COVID-19 resources on Infection control

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Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

Systematic reviews

Background: The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). Methods: EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning(CAL). All search results were processed using CAL to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. Results: Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. Conclusions: Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors.

Last updated on hub: 07 December 2020

Priority groups for coronavirus (COVID-19) vaccination: advice from the JCVI, 2 December 2020

Department of Health and Social Care

This advice is provided to facilitate the development of policy on COVID-19 vaccination in the UK. The Joint Committee on Vaccination and Immunisation (JCVI) advises that the first priorities for any COVID-19 vaccination programme should be the prevention of COVID-19 mortality and the protection of health and social care staff and systems. As the risk of mortality from COVID-19 increases with age, prioritisation is primarily based on age. Secondary priorities could include vaccination of those at increased risk of hospitalisation and at increased risk of exposure, and to maintain resilience in essential public services. This document sets out a framework for refining future advice on a national COVID-19 vaccination strategy.

Last updated on hub: 07 December 2020

Professional practice guidance for home visits during Covid-19 Pandemic

British Association of Social Workers England

This guidance has been produced to help social workers and their employers manage the risks of home visits during the coronavirus (Covid-19) pandemic. It aims to help social workers keep themselves safe and reduce risks of infection during home visits, enable social workers to fulfil their duties without undue risk, and minimise the risk of infection of others by social workers entering homes. It covers key issues to consider when planning a home visit, during a visit, and action to take immediately after a home visit. The key principles may also be helpful for social workers planning and carrying out face to face activities in other settings, such as hospitals or care homes during Covid-19. It does not cover social care workers who are providing hands-on personal care. The guidance has been developed by the British Association of Social Workers (BASW) in consultation with practitioners, managers and sector leaders and is applicable for all social workers across the UK. It will be reviewed and updated frequently.

Last updated on hub: 27 April 2020

Professional practice guidance for hospital social work with adults during Covid-19

British Association of Social Workers England

This guidance provides a professional risk framework to prepare for face to face social work in hospitals with adult patients, families or carers during Covid-19. It focuses on planning for and managing risk during coronavirus (Covid-19), whether with adults who are Covid-19 positive, negative or infection status unknown. It includes advice on planning a face to face encounter with a hospital adult patient, family or carer, such as liaising with other agencies, evaluating level of risk, and talking patients, families and carers about risk precautions. Developed by the British Association of Social Workers, the guidance is based on best available evidence, latest public health guidance, practice experience.

Last updated on hub: 11 May 2020

Proposal to regulate to stop movement of staff between care settings

Department of Health and Social Care

This consultation seeks views from the adult social care sector on the proposal to stop staff movement between different care settings and between health and care settings is critical to minimise the risk of infection of COVID-19. The findings of a study on the impact of coronavirus in care homes in England indicated one of the common factors in care homes with higher levels of infection among staff was the extent to which those homes employed staff who worked across multiple sites. The requirement would apply to Care Quality Commission (CQC) registered residential and nursing care home providers in England. These providers would be required not to use staff to provide nursing or personal care who are carrying on, or who have carried on within the previous 14 days, a regulated activity in another setting and/or for another health or social care provider subject to certain exceptions. The consultation closes on Wednesday 25 November 2020.

Last updated on hub: 25 November 2020

Protecting and supporting the clinically extremely vulnerable during lockdown

National Audit Office

This report looks at how effectively the Government identified and met the needs of clinically extremely vulnerable people to 1 August 2020. The objective of the shielding programme (the Programme) was to minimise mortality and severe illness among those who are CEV by providing them with public health guidance and support to stay at home and avoid all non-essential contact. Through the shielding programme, CEV people could get support accessing food, medicine and basic care.. The report sets out: the inception of the shielding programme (Part One); identifying clinically extremely vulnerable people (Part Two); supporting clinically extremely vulnerable people (Part Three); and outcomes and lessons learned (Part Four). The report finds that the shielding programme was a swift government-wide response to protect clinically extremely vulnerable people against COVID-19, pulled together at pace in the absence of detailed contingency plans. Government recognised the need to provide food, medicines and basic care to those CEV people shielding to help meet its objective of reducing the number of people suffering from severe illness and dying from COVID-19. There was impressive initial support offered to many people, with food provided to just over 500,000 people. Although the need to support was urgent, it took time for people to be identified as CEV, and therefore access formal support. This followed challenges extracting data from different IT systems and the understandable need for GPs and trusts to review the List of vulnerable people from their clinical perspective. Given the challenges in assessing the impact of shielding on CEV people’s health, government cannot say whether the £300 million spent on this programme has helped meet its central objective to reduce the level of serious illness and deaths from COVID-19 across CEV people.

Last updated on hub: 15 February 2021

Protecting children at a distance: summary of findings from Stage 1: a multi-agency investigation of child safeguarding and protection responses consequent upon COVID-19 lockdown/social distancing measures

King's College London

This report sets out the findings from the first stage of a study designed in response to widespread concerns about the operation of child safeguarding and protection arrangements consequent upon the Covid-19 lockdown and social distancing measures. In light of the challenges to intra- and interagency communication and the impact on joint working of actions taken by individual agencies, the study focuses on safeguarding and protection practice, practitioner working and the multiagency response to the COVID-19 pandemic. Stage I comprised 67 semi-structured hour-long interviews undertaken between June and September 2020 with safeguarding leaders in London from Safeguarding Partnerships, and children’s social care, health, police, law, education and mental health services. The report finds that that the speed at which lockdown was imposed exposed some inadequacies in contingency plans and poor resilience, despite the fact that no agencies reported significant reductions in overall staff capacity. Participants expressed widespread concern that children were largely side-lined in the response to the pandemic. They pointed to the urgent need for the government to recognise the multi-faceted long-term harm to children that is the likely legacy of the pandemic, from reduced educational attainment and employment opportunities to increased mental ill-health and delayed disclosure of maltreatment. The pandemic has both exposed and exacerbated inequalities, particularly digital poverty and gendered inequalities. An overarching government policy response is required that addresses preventative services and early help, including midwifery and health visiting, and that confronts the long-term implications for mental health services. Clear-sighted assessment of the right balance between infection control and safeguarding must inform policy and guidance at all levels and in all areas, including NHS England and legal processes, as well as clear and consistent public messaging.

