COVID-19 resources on Infection control

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West Midlands inquiry into COVID-19 fatalities in the BAME community

COVID-19 BAME Evidence Gathering Taskforce

Findings from the Labour Party-led COVID-19 BAME Evidence Gathering Taskforce, which was established to gather the evidence on the impact of Covid-19 on black and minority ethnic communities in the West Midlands. The report indicates that men and women in the black community have been over four times more likely to die from Covid-19 than white people (4.2 and 4.3 times respectively). Men of Bangladeshi and Pakistani origin were 3.6 times more likely to have a Covid-19 related death, while the figure for women was 3.4 times more likely. Key findings include: fear of inequitable treatment that might be received in the NHS was a deterrent for many in the BAME asking for help quickly enough; the BAME community experienced an NHS and care system that was overwhelmed, despite the heroism of our frontline NHS workers, many of whom were themselves from the BAME community; public health messages about symptoms or what to do when in need were poorly communicated to BAME communities; the voice of the BAME community has not been heard in the way the health services are designed and delivered; many BAME frontline workers had direct experience of inadequate provision of PPE with some having to make protective equipment themselves; a clear strategy for understanding the scientific evidence for the disproportionate impact of Covid-19 on the BAME community has not been communicated effectively. The report makes a number of recommendations and calls on the Government to commence a formal judge-led independent public inquiry into the Covid-19 fatalities in the BAME community and to consult with BAME communities on both the Chair and the Terms of Reference.

Last updated on hub: 01 September 2020

Expanding frontiers of risk management: care safety in nursing home during COVID-19 pandemic

International Journal for Quality in Health Care

Background: Nursing homes provide long-term care and have residential-oriented hospitalizations characterized by medical, nursing, and social-care treatments for a typically geriatric population. In the current emergency phase, the problem of infections in residential structures for the elderly is taking on considerable importance in relation to the significant prevalence rates of COVID-19. Safety improvement strategies: Prevention and control measures for SARS-CoV-2 infection in nursing homes should be planned before a possible outbreak of COVID-19 occurs and should be intensified during any exacerbation of the same. Each facility should identify a properly trained contact person—also external—for the prevention and control of infections, who can refer to a multidisciplinary support committee and who is in close contact with the local health authorities. The contact person should collaborate with professionals in order to prepare a prevention and intervention plan that considers national provisions and scientific evidence, the requirements for reporting patients with symptoms compatible with COVID-19, the indications for the management of suspected, probable or confirmed cases of COVID-19. Discussion: Adequate risk management in residential structures implies the establishment of a coordination committee with dedicated staff, the implementation of a surveillance program for the rapid recognition of the outbreaks, the identification of suitable premises and equipment, the application of universal precautions, the adaptation of care plans to reduce the possibility of contagion among residents, the protection of operators and staff training initiatives.

Last updated on hub: 31 August 2020

The Coronavirus and the risks to the elderly in long-term care

Journal of Aging and Social Policy

The elderly in long-term care (LTC) and their caregiving staff are at elevated risk from COVID-19. Outbreaks in LTC facilities can threaten the health care system. COVID-19 suppression should focus on testing and infection control at LTC facilities. Policies should also be developed to ensure that LTC facilities remain adequately staffed and that infection control protocols are closely followed. Family will not be able to visit LTC facilities, increasing isolation and vulnerability to abuse and neglect. To protect residents and staff, supervision of LTC facilities should remain a priority during the pandemic.

Last updated on hub: 31 August 2020

Covid-19 infection and attributable mortality in UK long term care facilities: cohort study using active surveillance and electronic records (March-June 2020)


This article is a preprint and has not been peer-reviewed. The lead researcher was Peter F Dutey-Magni. Background: Rates of Covid-19 infection have declined in many countries, but outbreaks persist in residents of long-term care facilities (LTCFs) who are at high risk of severe outcomes. Epidemiological data from LTCFs are scarce. This study used population-level active surveillance to estimate incidence of, and risk factors for Covid-19, and attributable mortality in elderly residents of LTCFs. Methods: Cohort study using individual-level electronic health records from 8,713 residents and daily counts of infection for 9,339 residents and 11,604 staff across 179 UK LTCFs. This study modelled risk factors for infection and mortality using Cox proportional hazards and estimated attributable fractions. Findings: 2,075/9,339 residents developed Covid-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory confirmed infections. Confirmed infection incidence in residents and staff respectively was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days. 121/179 (67.6%) LTCFs had at least one Covid-19 infection or death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. 1,694 all-cause deaths occurred in 8,713 (19.4% [18.6%; 20.3%]) residents. 217 deaths occurred in 607 residents with confirmed infection (case-fatality rate: 35.7% [31.9%; 39.7%]). 567/1694 (33.5%) of all-cause deaths were attributable to Covid-19, 28.0% of which occurred in residents with laboratory-confirmed infection. The remainder of excess deaths occurred in asymptomatic or symptomatic residents in the context of limited testing for infection, suggesting substantial under-ascertainment. Interpretation: 1 in 5 residents had symptoms of infection during the pandemic, but many cases were not tested. Higher occupancy and lower staffing levels increase infection risk. Disease control measures should integrate active surveillance and testing with fundamental changes in staffing and care home occupancy to protect staff and residents from infection.

