels, and with the acute health sector response; timely data on the impact of COVID-19 in care homes is essential to ensure that opportunities for preventing large numbers of deaths are not missed; evidence of asymptomatic transmission and atypical presentation of COVID-19 in geriatric populations should be reflected in guidance documents and testing policies; while there are infections local to care homes, regular testing of residents and staff will be essential, ideally followed by contact tracing and effective isolation; most countries have restricted visitors but this policy alone has not protected care homes from infection; staff pay and living conditions may be an important barrier to effective infection controls, particularly if staff do not have access to sick pay or need to work in multiple facilities (or live in crowded accommodation); access to healthcare and palliative care (in terms of personnel, medicines and equipment) needs to be guaranteed, particularly for homes without nursing or medical staff; measures to address the psychological impact of the pandemic on both staff and residents need to be put in place.

Last updated on hub: 04 November 2020

Introduction to and spread of COVID-19-like illness in care homes in Norfolk, UK

Journal of Public Health

Background: Residential care homes for the elderly are important settings for transmission of the SARS-CoV-2 virus that causes COVID-19 disease. Methods: This study undertook secondary analysis of 248 care homes in Norfolk, UK. The dataset counted nurses, care workers and non-care workers, their status (available, absent due to leave or sickness and extra staff needed to address the coronavirus pandemic) and residents (if any) with suspected COVID-19 in the period 6 April to 6 May 2020. Concurrent descriptions of access by the home to personal protection equipment (PPE: gloves, masks, eye protection, aprons and sanitizer) were in the data. PPE access was categorized as (most to least) green, amber or red. This study undertook two-stage modelling, first for suspected COVID-19 cases amongst residents and second relating any increases in case counts after introduction to staffing or PPE levels. Results: Counts of non-care workers had strongest relationships (P < 0.05) to introduction of suspected SARS-CoV-2 to the homes. Higher staff levels and more severe PPE shortages were linked to higher case counts (P < 0.05) during the monitoring period. Conclusion: Managing aspects of staff interaction with residents and some working practices might reduce ingression to and spread of COVID-19-like illness within care homes.

Last updated on hub: 27 January 2021

Is visiting [in the social context] associated with increased incidence of COVID-19 in long-term residential care facilities?

HSE Library

This summary of evidence contains a comprehensive representation of available research evidence, key reference sources and collated information on the impact of visitors on the incidence of COVID-19 in long-term residential care facilities.

Last updated on hub: 26 October 2020

Key measures for infection prevention and control: a guide for social care workers providing care in an individual’s home

Scottish Social Services Council

This guide highlights essential practical actions to support good infection control practice during COVID-19, particularly hand and cough hygiene and personal protective equipment (PPE). It signposts some of the key measures care workers will need to protect themselves and others when providing care and support for people, including those with suspected or confirmed COVID-19. The guide is for social care workers providing support and care to people living in their own homes; particularly care at home and housing support workers, referred to as ‘domiciliary care’ in the national guidance. It acknowledges that many of the people they support may be in the shielding category.

Last updated on hub: 18 September 2020

Leading in isolation during Covid-19

King's Fund

Lesley Flatley shares the challenges of leading an independent residential home during the pandemic and the feeling of isolation and loneliness that social care leaders may experience without the support of a large organisation like the NHS. The blog also looks at the actions and strategies they implemented to address and support the emotional and mental wellbeing of staff and residents and reflects on the lessons learned, including the role of technology.

Last updated on hub: 07 July 2020

Learning Disability Mortality Review (LeDeR) programme: action from learning: deaths of people with a learning disability from COVID-19

NHS England

This document describes how the NHS is working with partners and stakeholders to embed the learning from the University of Bristol’s report into the deaths of 206 people with a learning disability at the start of the COVID-19 pandemic. The report highlighted some good practice in the care of people with a learning disability, but it also highlighted concerns about the care that some people received. This document explains how the required changes to the services are being implemented so that action is taken. Specifically, it outlines the actions to improve the detection of deterioration in the health of people in community and home settings including people with a learning disability; actions to address the issue of ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) and learning disability as a cause of death; actions relating to diagnostic overshadowing, when the symptoms of physical ill health are incorrectly either attributed to a mental health/behavioural problem or considered inherent to the person’s learning disability or autism diagnosis; and actions relating to the reasonable adjustments that healthcare providers need to put in place to ensure that people with a learning disability have equal access to health services.

