COVID-19 resources on Infection control

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Advice and guidance on discharging COVID-19 positive patients to care homes

Royal College of Physicians

A brief summary of current advice and guidance about discharging patients to care homes. The main points are that: patients should be discharged as soon as they are fit, whether they are COVID-19 positive or not; COVID-19 positive patients being discharged into a care home setting can only be discharged into care homes that have been designated safe by the CQC – if their own care home is not COVID-19 safe, they need to be discharged into alternative accommodation; it is the responsibility of the local authority to find alternative accommodation.

Last updated on hub: 09 November 2020

Advice for emergency staffing situations: mutual aid

Social Care Wales

Advice for local authorities and independent and third sector providers of social care. This advice on mutual aid is provided in the context of the overarching principle of minimising staff movement to avoid cross infection. It contains advice for employers who, having exhausted all other options, require extra capacity due to significantly low staffing levels and whose vulnerable residents will be at risk without additional staffing resource. In Wales, all local authorities are signed up to the principle of mutual aid and assistance in an emergency situation. This means that local authorities agree to sharing staff and helping each other in times of emergency. Contents include: points to consider for short term staffing arrangements; managing infection prevention and control; case study example; and frequently asked questions.

Last updated on hub: 04 May 2021

Age-friendly health systems design to address COVID-19

Institute for Healthcare Improvement

Advice to help limit the exposure of older adults to coronavirus (COVID-19) by reducing their need to present to the hospital, reducing hospitalisations and, if hospitalised or in post-acute or long-term care community, increase the rate of safe discharges. It provides advice for professionals working in the community, in emergency departments and hospitals, and in long-term care.

Last updated on hub: 05 May 2020

An avoidable crisis: the disproportionate impact of Covid-19 on Black, Asian and minority ethnic communities

Labour Party

A report of a review into how people from Black, Asian and minority ethnic backgrounds have been impacted by Covid-19. The pandemic is having a disproportionate and devastating impact on ethnic minority communities. Not only are Black, Asian and minority ethnic people dying at a disproportionate rate, they are also overexposed to the virus and more likely to suffer the economic consequences. The report argues that, despite repeated warnings, the Government has failed to take sufficient action. Covid-19 has thrived on inequalities that have long scarred British society. Black, Asian and minority ethnic people are more likely to work in frontline or shutdown sectors which have been overexposed to Covid-19, more likely to have co-morbidities which increase the risk of serious illness and more likely to face barriers to accessing healthcare. Black, Asian and minority ethnic people have also been subject to disgraceful racism as some have sought to blame different communities for the spread of the virus. The virus has exposed the devastating impact of structural racism. The report makes both immediate and long-term recommendations to protect those most at risk and tackle structural inequalities in several key areas including the machinery of government, health, employment and in the education system.

Last updated on hub: 28 October 2020

An inquiry into the lived experience of Covid-19 in the home care sector in Ireland: clients’ experiences

Home and Community Care Ireland

This research is a qualitative study on the impact of Covid-19 on home care clients; including care provision, the medical and physical effects and the coping mechanisms used to get through the pandemic. The robust infection prevention and control (IPC) measures provided great reassurance to clients, with most continuing care without interruption. Home care proved to be the safest model of healthcare delivery in Ireland during the pandemic, with cases peaking at 193 cases in the week ending January 24th, 2021. Participants reported feeling a strain on their mental well-being. Social isolation was a significant factor. The requirement to cocoon and the closure of shops, recreational and day services meant participants had few social and leisure outlets, leading to reports of “cabin fever” and a loss of motivation. Having strong personal relationships was an important coping mechanism for participants. They pointed to family, friends, volunteer networks and carers as key sources of comfort, companionship and support. Participants used technology and the internet to maintain social connections, shop online and play video games. Offline, participants struggled with the closure of recreational and support services, with laborious activities like needlework being a popular activity. Participants spoke about the importance of keeping a positive mindset when coping with the pandemic. In conclusion, the IPC measures put in place by providers reassured participants that their home was safe and helped make home care the safest method of care during Covid-19 pandemic. While cocooning and social isolation placed a mental strain on participants, personal relationships, technology and a positive mentality helped them adapt and persevere.

