COVID-19 resources on infection control

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Putting on and taking off PPE: a guide for care homes

Public Health England

Video that provides advice to those working in care homes on how to work safely during this period of sustained transmission of COVID-19.The guidance includes: a flowchart for care workers providing care to residents to identify whether there is a need for personal protective equipment (PPE); PPE recommendations for care home staff; frequently asked questions on the use of PPE in care homes; and examples which help to identify the correct use of PPE when undertaking activities that require physical contact or activities which do not require physical contact but are carried out in close proximity to residents

Last updated on hub: 23 July 2020

Rapid evidence review: inequalities in relation to COVID-19 and their effects on London

Greater London Authority

This report provides the outcomes of a rapid evidence review to document and understand the impact of COVID-19 (in terms of both health and the broader impacts on existing social and economic inequalities) on those with protected characteristics as well as those living in poorer, or more precarious, socioeconomic circumstances, paying particular attention to its effect in London. It highlights the disproportionate effect of Covid-19 in relation to disability, ethnicity, religion, gender, sexual orientation, gender identity, socioeconomic position, age and other factors, including homelessness and being in prison. This is both in terms of risk of COVID-19 infection, complications and mortality, and in terms of the negative economic, social and psychological consequences of Government policies to mitigate the health impacts of the pandemic. The research analysed existing data from local and national sources to assess the impact of the pandemic on people with characteristics protected by law. It reveals that, across the country: Black people are at almost twice the risk of death from Covid-19 than White people; men are disproportionately more likely to die from Covid-19, but women have experienced disproportionate economic, social and psychological impacts; death rates are three times higher for men in lower-paid, manual roles, such as construction and personal care, than in those in management, business and desk-based jobs; the pandemic has negatively impacted disabled Londoners who reported increased difficulties performing practical tasks such as shopping for groceries, as well as accessing up-to-date health information about the virus; almost four in five LGBTQ+ people said that their mental health had been negatively impacted by the coronavirus lockdown. The report also found that voluntary and community sector organisations play a crucial role in reaching those disproportionately impacted and marginalised groups, including disabled people.

Last updated on hub: 08 October 2020

Rapid learning review of domiciliary care in Northern Ireland

Northern Ireland. Department of Health

This rapid learning review has collated and considered any learning about domiciliary care issues during the Covid-19 pandemic in Northern Ireland in order to inform current and future planning as the pandemic continues. The review focused on four themes: service user and carer experience; service provision; workforce experience; and infection prevention and control. Work stream leads were appointed for each theme and they undertook a wide engagement with a range of stakeholders and using a variety of methods for collecting data. In addition, a workforce and management survey was carried out to seek feedback on three of the four themes. These were workforce, service provision/business continuity and infection prevention and control. A rapid literature review was also commissioned to add to the evidence from stakeholders. The evidence from the literature review was broadly consistent with the messages from the stakeholder engagement with common themes and lessons learned identified. The review highlighted some of the challenges domiciliary care staff faced such as PPE, training, testing and lack of adequate support. Staff felt overlooked and that domiciliary care did not get the recognition it deserved. The review has also highlighted the wider systemic issues that affect domiciliary care, including pay, terms and conditions of the workforce. Domiciliary care service users and their family carers reported feeling forgotten about and afraid to use domiciliary care because of fear of infection during the earlier stages of the pandemic. For many others, however, domiciliary care was the only service that continued for them. Both situations placed service users and carers under very significant pressure.

Last updated on hub: 26 November 2020

Rapid response guidance note: vaccination and mental capacity (first update)

39 Essex Chambers

A general discussion examining to the legal position in relation to testing for COVID-19, especially as testing (a) starts to be more generally available; and (b) is increasingly been rolled out as mandatory in certain settings. It primarily relates to the position in England in relation to those aged 18 and above; specific advice should be sought in respect of Wales and those under 18.

Last updated on hub: 12 January 2021

Rapid review for care homes in relation to Covid-19 in Wales

Welsh Government

This rapid review aimed to ensure that the lessons from best practice are learned and shared by Local Authorities and Health Boards who were involved in working with care homes during the initial period of the Covid-19 pandemic in the spring and summer of 2020. The work for the review has included reading some research studies, reading many submitted reports by Health and Social Care leaders from Wales and a series of interviews with stakeholders including a number of Care Home managers and owners. The report includes sections summarising the context for care homes, the initial impact of the virus and the response, and the best practices that were found in helping care homes to address the pandemic. The final section draws together a set of considerations that health and social care partners could use to assist them in completing their action plans for the winter. The review highlights the importance for health and care to work in partnership with care home managers to ensure that: every care home has an effective Infection Control Plan that is put into place; every care home has an effective plan for business continuity that includes ensuring that there are staff available to meet residents’ needs; every care home should be supported to ensure there are meaningful and helpful day to day activities for residents and that the wellbeing of both staff and residents are taken into account in all the decisions that are made; every care home has the right protective equipment; every care home has access to tests for residents and staff to know who may have the virus; and every care home has good access to primary health services including GPs.

