COVID-19 resources on Infection control

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National discussions on mandatory vaccination for long-term care staff in 24 countries

International Long-term Care Policy Network

Following the enormous impacts of Covid-19 among people who use long-term care, most countries have prioritised people who live and work in care homes for vaccinations. In some countries there is also a debate on whether it should be compulsory for people working in this sector (or particularly in care homes) to be vaccinated, or whether there are other measures that may be more acceptable and effective at increasing vaccination take-up and may not deter people from working in the sector. This post provides an overview of the situation in May 2021 in 24 countries. This review finds that most countries have stated that staff working in long-term care would be among the first groups to be prioritized for Covid-19 vaccinations but in many countries there have been practical difficulties in facilitating access to vaccination for this group which, added to some vaccine hesitancy, has resulted in lower vaccination rates for staff than ideal. Vaccines are mandatory for healthcare personnel in Italy. While many countries have debated whether to make Covid-19 vaccinations mandatory for certain groups, including people working in long-term care, none of the 24 countries for which we have information have adopted this as a national policy, although there are some local/regional examples where this has become the practice or where providers require that their employees are vaccinated. There are a few examples of other vaccinations (such as flu) being made mandatory for staff working in long-term care and/or health care. Most countries do not have data systems that support monitoring of vaccination rates among staff working in the long-term care sector.

Last updated on hub: 16 June 2021

New analysis finds the pandemic has significantly increased older people’s need for social care

Age UK

New Age UK analysis finds that the experience of living through the fear, enforced isolation and inactivity caused by the pandemic has sharply accelerated the care needs of significant numbers of older people.

Last updated on hub: 25 May 2021

NICE guidance: preventing infection and promoting wellbeing

Skills for Care

This webinar – delivered by NICE – focuses on two areas of NICE guidance: helping to prevent infection and promoting positive mental wellbeing, considering the particular challenges for social care during the COVID-19 pandemic. The webinar also covers NICE COVID-19 rapid guidelines and NICE social care quick guides.

Last updated on hub: 29 June 2020

Nontraditional small house nursing homes have fewer COVID-19 cases and deaths

Journal of the American Medical Directors Association

Objectives: Green House and other small nursing home (NH) models are considered “nontraditional” due to their size (10–12 beds), universal caregivers, and other home-like features. They have garnered great interest regarding their potential benefit to limit Coronavirus Disease 2019 (COVID-19) infections due to fewer people living, working, visiting, and being admitted to Green House/small NHs, and private rooms and bathrooms, but this assumption has not been tested. If they prove advantageous compared with other NHs, they may constitute an especially promising model as policy makers and providers reinvent NHs post-COVID. Design: This cohort study compared rates of COVID-19 infections, COVID-19 admissions/readmissions, and COVID-19 mortality, among Green House/small NHs with rates in other NHs between January 20, 2020 and July 31, 2020. Setting and Participants: All Green House homes that held a skilled nursing license and received Medicaid or Medicare payment were invited to participate; other small NHs that replicate Green House physical design and operational practices were eligible if they had the same licensure and payer sources. Of 57 organizations, 43 (75%) provided complete data, which included 219 NHs. Comparison NHs (referred to as “traditional NHs”) were up to 5 most geographically proximate NHs within 100 miles that had <50 beds and ≥50 beds for which data were available from the Centers for Medicare and Medicaid Services (CMS). Because Department of Veterans Affairs organizations are not required to report to CMS, they were not included. Methods: Rates per 1000 resident days were derived for COVID-19 cases and admissions, and per 100 COVID-19 positive cases for mortality. A log-rank test compared rates between Green House/small NHs and traditional NHs with <50 beds and ≥50 beds. Results: Rates of all outcomes were significantly lower in Green House/small NHs than in traditional NHs that had <50 beds and ≥50 beds (log-rank test P < .025 for all comparisons). The median (middle value) rates of COVID-19 cases per 1000 resident days were 0 in both Green House/small NHs and NHs <50 beds, while they were 0.06 in NHs ≥50 beds; in terms of COVID-19 mortality, the median rates per 100 positive residents were 0 (Green House/small NHs), 10 (<50 beds), and 12.5 (≥50 beds). Differences were most marked in the highest quartile: 25% of Green House/small NHs had COVID-19 case rates per 1000 resident days higher than 0.08, with the corresponding figures for other NHs being 0.15 (<50 beds) and 0.74 (≥50 beds). Conclusions and Implications: COVID-19 incidence and mortality rates are less in Green House/small NHs than rates in traditional NHs with <50 and ≥50 beds, especially among the higher and extreme values. Green House/small NHs are a promising model of care as NHs are reinvented post-COVID.

