COVID-19 resources on Infection control

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Misconduct in public office: why did so many thousands die unnecessarily?

This report sets out the findings and recommendations of The People’s Covid Inquiry, which took place fortnightly from 24 February to 16 June 2021. A panel of four, chaired by Michael Mansfield QC, heard evidence from over 40 witnesses including bereaved families, frontline NHS and key workers, national and international experts, trade union and council leaders, and representatives from disabled people’s and pensioners’ organisations. The Inquiry considered: how well prepared was the NHS; how the government responded; whether the Government adopted the right public health strategy; impact on the population: bereaved families, care homes and older people, palliative care, disabled people, children and young people, and schools; impact on frontline staff; inequalities and discrimination; profiteering from the people’s health; and governance of the pandemic. The Inquiry found that the NHS was not well prepared for the pandemic. The UK COVID-19 death toll need not have been so high. The straitened circumstances of the NHS were an important contributor to what transpired. Furthermore, The failure to recognise and address health determinants has led to a decline in the health of the UK population, a widening of health inequalities, and the consequent increased burden of COVID-19 mortality and morbidity falling upon the most disadvantaged sections of society. The spread of the pandemic, and the death toll was also worsened by a poor public health response – the consequence of over a decade of reduced funding, loss of expertise, dissipation of services, and multiple reorganisations.

Last updated on hub: 19 January 2022

Changes in COVID-19 outbreak severity and duration in long-term care facilities following vaccine introduction, England, November 2020 to June 2021

Eurosurveillance

This study describes the impact of changing epidemiology and vaccine introduction on characteristics of COVID-19 outbreaks in 330 long-term care facilities (LTCF) in England between November 2020 and June 2021. As vaccine coverage in LTCF increased and national incidence declined, the total number of outbreaks and outbreak severity decreased across the LTCF. The number of infected cases per outbreak decreased by 80.6%, while the proportion of outbreaks affecting staff only increased. The study supports findings of vaccine effectiveness in LTCF.

Last updated on hub: 06 January 2022

Contact tracing for COVID-19: the use of motivational interviewing and the role of social work

Clinical Social Work Journal

One method in mitigating the impact of COVID-19 is that of contact tracing. It is estimated that in the US, 35,000–100,000 contact tracers will be hired (and trained) to talk to recently-infected individuals, understand who they have exposed to the virus, and encourage those exposed to self-quarantine. The Center for Disease Control recommends the use of motivational interviewing (MI) by contact tracers to encourage compliance with contact tracing/quarantine. Contact tracers need to sensitively communicate with COVID-19-exposed individuals who may also be experiencing other issues caused by the pandemic, such as anxiety, depression, grief, anger, intimate partner violence, health problems, food insecurity, and/or unemployment. Social workers are particularly prepared to address the mental health and other psychosocial problems that may be encountered in the tracing process. This article describes contact tracing, its use in other diseases, the role of MI, psychosocial issues that contact tracers may encounter, and how social work can respond to these needs. A sample dialogue of contact tracing using MI is presented with a discussion of the content and skills used in the process.

Last updated on hub: 23 December 2021

The lived experience of implementing infection control measures in care homes during two waves of the COVID-19 pandemic. a mixed-methods study

