COVID-19 resources on Infection control

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Social distancing and isolation strategies to prevent and control the transmission of COVID-19 and other infectious diseases in care homes for older people: an international review

International Journal of Environmental Research and Public Health

Older people living in care homes are at high risk of poor health outcomes and mortality if they contract COVID-19 or other infectious diseases. Measures used to protect residents include social distancing and isolation, although implementation is challenging. This review aimed to assess the social distancing and isolation strategies used by care homes to prevent and control the transmission of COVID-19 and other infectious diseases. Seven electronic databases were searched: Medline, CINAHL, Embase, PsycINFO, HMIC, Social Care Online, and Web of Science Core Collection. Grey literature was searched using MedRxiv, PDQ-Evidence, NICE Evidence Search, LTCCovid19.org and TRIP. Extracted data were synthesised using narrative synthesis and tabulation. 103 papers were included (10 empirical studies, seven literature reviews, and 86 policy documents). Strategies used to prevent and control the transmission of COVID-19 and other infectious diseases included social distancing and isolation of residents and staff, zoning and cohorting of residents, restriction of resident movement/activities, restriction of visitors and restriction of staff working patterns. This review demonstrates a lack of empirical evidence and the limited nature of policy documentation around social distancing and isolation measures in care homes. Evaluative research on these interventions is needed urgently, focusing on the well-being of all residents, particularly those with hearing, vision or cognitive impairments.

Last updated on hub: 25 March 2022

The impact of organisational characteristics of staff and facility on infectious disease outbreaks in care homes: a systematic review

BMC Health Services Research

Background: Infectious disease outbreaks are common in care homes, often with substantial impact on the rates of infection and mortality of the residents, who primarily are older people vulnerable to infections. There is growing evidence that organisational characteristics of staff and facility might play a role in infectious disease outbreaks however such evidence have not previously been systematically reviewed. Therefore, this systematic review aims to examine the impact of facility and staff characteristics on the risk of infectious disease outbreaks in care homes. Methods: Five databases (MEDLINE, EMBASE, ProQuest, Web of Science, CINAHL) were searched. Studies considered for inclusion were of any design reporting on an outbreak of any infectious disease in one or more care homes providing care for primarily older people with original data on: facility size, facility location (urban/rural), facility design, use of temporary hired staff, staff compartmentalizing, residence of staff, and/or nursing aides hours per resident. Retrieved studies were screened, assessed for quality using CASP, and analysed employing a narrative synthesis. Results: Sixteen studies (8 cohort studies, 6 cross-sectional studies, 2 case-control) were included from the search which generated 10,424 unique records. COVID-19 was the most commonly reported cause of outbreak (n = 11). The other studies focused on influenza, respiratory and gastrointestinal outbreaks. Most studies reported on the impact of facility size (n = 11) followed by facility design (n = 4), use of temporary hired staff (n = 3), facility location (n = 2), staff compartmentalizing (n = 2), nurse aides hours (n = 2) and residence of staff (n = 1). Findings suggest that urban location and larger facility size may be associated with greater risks of an infectious disease outbreak. Additionally, the risk of a larger outbreak seems lower in larger facilities. Whilst staff compartmentalizing may be associated with lower risk of an outbreak, staff residing in highly infected areas may be associated with greater risk of outbreak. The influence of facility design, use of temporary staff, and nurse aides hours remains unclear. Conclusions: This systematic review suggests that larger facilities have greater risks of infectious disease outbreaks, yet the risk of a larger outbreak seems lower in larger facilities. Due to lack of robust findings the impact of facility and staff characteristics on infectious disease outbreaks remain largely unknown.

Last updated on hub: 25 March 2022

Tell me more summary report

Age Cymru

Tell Me More is an engagement project which aims to gather insights into the lived experience of care home residents during the Covid-19 pandemic and is funded by Welsh Government. This report details key themes that featured in the conversations we had with people living in care homes during 2021, one of the most challenging times that care homes have experienced as a result of the global pandemic. The report reflects the range of perspectives voiced by residents on care home life, through the restrictions that were in place because of regulation, guidance, or care home policy. It reflects the findings from conversation with 105 residents living in 22 care homes throughout Wales. Everyone we spoke with told us that they had felt safe in the home where they live, they told us that care staff were working to protect them from the virus. Some residents however felt that this, at times, overtook their rights to make individual choices and restricted their freedom to make decisions that affected their quality of life. Residents told us how finding company during the pandemic was very important to them. Despite the barrier of PPE, residents often spoke of staff becoming ‘more like family’ their reason to keep going and the main connector for them with the outside world. However, one of the most talked about subjects we encountered was family visits to the homes. Some residents shared their sadness and frustration about this. Residents told us that they spent most of their time alone and in their rooms. They told us that they had little to look forward too and their days were long. Many residents told us that they found it difficult to know what to do with their days, many felt the effects of the loss of community engagement and fun activities.

