COVID-19 resources on Infection control

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A rapid systematic review of measures to protect older people in long term care facilities from COVID-19


The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in long term care facilities to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff, and visitors. Databases (including MedRXiv pre-published repository) were systematically searched to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff, or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities, and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2-85.4% in residents and 0.6-62.6% in staff. Mortality rates ranged from 5.3-55.3% in residents. Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in long term care facilities.

Last updated on hub: 17 November 2020

A record of our own: lockdown experiences of ethnic minority prisoners

Zahid Mubarek Trust

Findings of a review of the experiences of ethnic minority prisoners, including those from Gypsy, Roma and Traveller (GRT) communities, during lockdown. The project aimed to provide a platform for ethnic minority prisoners and their families to describe the impact Covid-19 had on their lives and to consider what lessons could be learned for the future. The evidence presented in this report focusses on the findings from 87 questionnaires which were completed by prison leavers or family members of prisoners (40 interviews and 47 written submissions) and which covered conditions in 29 prisons. The findings cover: changes to the prison regime; measures to prevent the spread of Covid-19; communication; contact with families; healthcare; mental health; resettlement support; and staff-prisoner relationships and fairness. While the changes to the prison regime may have been successful in reducing the spread of Covid-19 and saving lives, they also had profound and long-lasting effects on ethnic minority prisoners and their families, with one participant describing them as a “double punishment”. Issues highlighted in this report include: not enough time out of cells; inadequate communication; inconsistent implementation of the regulations; lack of provision to support prisoners’ mental health; and resourcing and inequalities across the prison estate.

Last updated on hub: 07 April 2021

A study of universal SARS-CoV-2 RNA testing of residents and staff in a large group of care homes in South London

Corrected proof first published 5 September 2020. Background: Care homes have experienced a high number of coronavirus disease 2019 (COVID-19)–related deaths among residents since the onset of the pandemic. However, up to May 2020, there has been a lack of information about the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among residents and staff in care homes and limited testing in this setting. Methods: Combined nose and throat swab testing for SARS-CoV-2 RNA was carried out in 2455 residents and staff across 37 care homes in the London Borough of Bromley across a 3-week period. Results were reported within 24 hours of sample delivery, and data were collected on the presence or absence of symptoms. Results: Overall, the point prevalence of SARS-CoV-2 infection was 6.5%, with a higher rate in residents (9.0%) than in staff (4.7%). A key finding was the high proportion of asymptomatic infection detected in staff (69%) and residents (51%), with evidence of underdetection of symptoms by care home staff. Conclusions: The high proportion of asymptomatic infection combined with underdetection of symptoms by care home staff indicates that offering a test to all residents and staff in care homes with rapid reporting of results would assist accurate identification of infected individuals, facilitating prompt infection prevention and control action. Citation: Marossy, A. et al. (2020). A Study of Universal Severe Acute Respiratory Syndrome Coronavirus 2 RNA Testing Among Residents and Staff in a Large Group of Care Homes in South London. The Journal of Infectious Diseases.

Last updated on hub: 13 November 2020

A telling experience: understanding the impact of Covid-19 on people who access care and support: a rapid evidence review with recommendations

Think Local Act Personal

A review of the evidence exploring the impact of the Care Act Easements (CAE) and/or Covid-19 on the lives of people who accessed care and support, and unpaid carers. The evidence reviewed pointed to the general confusion and anxiety of the early pandemic upon the general public and specifically upon those who accessed care and support, focusing on: loneliness and isolation; financial pressures; practical issues around food shopping; increase in health anxiety; and changes to the streetscape. The research also revealed more specific findings related to those who accessed care and support and their unpaid or family carers, including: an overarching challenge around communications; concerns around Personal Protective Equipment (PPE); cancellations of respite and day services; and some examples of changes to care packages. The review also identifies areas of good practice and learning which might be drawn upon to help build a legacy for future care and support, including: support to shape future communications and advice around a potential second Covid-19 wave; building on aspects of flexible and agile working, particularly in terms of digital models of provision; supported living and extra care providers such as Shared Lives; potential of personalisation reaffirmed as the cornerstone of future delivery; pockets of good practice around co-production to build upon for future learning; innovation and good practice in commissioning to build a new a vision for mental health support and more widely across health and social care; potential of the informal networks of Mutual Aid groups and neighbourhood support and of national networks to share information, good practice and learning at a sector leadership level.