Journal of Long-Term Care

Context: During COVID-19 care-homes had to implement strict Infection Control Measures (ICMs), impacting on care and staff morale. Objectives: To explore the lived experiences of care-home staff in implementing ICMs. Methods: Mixed-methods study comprising 238 online survey responses and 15 in-depth interviews with care-home staff, November 2020-January 2021 in England. Results: Three themes were identified: ‘Integrating COVID-19 ICMs with caring’, ‘Conveying knowledge and information’, ‘Professional and personal impacts of care-work during the pandemic’. Reported adherence to ICMs was high but fatalistic attitudes towards COVID-19 infection were present. Challenges of providing care using personal protective equipment (PPE), especially for residents with dementia, were highlighted. Interviewees reported dilemmas between strictly implementing ICMs and conflicts with providing best care to residents and preserving personal space. Nine months into COVID-19, official guidance was reported as confusing, constantly changing and poorly suited to care-homes. Care-home staff appreciated opportunities to work with other care-homes and experts to interpret and implement guidance. ICM training was undertaken using multiple techniques but with little evaluation of these or how to sustain behaviour change. Limitations: Results may not be generalizable to other countries. Implications COVID-19 has had a profound effect on well-being of care-home staff. Despite challenges, participants reported broadly good morale, potentially a consequence of supportive colleagues and management. Nevertheless, clear, concise and care-home focussed ICM guidance is still needed. This should include evidence-based assessments on implementing and sustaining adherence. Groups of care-home staff and ICM experts working together to co-create, interpret and implement guidance were viewed positively.

Last updated on hub: 23 December 2021

CG report 6: effects of COVID-19 in care homes – a mixed method review

University of Oxford

This report provides an up-to-date review of the global effects of the COVID-19 pandemic in care homes. The review used a mixed methods approach to assess care home mortality by country, how the deaths compared with previous periods, and how excess deaths may be explained. The study included national datasets for 25 countries on mortality, 17 cohort studies assessing deaths compared to a previous period, and 16 cohort studies reporting interventions or factors associated with excess mortality. Analysis of national datasets for 25 countries shows that care home deaths were, on average, 30% of the total COVID-19 deaths (range: 9-64%). The 17 cohort studies also point to excess mortality worsening during the pandemic, with excess mortality being reported for both COVID-19 positive and negative patients. Several reported interventions or factors suggest the potential to mitigate the risk in care homes substantially. Interventions that could reduce mortality include improving the care home quality, increasing staffing levels, reducing the number of beds in the facility, employing staff confinement strategies with residents, and improving clinical care such as implementing daily examinations. Some care home solutions like US ‘Green House’ homes, which usually have fewer than 12 beds, may provide crucial insights into the care home problem compared with larger homes. Conclusion: the scale of the problem in care homes requires robust evaluation and coordinated strategies to improve outcomes for those most vulnerable to COVID-19. Failure to address these systemic problems could mean global care home populations will be similarly affected by future crises and pandemics.

Last updated on hub: 23 December 2021

Infection prevention and control in nursing homes during COVID-19: an environmental scan

Geriatric Nursing

To examine processes and programmatic elements of infection prevention and control (IPC) efforts and identify themes and promising approaches in nursing homes (NHs), an environmental scan was conducted. Data sources included a literature search, relevant listservs and websites, and expert consensus based on a virtual summit of leaders in IPC in long-term care settings. Three thematic areas emerged which have the potential to improve overall IPC practices in the long-term care setting: staffing and resource availability, training and knowledge of IPC practices, and organizational culture. If improved IPC practices and reduced cross-transmission of infections in NHs are to be sustained, both short-term and long-term changes in these areas are essential to fully engage staff, build trust, and enhance a ‘just’ organizational culture.

Last updated on hub: 21 December 2021

Coronavirus (COVID-19) test kits for children's homes

Department for Education

Sets out when to test children and staff, type of test that should be used, and how to order more COVID-19 tests for children's homes settings. This guidance supports children’s homes in using and ordering polymerase chain reaction (PCR) test kits and lateral flow device (LFD) tests. Covers the testing options for both open children’s homes and secure children's homes. Updated on 20 December 2021 to reflect that daily testing is now recommended for contacts of COVID-19. [First published 14 December 2020. Last updated 20 December 2021]

Last updated on hub: 21 December 2021

Personal protective equipment (PPE) recommendation for unpaid carers

UK Health Security Agency

This resource outlines personal protective equipment (PPE) advice for unpaid carers. Unpaid carers should ensure they wear the correct PPE for the situation in which they are providing care. It sets out four examples of situations that they might encounter. For each it describes the PPE that they should wear. 1. When they are within 2 metres of the person you are caring for who has COVID-19 or flu like symptoms such as coughing, high temperature or loss of taste or smell; 2.When providing personal care, involving potential contact with blood or body fluids; 3.When they are within 2 metres of a person you are caring for and contact with blood or body fluids is not likely; 4.When they are more than 2 metres from the person they are caring for and undertaking domestic duties.