Last updated on hub: 10 August 2021

Protecting children at a distance: summary of findings from Stage 2: A multi-agency investigation of child safeguarding and protection responses consequent upon COVID-19 lockdown/social distancing measures

King's College London

This study sets out the findings from the second stage of a study designed in response to widespread concerns about the operation of child safeguarding and protection arrangements consequent upon the Covid-19 lockdown and social distancing measures. In light of the challenges to intra- and interagency communication and the impact on joint working of actions taken by individual agencies, the study focuses on the multiagency response to the COVID-19 pandemic and the implications for professional practice and service provision. Stage 2 comprised a national survey of safeguarding leaders and children’s social care, health, police, law, education and mental health services, to explore the evolving concerns and response to the COVID-19 pandemic following the full reopening of schools in September 2020 – 417 responses from data collected from 1st February – 8th March 2021 were 2 analysed. It appears that the pandemic has helped to embed Safeguarding Partnerships arrangements through increased activity and communication in response to the crisis. Broader joint/collaborative working between individual agencies seems to have held up well overall, with many respondents reporting that levels of collaboration had been maintained. One of the biggest impacts on professional practice has been the social distancing measures put in place to control the pandemic, which have significantly reduced the in-person contact between universal/early help/specialist safeguarding practitioners and children/families. The study highlights the different approaches to, and appetite for, face-to-face work, both between and within disciplines in the early stages of the pandemic but it is clear that there are many potential benefits to be gained from remote communication in the operation of statutory meetings, conferences and court hearings, particularly in terms of the efficient use of professionals’ time and in facilitating ‘attendance’ at meetings which might otherwise require significant time taken up in travelling. Coordinated cross-government attention and investment is needed to address the complexity of inter- and multi-agency information sharing, assessment and service delivery to safeguard children and young people.

Last updated on hub: 10 August 2021

Protecting nursing home residents from Covid-19: federal strike team findings and lessons learned

NEJM Catalyst Innovations in Care Delivery

As part of the national response to Covid-19 in nursing homes, a federal strike team initiative: (1) offered technical assistance and recommendations to facilities experiencing large outbreaks; (2) identified innovative actions taken to safeguard the residents, visitors, and staff; and (3) explored opportunities to strengthen federal, state, and local guidance and support. Between July and November 2020, federal teams visited 96 nursing homes in 30 states. These facilities faced challenges related to staffing, personal protective equipment supplies, Covid-19 testing, and infection prevention and control (IPC) measure implementation. Promising practices included actions taken at the facility level to bolster IPC, as well as system-level support from health departments, health care coalitions, and quality improvement partners. Addressing a novel emerging infectious pathogen such as SARS-CoV-2, the pathogen that causes Covid-19, requires both guidance and education for best practices, along with robust surveillance and a culture of collective accountability across health care settings, including nursing homes.

Last updated on hub: 13 August 2021

Protecting nursing homes and long term care facilities from COVID-19: a rapid review of international evidence

Journal of the American Medical Directors Association

Objectives: The COVID-19 pandemic has highlighted the extreme vulnerability of older people and other individuals who reside in long term care, creating an urgent need for evidence-based policy that can adequately protect these community members. This study aimed to provide synthesized evidence to support policy decision-making. Design: Rapid narrative review investigating strategies that have prevented or mitigated SARS-CoV-2 transmission in long term care. Setting and Participants: Residents and staff in care settings such as nursing homes and long term care facilities. Methods: PubMed/Medline, Cochrane Library and Scopus were systematically searched, with studies describing potentially effective strategies included. Studies were excluded if they did not report empirical evidence (for example commentaries and consensus guidelines). Study quality was appraised on the basis of study design; data were extracted from published reports and synthesised narratively using tabulated data extracts and summary tables. Results: Searches yielded 713 articles; 80 papers describing 77 studies were included. Most studies were observational with no randomized controlled trials identified. Intervention studies provided strong support for widespread surveillance, early identification and response, and rigorous infection prevention and control (IPC) measures. Symptom or temperature based screening, and single point-prevalence testing, were found to be ineffective, and serial universal testing of residents and staff was considered crucial. Attention to ventilation and environmental management, digital health applications and acute sector support were also considered beneficial although evidence for effectiveness was lacking. In observational studies, staff represented substantial transmission risk and workforce management strategies were important components of pandemic response. Higher performing facilities with less crowding and higher nurse staffing ratios had reduced transmission rates. Outbreak investigations suggested that facility-level leadership, inter-sectoral collaboration and policy that facilitated access to critical resources were all significant enablers of success. Conclusions and Implications: High quality evidence of effectiveness in protecting LTCFs from COVID-19 was limited at the time of this study, though continues to emerge. Despite widespread COVID-19 vaccination programs in many countries, continuing prevention and mitigation measures may be required to protect vulnerable long term care residents from COVID-19 and other infectious diseases. This rapid review summarises current evidence regarding strategies which may be effective.

Last updated on hub: 18 August 2021

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