Last updated on hub: 13 October 2020

A testing service for homecare workers in England

Department of Health and Social Care

Sets out how homecare agencies in England can order regular tests for their homecare (domiciliary care) staff. NHS Test and Trace is making weekly Covid-19 testing available to all homecare workers in Care Quality Commission (CQC)-registered domiciliary care organisations. The guidance prescribes that agency managers should order tests every 28 days for their homecare workers; four tests are delivered for each homecare worker to the agency, for a 28 day testing cycle; each homecare worker should be given four test kits every 28 days; every 7 days a care worker should take a test, register it online, and return it by post between Thursday and Sunday. Homecare workers will receive their results in 2 to 4 days by email and text message (SMS). This approach aims to: identify homecare workers who currently have Covid-19 so they are able to self-isolate if their result is positive; protects those receiving care from infection passed to them by homecare workers who are confirmed positive; and prevents and controls the spread of the virus by identifying asymptomatic cases. [First published: 20 November 2020; Last updated:1 July 2021]

Last updated on hub: 25 November 2020

Accommodation for perpetrators of domestic abuse: emerging issues and responses due to COVID-19

Drive Project

Isolation and social distancing during the COVID-19 lockdown have led and are likely to continue to lead to an increase in domestic abuse, violence and coercive control at all levels of risk. This paper argues that, where it would be in the best interests of the victim and better ensure their safety and wellbeing, adequate housing provision is urgently needed for perpetrators of domestic violence. The lack of availability of such accommodation is limiting options available to victims and police in their endeavour to keep victims safe.

Last updated on hub: 30 June 2020

Achieving residential care business success: moving beyond COVID-19


Coming from a range of backgrounds of working and investing in residential care provision, the panellists in this webinar offer practical ideas on how residential care businesses can move through the coronavirus crisis as well sharing their views on the future of the market. The webinar provides advice and guidance on a multitude of topics, including: new care home design and layout trends to boost enquiry conversions and infection control; the power technology is having on restoring consumer confidence when placing a loved one; and new staffing processes that are been implemented to boost compliance and minimise risk.

Last updated on hub: 13 July 2020

Achieving safe, effective, and compassionate quarantine or isolation of older adults with dementia in nursing homes

American Journal of Geriatric Psychiatry

Nursing homes are facing the rapid spread of COVID-19 among residents and staff and are at the centre of the public health emergency due to the COVID-19 pandemic. As policy changes and interventions designed to support nursing homes are put into place, there are barriers to implementing a fundamental, highly effective element of infection control, namely the isolation of suspected or confirmed cases. Many nursing home residents have dementia, associated with impairments in memory, language, insight, and judgment that impact their ability to understand and appreciate the necessity of isolation and to voluntarily comply with isolation procedures. While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. This commentary discusses strategies for effective, safe, and compassionate isolation care planning, and present a case vignette of a person with dementia who is placed in quarantine on a dementia unit.

Last updated on hub: 08 October 2020

Admission and care of residents in a care home during COVID-19

Department of Health and Social Care

Government guidance setting out how to admit and care for residents of care homes safely and protect care home staff during the coronavirus (COVID-19) pandemic. It also includes information on reporting COVID-19 cases, providing care after death and supporting existing residents that may require hospital care. The guidance is intended for care homes, local health protection teams, local authorities, clinical commissioning groups (CCGs) and registered providers of accommodation for people who need personal or nursing care. This includes registered residential care and nursing homes for people with learning disabilities, mental health or other disabilities. [Published 2 April 2020. Last updated 17 August 2021].

Last updated on hub: 06 April 2020

Adult secure service user, family and carer feedback survey during the Coronavirus (COVID-19) pandemic

Rethink Mental Illness

Findings from a survey to gather the views and experiences of people in adult secure services, in all service categories including mental illness, personality disorder, learning disability and autism (both in the hospital and the community), and their families and carers, to find out the impact of COVID-19 on them from March to June 2020. The most striking finding was the considerable variation in responses – both between services and within the same service. This report sets out 9 key areas where people identified examples of what is working well, as well as where lessons could be learnt and improvements made, not only for a potential second wave of the pandemic but also to ensure long lasting improvements for services as a consequence of this experience. The key areas are: activities; outdoor access; leave and progress; communication; digital access; family and friends contact; infection control; physical health; and staff. Leave was the most common theme in all of the responses to the survey and overwhelmingly people found the restrictions difficult. People cited a range of reasons for this – not being able to continue with community activities, feeling ‘cooped up’ and the impact on seeing friends and family. Some people linked these restrictions to the effect this was having on their progress and were frustrated that this was holding them up. There was also frustration for people that lockdown easing in the community was not always reflected in the lifting of restrictions in their hospital. Overall, people said they were very understanding of the measures that needed to be in place to limit the impact of COVID-19 and keep them safe.

Last updated on hub: 19 November 2020

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