COVID-19 resources on Infection control

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Analysis of social interactions and risk factors relevant to the spread of infectious diseases at hospitals and nursing homes


Ensuring the safety of healthcare workers is vital to overcome the ongoing COVID-19 pandemic. This study presents an analysis of the social interactions between the healthcare workers at hospitals and nursing homes. Using data from an automated hand hygiene system, social interactions between healthcare workers to identify transmission paths of infection in hospitals and nursing homes were inferred. A majority of social interactions occurred in medication rooms and kitchens emphasising that health-care workers should be especially aware of following the infection prevention guidelines in these places. Using epidemiology simulations of disease at the locations, this study found no need to quarantine all healthcare workers at work with a contagious colleague. Only 14.1% and 24.2% of the health-care workers in the hospitals and nursing homes are potentially infected when we disregard hand sanitization and assume the disease is very infectious. Based on the simulations, this study observed a 41% and 26% reduction in the number of infected healthcare workers at the hospital and nursing home, when it is assumed that hand sanitization reduces the spread by 20% from people to people and 99% from people to objects. The analysis and results presented here forms a basis for future research to explore the potential of a fully automated contact tracing systems.

Last updated on hub: 21 September 2021

Staying ‘Covid-safe’: proposals for embedding behaviours that protect against Covid-19 transmission in the UK

British Journal of Health Psychology

Objectives: The Scientific Pandemic Insights group on Behaviours (SPI-B) as part of England’s Scientific Advisory Group on Emergencies (SAGE), were commissioned by the UK Cabinet Office to identify strategies to embed infection control behaviours to minimize Covid-19 transmission in the long term. Methods: With minimal direct evidence available, three sources of information were used to develop a set of proposals: (1) a scoping review of literature on sustaining behaviour change, (2) a review of key principles used in risk and safety management, and (3) prior reports and reviews on behaviour change from SPI-B. The information was collated and refined through discussion with SPI-B and SAGE colleagues to finalize the proposals. Results: Embedding infection control behaviours in the long-term will require changes to the financial, social, and physical infrastructure so that people in all sections of society have the capability, opportunity, and motivation needed to underpin those behaviours. This will involve building Covid-safe educational programmes, regulating to ensure minimum standards of safety in public spaces and workspaces, using communications and social marketing to develop a Covid-safe culture and identity, and providing resources so that all sections of society can build Covid-safe behaviours into their daily lives. Conclusions: Embedding ‘Covid-safe’ behaviours into people’s everyday routines will require a co-ordinated programme to shape the financial, physical, and social infrastructure in the United Kingdom. Education, regulation, communications, and social marketing, and provision of resources will be required to ensure that all sections of society have the capability, opportunity, and motivation to enact the behaviours long term.

Last updated on hub: 01 September 2021

Beyond the control of the care home: a meta-ethnography of qualitative studies of infection prevention and control in residential and nursing homes for older people

Health Expectations

Objective: This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design: This study had a meta-ethnography design. Data Sources: Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods: A meta-ethnography was performed. Results: Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions: Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution: A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.

Last updated on hub: 01 September 2021

Ethical issues for practice and research in congregate settings during the Covid-19 pandemic: cases and commentaries

Ethics and Social Welfare

This paper comprises two cases illustrating ethical challenges experienced by people working with residents and staff in congregate settings (residential homes) during Covid-19. In congregate settings restrictions were more stringent due to residents’ vulnerability and high risks of the virus spreading. In the first case, a UK social worker recounts his proactive advocacy on behalf of a young woman living in residential care, enabling easing of some restrictions for her. In the second case, a German researcher discusses how limits on entering nursing homes resulted in postponing and then ending a participatory research project, with the researcher regretting loss of contact with a home. Following each case is a commentary from an outsider’s perspective. Both authors foreground their responsibilities to care about people facing difficult circumstances and to take action for change. This suggests that situated approaches to ethics, focussing on particular people, roles and relationships in context (such as the ethics of care and virtue ethics) are helpful in understanding the ethical challenges described. The cases illustrate the extra cognitive and practical effort required to engage in ethical reflection on the implications of new circumstances, in which taken-for-granted ways of being, thinking and acting are difficult or impossible

Last updated on hub: 24 August 2021

Visiting and the law: a guide for care homes during COVID-19

The Relatives & Residents Association

This guide provides a summary of the current Government guidance on visiting inside care homes in England and the relevant legal duties on care providers. It provides an overview of the legal duties on care providers relevant to visiting, including the Care Act, Mental Capacity Act and Human Rights Act. Aiming to be practical, accessible and user-friendly, the guide also contains worked examples and pointer questions. The guide is not legal advice, but we hope it will help care homes to explore their visiting policies and practice, to help respect and protect the rights of residents.