Last updated on hub: 31 August 2020

COVID‐19 and care homes in England: What happened and why?

Social Policy and Administration

In the context of very high mortality and infection rates, this article examines the policy response to COVID‐19 in care homes for older people in the UK, with particular focus on England in the first 10 weeks of the pandemic. The timing and content of the policy response as well as different possible explanations for what happened are considered. Undertaking a forensic analysis of policy in regard to the overall plan, monitoring and protection as well as funding and resources, the first part lays bare the slow, late and inadequate response to the risk and reality of COVID‐19 in care homes as against that in the National Health Service (NHS). A two‐pronged, multidimensional explanation is offered: structural, sectoral specificities; political and socio‐cultural factors. Amongst the relevant structural factors are the institutionalised separation from the health system, the complex system of provision and policy for adult social care, widespread market dependence. There is also the fact that logistical difficulties were exacerbated by years of austerity and resource cutting and a weak regulatory tradition of the care home sector. The effects of a series of political and cultural factors are also highlighted. As well as little mobilisation of the sector and low public commitment to and knowledge of social care, there is a pattern of Conservative government trying to divest the state of responsibilities in social care. This would support an interpretation in terms of policy avoidance as well as a possible political calculation by government that its policies towards the care sector and care homes would be less important and politically damaging than those for the NHS.

Last updated on hub: 31 August 2020

COVID-19 and the female health and care workforce: survey of health and care staff for the Health and Care Women Leaders Network, August 2020

NHS Confederation

This report sets out the findings of a survey to understand the impact the Covid-19 pandemic has had on women working across health and care services. A total of 1,308 women responded to the survey. While the overwhelming majority of respondents to the survey were white, there were some key differences in the findings in relation to participants from black and minority ethnic (BME) backgrounds. The survey found that most respondents – almost three-quarters – had reported that their job had a greater negative impact than usual on their emotional wellbeing as a result of the pandemic, and more than half had suffered a negative impact on their physical health. Staff from BME backgrounds also reported feeling traumatised by the disproportionate impact of the virus, compounded by concerns over risk assessments not being performed in a timely manner, if at all. In addition, the analysis shows that PPE availability and training have been broadly adequate, but could be stronger; managerial support has been strong, but some issues emerge over sharing concerns; struggles with work-life balance since lockdown started; some respondents had safety concerns when working from home. The report also draws out some of the positive experiences, such as opportunities for learning and the strength of support many have received from their managers. Recommendations to improve the working conditions for women in health and care services are included.

Last updated on hub: 27 August 2020

Overview of adult social care guidance on coronavirus (COVID-19)

Department of Health and Social Care

Brings together information for adult social care providers on COVID-19 guidance and support. The resource covers help with infection prevention and control; what to do when you suspect an outbreak; reporting an outbreak; caring for patients discharged from hospital or another social care facility; visits to care homes and other care settings; information for providers of care in supported living and domiciliary settings; how to get social care workers and people in care homes tested; managing care workers during COVID-19; securing PPE and related supplies; help for holders of direct payments, commissioners and care providers; information for social care providers on mental health and wellbeing and financial support; Capacity Tracker and guidance on using it; information for unpaid carers; easements of the Care Act; COVID-19 ethical framework for adult social care; caring for people who are protected by safeguards under the Mental Capacity Act 2005, including the deprivation of liberty safeguards; steps to take following a coronavirus-related death of a person who worked in adult social care. [First published 25 August 2020; Last updated 10 June 2021]

Last updated on hub: 27 August 2020

Impact of infection outbreak on long-term care staff: a rapid review on psychological well-being

