COVID-19 resources on Infection control

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Pilot point prevalence survey of COVID-19 among domiciliary care staff in England

Public Health England

This pilot study provides the first estimate of the extent of COVID-19 infections among domiciliary care workers in England. A prospective descriptive survey of a sample of workers from domiciliary care providers was carried out in June 2020, using a sampling frame of all care providers in England registered with CQC. The findings provide evidence that the prevalence of COVID-19 among domiciliary care workers is in line with the general population as opposed to a higher prevalence as observed in studies of front-line healthcare workers and care home staff. It should be noted that this study took place post the peak of the first wave of the COVID-19 pandemic and as a result its findings are not directly comparable to those emerging from care home and healthcare worker studies.

Last updated on hub: 16 July 2020

Point of care testing using rapid automated antigen testing for SARS-COV-2 in care homes – an exploratory safety, usability and diagnostic agreement evaluation

medRxiv

Introduction Successful adoption of POCTs (Point-of-Care tests) for COVID-19 in care homes requires the identification of ideal use cases and a full understanding of contextual and usability factors that affect test results and minimise biosafety risks. This paper presents findings from a scoping-usability and test performance study of a microfluidic immunofluorescence assay for COVID-19 in care homes. Methods A mixed-methods evaluation was conducted in four UK care homes to scope usability and to assess the agreement with qRT-PCR. A dry run with luminescent dye was carried out to explore biosafety issues. Results The agreement analysis was carried out on 227 asymptomatic participants (159 staff and 68 residents) and 14 symptomatic participants (5 staff and 9 residents). Asymptomatic specimens showed 50% (95% CI: 1.3%-98.7%) positive agreement and 96% (95% CI: 92.5%-98.1%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.911 (95% CI: 0.857-0.965). Symptomatic specimens showed 83.3% (95% CI: 35.9%-99.6%) positive agreement and 100% (95% CI: 63.1%-100%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.857 (95% CI: 0.549-1). The dry run showed four main sources of contamination that led to the modification of the standard operating procedures. Simulation after modification showed no further evidence of contamination. Conclusion Careful consideration of biosafety issues and contextual factors associated with care home are mandatory for safe use the POCT. Whilst POCT may have some utility for ruling out COVID-19, further diagnostic accuracy evaluations are needed to promote effective adoption.

Last updated on hub: 06 May 2021

Policy briefing: the COVID-19 vaccination and unpaid carers (England only)

Carers UK

Unpaid carers are included in the priority lists for the COVID-19 vaccine in the same way that they are for the flu jab. This briefing sets out the position in more detail and explores recommendations for deployment of the vaccine to unpaid carers in detail.

Last updated on hub: 13 January 2021

Post-pilot rollout clinical guidance for testing visitors to care homes with Lateral Flow Antigen Testing Devices

Department of Health and Social Care

This document provides clinical guidance for the testing of visitors for SARS-CoV-2 (the virus that causes COVID-19) using lateral flow technology on entry to residential care homes. A visitor is defined as any relative or friend wishing to visit a resident or any occasional visiting professional who is not a healthcare professional (e.g., a hairdresser). There has been a clear ministerial steer that for visitors to be allowed into care homes as part of overall approach to promoting wellbeing amongst care homes residents. Lateral Flow Antigen testing involves the processing of human nasal swabs, throat swabs, or sputum samples with a Lateral Flow Device (LFD). The device detects a protein (antigen) produced by the virus at its most infectious stage. The document provides advice in relation to site set-up; testing process; supply and equipment management; and data management.

Last updated on hub: 03 March 2021

Potential impact of COVID-19: government policy on the adult social care workforce

Institute for Employment Studies

This report is the output of a research project to identify how government COVID-19 related policy may have impacted upon the adult social care workforce in England. The project had a particular focus on Test and Trace, and the ways in which policy changes may have enabled and incentivised the necessary behaviours of care workers. The working hypothesis has been that care workers’ behaviours are likely to be driven by a combination of commitment to those they care for, risks to themselves and their families from COVID-19 and impacts on incomes. Government policy changes were identified based on the assumed likelihood to impact on these factors. The key findings and observations include: the fragmented nature of the sector is likely to make it challenging to get information and support to the people that need it, and therefore ensure that the desired behaviour changes are happening; government guidance and measures appear to have been rushed, heavily focused on care homes and their workers, and impossible to find in one place on the internet; testing has been hard to access – this has been a disincentive to get tested, as is the fear of being unable to work if testing positive; a major concern for individuals is loss of income if having to rely on Statutory Sick Pay. The report makes recommendations for further research into the actual impact of policy on the workforce and suggestions for improving policy development, communication and implementation.

Last updated on hub: 29 September 2020

PPE guide for community health and social care settings: what PPE to wear and when: an illustrative guide

Public Health England

This resource outlines personal protective equipment (PPE) advice for health and social care workers in community setting to prevent the transmission of COVID-19. It shows: which PPE to wear depending on where and how staff are working; how to work safely using your PPE and safer working practices to protect staff and residents. The guide sets out five common scenarios community health and social care professionals might encounter, describing what PPE they should wear in each case. The scenarios include: personal care involving touching the person who is cared for; when professionals are within 2 metres of anyone who has a cough; when staff are within 2 metres of the individual being cared for but not touching them; when staff are caring for a person who is shielding; and when they are in the workplace and 2 metres away from people they are caring for. This guidance should be used in conjunction with local policies.