Last updated on hub: 23 August 2021

Protecting nursing homes and long term care facilities from COVID-19: a rapid review of international evidence

Journal of the American Medical Directors Association

Objectives: The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision-making. Design: Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long term care. Setting and Participants: Residents and staff in care settings such as nursing homes and long term care facilities. Methods: PubMed/Medline, Cochrane Library and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (for example commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesised narratively using tabulated data extracts and summary tables. Results: Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control (IPC) measures. Symptom or temperature based screening, and single point-prevalence testing, were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, inter-sectoral collaboration and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications: High quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long term care residents from COVID-19 and other infectious diseases. This rapid review summarises current evidence regarding strategies which may be effective.

Last updated on hub: 18 August 2021

Impact of COVID-19 restrictions on carers of persons with dementia in the UK: a qualitative study

Age and Ageing

Background: informal carers provide the majority of the support for persons with dementia living at home. Restrictions imposed due to COVID-19 have had a profound impact on the daily life of the entire population. This study provides insight into the impact of these restrictions on carers of people with dementia living at home. Design: qualitative semi-structured interviews. Participants: purposive sample of carers who provide at least 10 hours of care a week for the person with dementia living at home. Setting: UK. Results: twenty-three carers were interviewed, and thematic analysis identified three main themes : Changes to daily life, impact on carer health and wellbeing and reduced support from health and social support networks. The results highlight the impact of restrictions imposed on daily life and routines due to the pandemic, wellbeing of carers, reduced social support, lack of access to health and care professionals and respite for carers. The restrictions have had negative consequences on carers’ wellbeing, and they have experienced difficulties in accessing formal care services and respite care. Conclusion: carers attempt to continue to provide physical, emotional and practical support for persons with dementia in the community throughout the COVID-19 restrictions. To prevent a future carer crisis, carers need better support systems including formal carer services, telecare solutions that work for them and additional support for respite, as the restrictions from this pandemic continue.

Last updated on hub: 17 August 2021

Impact of visitation and cohorting policies to shield residents from COVID-19 spread in care homes: an agent-based model: controlling COVID-19 in care homes

American Journal of Infection Control

Background: This study examines the impact of visitation and cohorting policies as well as the care home population size upon the spread of COVID-19 and the risk of outbreak occurrence in this setting. Methods: Agent-based modelling Results: The likelihood of the presence of an outbreak in a care home is associated with the care home population size. Cohorting of residents and staff into smaller, self-contained units reduces the spread of COVID-19. Restricting the number of visitors to the care home to shield its residents does not significantly impact the cumulative number of infected residents and risk of outbreak occurrence in most scenarios. Only when the community prevalence where staff live is considerably lower than the prevalence where visitors live (the former prevalence is less than or equal to 30% of the latter), relaxing visitation increases predicted infections much more significantly than it does in other scenarios. Maintaining a low infection probability per resident-visitor contact helps reduce the effect of allowing more visitors into care homes. Conclusions: Our model predictions suggest that cohorting is effective in controlling the spread of COVID-19 in care homes. However, according to predictions shielding residents in care homes is not as effective as predicted in a number of studies that have modelled shielding of vulnerable population in the wider communities.

Last updated on hub: 17 August 2021

Protecting nursing home residents from Covid-19: federal strike team findings and lessons learned

NEJM Catalyst Innovations in Care Delivery

As part of the national response to Covid-19 in nursing homes, a federal strike team initiative: (1) offered technical assistance and recommendations to facilities experiencing large outbreaks; (2) identified innovative actions taken to safeguard the residents, visitors, and staff; and (3) explored opportunities to strengthen federal, state, and local guidance and support. Between July and November 2020, federal teams visited 96 nursing homes in 30 states. These facilities faced challenges related to staffing, personal protective equipment supplies, Covid-19 testing, and infection prevention and control (IPC) measure implementation. Promising practices included actions taken at the facility level to bolster IPC, as well as system-level support from health departments, health care coalitions, and quality improvement partners. Addressing a novel emerging infectious pathogen such as SARS-CoV-2, the pathogen that causes Covid-19, requires both guidance and education for best practices, along with robust surveillance and a culture of collective accountability across health care settings, including nursing homes.

Last updated on hub: 13 August 2021

Adult social care monthly statistics, England: August 2021

Department of Health and Social Care

Experimental statistics on a range of topics including infection control measures, staffing levels, coronavirus (COVID-19) vaccinations and testing for COVID-19 in adult social care settings. As of 27 July 2021, the proportions who had received both doses of the COVID-19 vaccine were: 93.5% of residents and 78.0% of staff of older adult care homes; 88.5% of residents of younger adult care homes; 75.2% of staff of younger adult care homes, 64.6% of domiciliary care staff and 32.2% of staff employed in other social care settings. In the week ending 28 July 2021: 91.9% of care homes in England were able to accommodate residents receiving visitors within care homes, compared to 40.3% at the beginning of March 2021; 83.8% of care homes who had staff required to self-isolate paid those staff their full wages while self-isolating. This proportion has remained consistent since mid-December; 74.0% of care homes had no staff members working in another health or social care setting, this proportion has gradually declined from 78.2% at the end of April 2021. Between May and mid-July, the number of positive PCR and LFD tests returned among care home staff and residents gradually increased but was still substantially lower than numbers in mid-January.

Last updated on hub: 13 August 2021

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