Last updated on hub: 22 March 2022

Living through the COVID-19 pandemic: experiences of people approaching later life

National Centre for Social Research

This report sets out the findings of a qualitative study to explore the lived experiences of people aged 50-70 during the pandemic. In particular, the aim was to understand why: people who say they are struggling to get by financially and/or who have long-term, limiting health conditions feel less socially connected, including when online; and the experience of spending more time at home during lockdowns, when self-isolating or when shielding, makes people more aware of the state of repair of their homes, their future aspirations in this respect, and what type of issues and barriers arise. The study consisted of 30 in-depth telephone and online interviews with people aged 50-70 who agreed to be followed-up from the first NatCen Panel Survey (June 2020). People’s subjective feelings about their income or economic situation, and long term-health conditions, were important in affecting their feelings about connections with others. But they were not the only or main factors determining this during the pandemic. Three broad patterns emerged: the effects of measures used to try to control and manage the pandemic on in-person connections both weakened and strengthened connections; it was more difficult to maintain or develop a sense of social connection in areas where there was a higher turnover of residents; the usual social networks of support, and preferences for social contact that people had, changed due to the pandemic. Furthermore, the study found that: participants told us they largely drew on informal channels of support, including family, friends and neighbours; online activity increased for all interviewees during the pandemic – but attitudes diverged on the extent to which this was welcomed; the size of participants’ homes relative to the number of people living there, and whether the space allowed for privacy and separate places to work or study, were important to people’s levels of satisfaction with their homes.

Last updated on hub: 16 March 2022

Triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic in private care homes and domiciliary care agencies: lived experiences of care workers in the Midlands region, UK

Health and Social Care in the Community

COVID-19 was first reported in China and later spread across the world causing panic because there is no cure for it. The pandemic has adversely affected frontline health workers and patients, owing to poor preparedness. The study explored the triggers of mental health problems among frontline healthcare workers during the COVID-19 pandemic. An exploratory qualitative approach was utilised in the study. Forty individual semi-structured interviews were held with frontline healthcare workers. A thematic approach underpinned by some aspects of interpretive phenomenological analysis (IPA) and the Silences Framework (SF) was utilised. The research found that triggers of mental health problems among frontline health workers in private care homes and domiciliary care agencies are fear of infection and infecting others, lack of recognition/disparity between National Health Service (NHS) and social care, lack of guidance, unsafe hospital discharge, death and loss of professionals and residents, unreliable testing and delayed results and shortage of staff. It is important to support frontline workers in private care homes and domiciliary care agencies.

Last updated on hub: 15 March 2022

Nursing home design and Covid-19: implications for guidelines and regulation

Journal of the American Medical Directors Association

Objectives: Nursing homes (NHs) are important health care and residential environments for the growing number of frail older adults. The COVID-19 pandemic highlighted the vulnerability of NHs as they became COVID-19 hotspots. This study examines the associations of NH design with COVID-19 cases, deaths, and transmissibility and provides relevant design recommendations. Design: A cross-sectional, nationwide study was conducted after combining multiple national data sets about NHs. Setting and Participants: A total of 7785 NHs were included in the study, which represent 50.8% of all Medicare and/or Medicaid NH providers in the United States. Methods: Zero-inflated negative binomial models were used to predict the total number of COVID-19 resident cases and deaths, separately. The basic reproduction number (R0) was calculated for each NH to reflect the transmissibility of COVID-19 among residents within the facility, and a linear regression model was estimated to predict log(R0 – 1). Predictors of these models included community factors and NHs’ resident characteristics, management and rating factors, and physical environmental features. Results: Increased percentage of private rooms, larger living area per bed, and presence of a ventilator-dependent unit are significantly associated with reductions in COVID-19 cases, deaths, and transmissibility among residents. After setting the number of actual residents as the exposure variable and controlling for staff cases and other variables, increased number of certified beds in the NH is associated with reduced resident cases and deaths. It also correlates with reduced transmissibility among residents when other risk factors, including staff cases, are controlled. Conclusions and Implications: Architectural design attributes have significant impacts on COVID-19 transmissions in NHs. Considering the vulnerability of NH residents in congregated living environments, NHs will continue to be high-risk settings for infection outbreaks. To improve safety and resilience of NHs against future health disasters, facility guidelines and regulations should consider the need to increase private rooms and living areas.