Journal of Long-Term Care

Context: Older people and people with an intellectual disability who receive long-term care are considered particularly vulnerable to infection outbreaks, such as the current Coronavirus Disease 2019. The combination of healthcare concerns and infection-related restrictions may result in specific challenges for long-term care staff serving these populations during infection outbreaks. Objectives: This review aimed to: (1) provide insight about the potential impact of infection outbreaks on the psychological state of healthcare staff and (2) explore suggestions to support and protect their psychological well-being. Method: Four databases were searched, resulting in 2,176 hits, which were systematically screened until six articles remained. Thematic analysis was used to structure and categorise the data. Findings: Studies about healthcare staff working in long-term care for people with intellectual disabilities were not identified. Psychological outcomes of healthcare staff serving older people covered three themes: emotional responses (i.e., fears and concerns, tension, stress, confusion, and no additional challenges), ethical dilemmas, and reflections on work attendance. Identified suggestions to support and protect care staff were related to education, provision of information, housing, materials, policy and guidelines. Limitations: Only six articles were included in the syntheses. Implications: Research into support for long-term care staff during an infection outbreak is scarce. Without conscious management, policy and research focus, the needs of this professional group may remain underexposed in current and future infection outbreaks. The content synthesis and reflection on it in this article provide starting points for new research and contribute to the preparation for future infection outbreaks.

Last updated on hub: 21 August 2020

Efficacy of a test-retest strategy in residents and health care personnel of a nursing home facing a COVID-19 outbreak

Journal of the American Medical Directors Association

Objective: To assess the American Testing Guidance for Nursing Homes (NHs)—updated May 19, 2020—with a new COVID-19 case. Design: Case investigation. Setting and Subjects: All 79 residents and 34 health care personnel (HCP) of an NH. Methods: Seven days after identification of a COVID-19 resident, all residents and HCP underwent real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) testing for SARS-CoV-2 with nasopharyngeal swabs. This was repeated weekly in all previously negative subjects until the testing identified no new cases, and in all positive subjects until the testing was negative. COVID-19 infection prevention and control (IPC) measures were implemented in all residents and HCP with positive testing or with COVID-19 symptoms. Standard IPC was also implemented in all HCP. Six weeks after initial testing, all residents underwent testing for enzyme-linked immunosorbent assay–based IgG antibodies directed against the SARS-CoV-2. Symptoms were serially recorded in residents and HCP. Results: A total of 36 residents had a positive rRT-PCR at baseline and 2 at day 7. Six HCP had a positive rRT-PCR at baseline and 2 at day 7. No new COVID-19 cases were diagnosed later. Among the SARS-CoV-2–positive cases, 6 residents (16%) and 3 HCP (37%) were asymptomatic during the 14 days before testing. Twenty-five residents (92.3%) and all 8 HCP (100%) with a positive rRT-PCR developed IgG antibodies against SARS-CoV-2. Among the residents and HCP always having tested negative, 2 (5%) and 5 (11.5%), respectively, developed IgG antibodies against SARS-CoV-2. These 2 residents had typical COVID-19 symptoms before and after testing and 2/5 HCP were asymptomatic before and after testing. Conclusions and Implications: This study shows the validity of the updated American Testing Guidance for Nursing Homes (NHs). It suggests implementing COVID-19 IPC in both residents and HCP with positive testing or COVID-19 symptoms and warns that asymptomatic HCP with repeated negative rRT-PCR testing can develop antibodies against SARS-CoV-2.

Last updated on hub: 21 August 2020

Uncovering the devaluation of nursing home staff during COVID-19: Are we fuelling the next health care crisis?

Journal of the American Medical Directors Association

Editorial. As the COVID-19–related mortality rate of nursing home residents continues to rise, so too will the rates of mortality and morbidity of staff who care for them. The COVID-19 pandemic has also revealed and accentuated the ageism and devaluing of older people pervasive in many societies. The editorial suggests that we need to better protect and support the frail older adults residing in nursing homes, their relatives, and the workforce (staff and leadership) that provide care in these settings. The editorial goes on to provide some considerations for nursing home leaders and regulators to support the health and well-being of nursing home staff and residents. These are categorized into 4 main areas: clear direction and guidance, keeping staff healthy, human resource policies, and implementing new clinical changes. The editorial concludes that the key message for policy makers is that we need to bring to the forefront the critical role of leaders and their capacity to effectively lead in nursing homes, which are complex environments.

Last updated on hub: 21 August 2020

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