Last updated on hub: 27 October 2020

Rapid review of the evidence on impacts of visiting policies in care homes during the COVID-19 pandemic

International Long-term Care Policy Network

This is a pre-print article (not yet peer-reviewed). The researchers carried out a rapid review of evidence to address three questions: What is the evidence on the impact of visitors in terms of infections in care homes? What is the evidence on the impact of closing care homes to visitors on the wellbeing of residents? and What has been the impact of restricting visits on quality of care? Findings: the review found no scientific evidence that visitors to care homes introduced COVID-19 infections, however during the peak of the pandemic most countries did not allow visiting and there are some anecdotal reports attributing infections to visitors before restrictions. The review also found that there is increasing evidence that care home residents experienced greater depression and loneliness and demonstrated more behavioural disturbance during the period that included visitor bans. In addition, there is evidence of substantial care provision by unpaid carers and volunteers in care homes prior to the pandemic, hence visiting restrictions may have resulted in reductions in quality of care or additional tasks for care home staff. Conclusions: Given that there were already low rates of social interactions among residents and loneliness before the COVID-19 pandemic, the evidence reviewed suggests that visiting restrictions are likely to have exacerbated this further. While there is no scientific evidence identifying visitors as the source of infections this is likely to reflect that most care homes did not allow visitors during the initial peaks of the pandemic. A pilot re-opening homes to visits under strict guidelines did not result in any infections. Allowing visitors in facilities where there are no COVID-19 cases is important to support resident wellbeing. Safeguards to reduce risk of COVID-19 infection have been described, including visits through windows/glass, outdoor visits, and well-ventilated indoor spaces, screening of visitors, use of masks and other PPE and hand hygiene and cleaning. In addition, it is important to recognize and support the provision of unpaid care, particularly for people who pre-COVID had a history of regular visiting to provide care (e.g. feeding, grooming, emotional support). They should be classified as essential workers, provided training and PPE, and be allowed to visit regularly and provide care, interacting as closely with residents as staff.

Last updated on hub: 02 November 2020

Rapid review update 1: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?

McMaster University

This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review is based on the most recent research evidence available at the time of release. A previous version was completed on October 16, 2020. This updated version includes evidence available up to November 30, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. At the organisational level, increased staffing, particularly Registered Nurse (RN) staffing was consistently associated with reduced risk of COVID-19 infections, outbreaks and mortality while for-profit status, facility size/density and movement of staff between facilities was consistently associated with increased risk of COVID-19 infections, outbreaks and mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies.

Last updated on hub: 22 December 2020

Rapid review: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?

McMaster University

This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review includes evidence available up to October 5, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies.

Last updated on hub: 22 December 2020

Readying the NHS and social care for the COVID-19 peak

House of Commons

An examination of the health and social care response to COVID-19 in England and of the challenges to the services that the outbreak posed. The NHS was severely stretched but able to meet overall demand for COVID-19 treatment during the pandemic’s April peak; from early March to mid-May, the NHS increased the quantity of available ventilators and other breathing support, which are essential for the care of many COVID-patients. The report suggests that it has been a very different story for adult social care, despite the hard work and commitment of its workforce. Years of inattention, funding cuts and delayed reforms have been compounded by the Government’s slow, inconsistent and, at times, negligent approach to giving the sector the support it needed during the pandemic – responsibilities and accountabilities were unclear at the outset and there has been a failure to issue consistent and coherent guidance throughout the pandemic; 25,000 patients from were discharged from hospitals into care homes without making sure all were first tested for COVID-19; and the Government failed to provide adequate PPE for the social care sector and testing to the millions of staff and volunteers through the first peak of the crisis. The report argues that there are many lessons that the government must learn, not least giving adult social care equal support to the NHS and considering them as two parts of a single system, adequately funded and with clear accountability arrangements.

Last updated on hub: 03 August 2020

Real-time digital contact tracing: development of a system to control COVID-19 outbreaks in nursing homes and long-term care facilities

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective: We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods: We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results: Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52% fewer cases than conventional methods. Conclusions: Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit. Citation: Wilmink G et al. (2020) Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities. JMIR Public Health Surveill 2020;6(3):e20828

Last updated on hub: 13 November 2020

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