Last updated on hub: 24 November 2020

Learning from the impacts of COVID-19 on care homes: a pilot survey

International Long-term Care Policy Network

Findings of an anonymous online pilot survey of care home managers and directors across England, surveyed between May 15th and June 1st to understand the challenges care homes faced during the COVID-19 pandemic, what strategies they used to mitigate them and what they would need in future to strengthen their response. The survey covered four key themes, including partnership working, infection control, workforce and wellbeing of residents. Care home providers described marked differences in the support offered to them by local government and NHS organisations. While many had received supportive offers from local authorities, NHS Clinical CCGs and the CQC, this was not universal, and many received conflicting advice from different organisations, often sensing that their NHS colleagues were sometimes unable to identify with the daily challenges in care homes. Three quarters of managers and directors expressed concerns about staff wellbeing and reported how staff shortages had increased pressures on care staff, leading at times to an unavoidable reliance on agency staff. Residents had been impacted adversely by the prolonged absence of their loved ones, with reports of residents experiencing resulting deterioration in mood from 84% of managers and of reduced oral intake from 30%. Despite these challenges, it was clear that some providers had gone to great lengths to implement stringent infection control measures such as enhanced cleaning and restructuring or rearranging their homes to facilitate appropriate segregation of residents. Others closed to visitors and required facemasks in all communal areas before these were formally advised. Measures were also taken in many homes to support staff, while local communities and relatives also helped by providing food and Personal Protective Equipment (PPE) and letters of support. Yet the pandemic has revealed clearly a deep divide between health and social care that must urgently be addressed.

Last updated on hub: 04 November 2020

LESS COVID-19: Learning by Experience and Supporting the Care Home Sector during the COVID-19 pandemic: key lessons learnt, so far, by frontline care home and NHS staff

National Care Forum

This report sets out findings of a research study to capture the experiences of frontline care home and NHS staff caring for older people with COVID-19 and to share the lessons learnt about the presentation, trajectories, and management of the infection with care homes that have and have not yet experienced the virus. The research comprised two phases: interviews with frontline care home and NHS staff in June and July (n=35); and consultation with senior operational and quality managers in care homes in September (n=11). The findings are presented under the following themes: clinical presentation – COVID-19 does not always present as a cough and fever in older people; unpredictable illness trajectory; managing symptoms and providing supportive care; recovery and rehabilitation – promoting physical, cognitive and emotional well-being post-virus; end of life care; infection prevention and control; and promoting partnership through cross sector working and support. The research highlights the value of ongoing reflective learning and the importance of sharing collective expertise in care and in practice. However, it also reveals systemic issues associated with underfunding, limited integration across health and social care and a lack of wider recognition and value of the contribution of the care home sector and (importantly) its staff. The report concludes with a call to action, stressing the importance of sharing collective expertise, expanding the use of digital technology, and formally recognising and supporting care home staff. It also calls on the Government to ensure policy making, guidance, effective resourcing (including PPE), and plans for action are created in equal partnership with the care sector; to invest in the care sector to enable better reward and recognition of the care workforce; and to improve the testing capacity for social care to cover all care settings, including day services.

Last updated on hub: 08 October 2020

Lessons Learned - outbreaks of COVID-19 in nursing homes

Letter to the editor published in the American Journal of Infection Control on 30 July 2020. Provides five key lessons learned and guidance for preventing the introduction of COVID-19 into the local nursing homes, and subsequently preventing its spread within these facilities. Citation: Kim, J. J. et al. (2020). Lessons learned - Outbreaks of COVID-19 in nursing homes. American Journal of Infection Control.

Last updated on hub: 13 November 2020

Life after lockdown: tackling loneliness among those left behind

British Red Cross

This report draws on findings from a collection of national-level polling, interviews and evaluations from British Red Cross services during COVID-19 to shed a light on how to refocus efforts on tackling loneliness and supporting those most affected by the crisis. Key findings include: there has been a significant increase in the number of people feeling lonely – since lockdown 41 per cent of UK adults report feeling lonelier; more than a quarter of UK adults agree that they worry something will happen to them and no one will notice; a third of UK adults haven’t had a meaningful conversation in the last week; some communities have been at greater risk of loneliness than others – people from Black, Asian and minority ethnic (BAME) communities, parents with young children, young people, those living with long term physical and mental health conditions, people on lower incomes and those with limited access to digital technology and the internet; COVID-19 has also meant a loss in social support for refugees and people seeking asylum. To meet the challenges ahead and ensure no one is left behind and feels alone, the report makes a number of recommendations: prioritise those most vulnerable to loneliness; secure sustained funding for tackling loneliness; continue to roll out social prescribing and ensure it delivers for loneliness; work collaboratively across sectors and specialisms, and with people with lived experience of loneliness.

Last updated on hub: 29 June 2020

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