Last updated on hub: 13 December 2021

Living with dementia during the COVID-19 pandemic: coping and support needs of community-dwelling people with dementia and their family carers. Research findings from the IDEAL COVID-19 Dementia Initiative (IDEAL-CDI)

University of York

This report sets out findings from the IDEAL COVID-19 Dementia Initiative (IDEAL CDI), which was established to identify concerns and issues faced by people living with dementia and their carers as a result of the coronavirus epidemic and the strict social restrictions imposed in England between March and June 2020. The report is based on interviews with people with dementia and carers from the IDEAL cohort. Some people with dementia coped well, while others coped with difficulty or were only just coping. The additional stress of COVID-19 exacerbated pre-existing coping difficulties. For many, social isolation increased anxiety. Some felt that lack of activity or lack of social contact caused a decline in their abilities to manage everyday tasks. Confusion about COVID-19 rules or difficulty remembering what to do led to anxiety when leaving the house. People felt that members of the public might not understand their particular needs. While some carers felt they were coping well, others experienced stress when having to leave the home because the person with dementia might not be safe if left alone. Some experienced increased strain in the caring relationship compounded by an uncertainty about future availability of respite. Some were concerned about the complex health needs of the person with dementia alongside COVID-19 risk and lack of personalised information. Both people with dementia and carers talked about the importance of access to safe outdoor space. People were anxious about how others would react or behave towards them regarding keeping a distance if they went out. Being connected to friends, family and wider community or support groups was important to help combat the effects of isolation. People from BAME communities worried about their increased vulnerability to the virus. A lack of trust in Government guidance and in health care services added to their anxiety. However, some benefitted from strong community and faith group involvement.

Last updated on hub: 07 December 2021

Mitigating the impact of SARS-CoV-2 on residential facilities for persons with intellectual disability and/or autism spectrum disorder: two experiences from the Italian red zone

Advances in Mental Health and Intellectual Disabilities

Purpose: Persons with intellectual disability and/or low-functioning autism spectrum disorder are with high support need (ID/ASD-HSN) are among the people who are most vulnerable to the COVID-19 pandemic. The specific vulnerability and the protective factors for persons with ID/LF-ASD attending residential and rehabilitative facilities have however received little attention. This paper aims to describe how two facilities located in the Italian COVID-19 red zone faced the risks associated with the spread of the pandemic and the results they have achieved so far. Design/methodology/approach: Interventions to contrast the spread of the pandemic and preserve clients’ health conditions have been systematically monitored and recorded since the very beginning of the pandemic. Findings: 26/138 clients had to undergo clinical screening and laboratory tests for COVID-like symptomatology, but only one resulted affected by COVID-19 and survived. Considering that Lombardy had 89,595 cases and 16,262 deaths (January–May 2020), one COVID-19 case/138 clients is a good result. Temporarily limiting physical contacts with friends/family in favor of reducing the burden of risk and adopting a system of prevention/safety strategies directed for persons with ID/LF-ASD attending and their caregivers have been useful measures. Research limitations/implications: Structured or semi-structured interviews (using professional caregivers as informant) to confirm behavioral and emotional changes in the clients could not be carried out because of lack of time and resources (which were captured by the management of the pandemic) and could be the next goal for our residential facilities to implement the management of epidemic acute phases in a research-oriented view. Originality/value: This study is a service evaluation report about facing COVID-19 pandemic. Only few such studies are present in medical literature about ID/ASD.

Last updated on hub: 03 December 2021

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