Last updated on hub: 14 March 2022

Barriers and facilitators to person-centred infection prevention and control: results of a survey about the Dementia Isolation Toolkit

BMC Geriatrics

Background: People working in long-term care homes (LTCH) face difficult decisions balancing the risk of infection spread with the hardship imposed on residents by infection control and prevention (ICP) measures. The Dementia Isolation Toolkit (DIT) was developed to address the gap in ethical guidance on how to safely and effectively isolate people living with dementia while supporting their personhood. In this observational study, we report the results of a survey of LTCH staff on barriers and facilitators regarding isolating residents, and the impact of the DIT on staff moral distress. Methods: We completed an online cross-sectional survey. Participants (n = 207) were staff working on-site in LTCH in Ontario, Canada since March 1, 2020, with direct or indirect experience with the isolation of residents. LTCH staff were recruited through provincial LTCH organizations, social media, and the DIT website. Survey results were summarized, and three groups compared, those: (1) unfamiliar with, (2) familiar with, and (3) users of the DIT. Results:61% of respondents identified distress of LTCH staff about the harmful effects of isolation on residents as a major barrier to effective isolation. Facilitators for isolation included delivery of 1:1 activity in the resident’s room (81%) and designating essential caregivers to provide support (67%). Almost all respondents (84%) reported an increase in moral distress. DIT users were less likely to report an impact of moral distress on job satisfaction (odds ratio (OR) 0.41, 95% CI 0.19-0.87) with 48% of users reporting the DIT was helpful in reducing their level of moral distress. Conclusions: Isolation as an ICP measure in LTCH environments creates moral distress among staff which is a barrier to its effectiveness. ICP guidance to LTCH would be strengthened by the inclusion of a dementia-specific ethical framework that addresses how to minimize the harms of isolation on both residents and staff.

Last updated on hub: 09 March 2022

Revoking vaccination as a condition of deployment across all health and social care: consultation response

Department of Health and Social Care

The government conducted a public consultation from 9 to 16 February 2022 on whether to revoke provisions which require COVID-19 vaccination as a condition of deployment in health and social care settings. This is the formal government response to that consultation. The government’s response confirms that they intend to proceed with bringing forward regulations to revoke vaccination as a condition of deployment. While the government intends to revoke vaccination of condition of deployment there remain long established IPC measures which in their own right minimise the risk of transmission of COVID-19 and help protect those that are vulnerable to COVID-19 as well as those caring for them. These are actively kept under review to ensure they are proportionate and effective.

Last updated on hub: 07 March 2022

Investigating the association between COVID-19 vaccination and care home outbreak frequency and duration

Public Health

Objectives: At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent and interrupt outbreaks of infectious disease in social care settings. This study aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19 outbreaks in Northern Ireland (NI). Study design: The researchers undertook an ecological study using routinely available national data. Methods: this study used Poisson regression to measure the relationship between the number of RT-PCR confirmed COVID-19 outbreaks in care homes, and as a measure of community COVID-19 prevalence, the Office for National Statistics COVID-19 Infection Survey estimated the number of people testing positive for COVID-19 in NI. This study estimated the change in this relationship and estimated the expected number of care home outbreaks in the absence of the vaccination programme. A Cox proportional hazards model estimated the hazard ratio of a confirmed COVID-19 care home outbreak closure. Results: Care home outbreaks reduced by two-thirds compared to expected following the introduction of the vaccination programme, from a projected 1625 COVID-19 outbreaks (95% prediction interval 1553-1694) between 7 December 2020 and 28 October 2021 to an observed 501. This study estimated an adjusted hazard ratio of 2.53 of the outbreak closure assuming a 21-day lag for immunity. Conclusions: These findings describe the association of the vaccination with a reduction in outbreak frequency and duration across NI care homes. This indicates probable reduced harm and disruption from COVID-19 in social care settings following vaccination. Future research using individual level data from care home residents will be needed to investigate the effectiveness of the vaccines and the duration of their effects.

Last updated on hub: 07 March 2022

Covid-19 response: living with Covid-19

Cabinet Office

This document outlines the government’s plan for living with COVID-19. This plan - underpinned by vaccines - will remove the remaining legal domestic restrictions while continuing to protect people most vulnerable to COVID-19 and maintaining resilience. The plan covers the implications for adult social care, stating that the Government will continue to support the adult social care sector with the following protections: supporting and encouraging the take-up of vaccines amongst care recipients and staff, including any further doses that may be recommended by JCVI for COVID-19 and other infections; supporting guidance on precautions for visitors and workers in adult social care; and providing access to free PPE to the end of March 2023 or until the UK IPC guidance on PPE usage for COVID-19 is amended or superseded (whichever is sooner). As a part of living sustainably with COVID-19, by 1 April the Government will publish updated IPC guidance. This will replace current COVID-19 IPC guidance for care homes, home care and other adult social care services. The Government will continue to work with local authorities and care providers to respond to outbreaks in care settings and manage local workforce pressures.

Last updated on hub: 02 March 2022

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