Last updated on hub: 10 August 2020

Practical steps to improve air flow in long-term care resident rooms to reduce COVID-19 infection risk

Journal of the American Medical Directors Association

The potential for spread of COVID-19 infections in skilled nursing facilities and other long-term care sites poses new challenges for nursing home administrators to protect patients and staff. It is anticipated that as acute care hospitals reach capacity, nursing homes may retain COVID-19 infected residents longer prior to transferring to an acute care hospital. This article outlines 5 pragmatic steps that long-term care facilities can take to manage airflow within resident rooms to reduce the potential for spread of infectious airborne droplets into surrounding areas, including hallways and adjacent rooms, using strategies adapted from negative-pressure isolation rooms in acute care facilities.

Last updated on hub: 13 November 2020

Preparing for a challenging winter 2020/21

Academy of Medical Sciences

This report considers a worst-case scenario for winter 2020/21 – a likely mix of COVID-19, bad seasonal influenza and cold weather; what this would mean for deaths, NHS capacity and social care; and the actions that would enable the health and social care system to better cope in the face of new winter pressures resulting from the pandemic. The need for health and social care undergoes large seasonal fluctuations, peaking in the winter, with the NHS and social care systems typically operating at maximal capacity in the winter months. The report identifies four additional challenges that have great potential to exacerbate winter 2020/21 pressures on the health and social care system, by increasing demand on usual care as well as limiting surge capacity: a large resurgence of COVID-19 nationally, with local or regional epidemics; disruption of the health and social care systems due to reconfigurations to respond to and reduce transmission of COVID-19; a backlog of non-COVID-19 care; and a possible influenza epidemic that will add pressure. The paper argues that there is a need for urgent preparation to mitigate the risks of a particularly challenging winter 2020/21, including: minimising community SARS-CoV-2 transmission and impact; organising health and social care settings to maximise infection control and ensure that COVID-19 and routine care can take place in parallel; improving public health surveillance for COVID-19, influenza and other winter diseases; and minimising influenza transmission and impact, including by maximising the uptake of influenza vaccination by health and social care workers. Includes a ‘Peoples perspective’ report in appendix, written by patients and carers, that calls for the actions to be developed through engagement with patients, carers and the public to ensure services, guidelines and communications work for people, rather than focusing plans on individual medical conditions.

Last updated on hub: 16 July 2020

Pre-print: What long-term care interventions and policy measures have been studied during the Covid-19 pandemic? Findings from a rapid mapping review of the scientific evidence published during 2020

International Long-term Care Policy Network

Context: Throughout the Covid-19 pandemic, long-term care researchers have aimed to generate evidence rapidly to inform the pandemic response. It is unclear which areas were prioritised during this period of rapid evidence generation. Objective(s): This study aimed to map the international scientific evidence on interventions and policy measures to mitigate the impacts of the Covid-19 pandemic on people who use and provide long-term care. Method(s): This study conducted a pragmatic, rapid mapping review of international evidence to identify the range of interventions, policies, and measures in long-term care studied during the Covid-19 pandemic and published throughout 2020. Reports were primarily identified from two academic databases (MEDLINE; Web of Science). Findings: This study included 137 studies from 22 countries, mostly focusing on the United States, Europe, and Canada. Half of the studies focused on preventing or controlling Covid-19 infections. Other common types of interventions were measures to treat Covid-19 or improve access to general healthcare, and studies of possible targets for policies and interventions, such as care home ownership. Only 13 studies covered home or community-based care. Limitations: This was a pragmatic review that aimed to map key areas of research in long-term care during the pandemic, rather than a systematic review of all available studies. Implications: During the first year of the Covid-19 pandemic, a substantial body of evidence on interventions to mitigate impacts of the pandemic in the long-term care sector emerged. However, reflecting the context and speed with which they were carried out, most studies did not apply an analytical lens and instead provided descriptive findings only. There were very few studies on home care or community-based care settings. As countries assess the lessons that can be learnt from the pandemic and improve preparedness of their long-term care systems for future pandemics and other shocks, it will be important to consider the importance of facilitating rapid generation of more robust evidence.

Last updated on hub: 25 May 2021

Preventing and managing COVID-19 across long-term care services: policy brief

World Health Organization

This briefing provides policy objectives and key action points to prevent and manage COVID-19 across long-term care settings. The brief builds on currently available evidence on the measures taken to prevent, prepare for and respond to the pandemic across long-term care services including care providers. COVID-19 has affected older people disproportionately, especially those living in long-term care facilities. In many countries, evidence shows that more than 40% of COVID-19 related deaths have been linked to long-term care facilities, with figures being as high as 80% in some high-income countries. Concerted action is needed to mitigate the impact across all aspects of long-term care, including home- and community-based care, given that most users and providers of care are those who are vulnerable to severe COVID-19. Specifically, the paper argues that the following policy objectives should be pursued to mitigate the impact of COVID-19 across long-term care: include long-term care in all phases of the national response to the pandemic; mobilise adequate funding; ensure effective monitoring and evaluation of the impact of COVID-19 on long-term care; secure staff and resources, including adequate health workforce and health products; ensure the continuum and continuity of essential services for people receiving long-term care; ensure that infection prevention and control standards are implemented and adhered to in all long-term care settings; prioritise testing, contact tracing and monitoring of the spread of COVID-19 among people receiving and providing long-term care services; provide support for family and voluntary caregivers; prioritise the psychosocial well-being of people receiving and providing long-term care services; ensure a smooth transition to the recovery phase; and initiate steps for the transformation and integration of health and long-term care systems.

Last updated on hub: 27 July 2020

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