Last updated on hub: 03 March 2021

Novel coronavirus (COVID19) standard operating procedure: COVID-19 vaccine deployment programme: frontline social care workers (JCVI Priority Cohort 2)

NHS England

This standard operating procedure (SOP) outlines the process for facilitating COVID-19 vaccination for frontline social care workers (excluding those working in care homes for older adults) as defined by the JCVI. This includes the identification of eligible care workers and the roles and responsibilities within local systems for enabling and supporting care workers to be vaccinated. The SOP also outlines how Hospital Hubs, Vaccination Centres and Local Vaccination Services should work to deliver COVID-19 vaccination to frontline social care workers at pace. It covers how they should work in partnership to match vaccination capacity to meet demand, support booking, on the day arrangements and data capture to monitor uptake. It does not cover the clinical delivery of the vaccine, which is covered in separate guidance.

Last updated on hub: 19 January 2021

Nursing home design and COVID-19: balancing infection control, quality of life, and resilience

Journal of the American Medical Directors Association

Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

Last updated on hub: 07 December 2020

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

Older people’s nonphysical contacts and depression during the COVID-19 lockdown


Background and Objectives: With the goal of slowing down the spread of the SARS-CoV-2 virus, restrictions to physical contacts have been taken in many countries. We examine to what extent intergenerational and other types of nonphysical contacts have reduced the risk of increased perceived depressive feelings during the lockdown for people aged 50+. Research Design and Methods: We implemented an online panel survey based on quota sampling in France, Italy, and Spain in April 2020, about 1 month after the start of the lockdown. Our analyses are based on logistic regression models and use post-stratification weights. Results: About 50% of individuals aged 50+ felt sad or depressed more often than usual during the lockdown in the 3 considered countries. Older people who increased or maintained unchanged nonphysical contacts with noncoresident individuals during the lockdown were at a lower risk of increased perceived depressive feelings compared to those who experienced a reduction in nonphysical contacts. The beneficial effect of nonphysical contacts was stronger for intergenerational relationships. The effects were similar by gender and stronger among individuals aged 70+, living in Spain and not living alone before the start of the lockdown. Discussion and Implications: In the next phases of the COVID-19 pandemic, or during any future similar pandemic, policy makers may implement measures that balance the need to reduce the spread of the virus with the necessity of allowing for limited physical contacts. Social contacts at a distance may be encouraged as a means to keep social closeness, while being physically distant.

Last updated on hub: 06 March 2021

On site testing for adult social care services: rapid lateral flow test kits

Department of Health and Social Care

This guidance explains how adult social care services can prepare and manage on-site lateral flow testing. This can include testing of people who work in social care; professionals visiting a social care service for work; people getting care and support from social care services; people visiting someone who gets care and support. Lateral flow antigen testing involves processing a throat and nasal swab sample with an extraction fluid and a rapid lateral flow device (LFT). The rapid LFT detects a COVID-19 antigen that is produced when a person is infectious with COVID-19. If this antigen is present, then a coloured strip will appear which indicates a positive result. Lateral flow testing is not a fool proof solution: it should be seen as an addition to PPE and other IPC measures and must not be seen as a way of relaxing their use. The guidance covers: testing process overview; testing technology and preparations; and testing instructions (prepare testing area, check-in the person being tested, sample collection, sample analysis, result analysis, process and record results, and results guidance). [Published: 24 March 2021; Last updated: 18 June 2021]

Last updated on hub: 08 March 2021

One year report on the status on the non-devolved provisions of the Coronavirus Act 2020: March 2021

Department of Health and Social Care

One-year status report on which powers in the Coronavirus Act 2020 are currently active. The Act was designed to protect public health in various ways, with the ultimate aim of facilitating sufficient preparation for a worst-case scenario. The Act ensured that the NHS had the capacity to deal with the peak of the virus by allowing the temporary registration of nurses and other healthcare professionals. It also protected critical societal functions and ensured that they were still able to continue, such as providing courts with the ability to use video technology. The Act meant that we were able to ensure effective support packages such as the Coronavirus Job Retention Scheme and Self-Employed Income Support Scheme were in place for people and businesses alike. To achieve this aim, the Act enables action in five key areas: increasing the available health and social care workforce; easing and reacting to the burden on frontline staff; supporting people, providing access financial support when they need it; containing and slowing the virus; and managing the deceased with respect and dignity.

Last updated on hub: 23 March 2021

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