Last updated on hub: 12 July 2021

An inquiry into the lived experience of Covid-19 in the home care sector in Ireland: the experiences of home care provider organisations

Home and Community Care Ireland

This exploratory research into the health, social and economic impact of the covid-19 pandemic on the eighteen home care provider organisations who responded to a survey sheds light on how those on the forefront of home care coped during one of the largest viral outbreaks in modern history. A questionnaire consisting of ten open-ended questions was developed following a rapid literature review and internal consultations. These questions were categorised under five subheadings: management, service provision, relationships, health and wellbeing, and the future. Key findings include: The most significant problem was workforce shortage – specifically, two thirds of organisations indicated low staffing levels due to a lack of childcare brought about by the closure of schools and creches; almost every third organisation noted a decrease in home care services, ranging from 20-30 per cent, mostly due to clients cocooning and self-isolating; another issue that featured strongly across all responses was related to uncertainty surrounding the pandemic – stress, fear, worry and even panic; almost every other organisation identified Protective Personal Equipment (PPS) to be a significant cause for concern – supply and distribution was a considerably more prevalent issue than the actual cost of PPE; to ensure the smooth running of business at a very chaotic time, all the providers implemented a range of novel policies and procedures – this rapid development of new ways of delivering service safely took place on several interrelated levels; the crisis exposed any structural shortcomings within the home care sector, but equally it brought about a sense of togetherness, cooperation and mutual support within the sector – and beyond it.

Last updated on hub: 09 November 2020

Analysis of social interactions and risk factors relevant to the spread of infectious diseases at hospitals and nursing homes

PLoS ONE

Ensuring the safety of healthcare workers is vital to overcome the ongoing COVID-19 pandemic. This study presents an analysis of the social interactions between the healthcare workers at hospitals and nursing homes. Using data from an automated hand hygiene system, social interactions between healthcare workers to identify transmission paths of infection in hospitals and nursing homes were inferred. A majority of social interactions occurred in medication rooms and kitchens emphasising that health-care workers should be especially aware of following the infection prevention guidelines in these places. Using epidemiology simulations of disease at the locations, this study found no need to quarantine all healthcare workers at work with a contagious colleague. Only 14.1% and 24.2% of the health-care workers in the hospitals and nursing homes are potentially infected when we disregard hand sanitization and assume the disease is very infectious. Based on the simulations, this study observed a 41% and 26% reduction in the number of infected healthcare workers at the hospital and nursing home, when it is assumed that hand sanitization reduces the spread by 20% from people to people and 99% from people to objects. The analysis and results presented here forms a basis for future research to explore the potential of a fully automated contact tracing systems.

Last updated on hub: 21 September 2021

Annex A: COVID-19 vaccine and health inequalities: considerations for prioritisation and implementation

Department of Health and Social Care

The purpose of this paper is to consider the impact on and implications for health inequalities in the prioritisation of COVID-19 vaccines when they are introduced in the context of initial supply constraints. This paper expands on the considerations informing the Joint Committee on Vaccination and Immunisation (JCVI) interim advice on priority groups for COVID-19 vaccine, which is intended to support the government in planning the vaccine programme, and it offers further considerations for its implementation. The conceptual framework adopted is one based on consideration of scientific evidence, ethics and deliverability, with a focus on the ethical principles of maximising benefit and minimising harm, promoting transparency and fairness, and mitigating inequalities in health. While age has the absolute highest risk of poor COVID-19 outcomes, many factors are associated with an increased relative risk (such as belonging to a BAME group and being male). These are mediated by a complex web of factors which are not straightforward to disentangle and can be potentially misleading, and if misinterpreted when translated to policy, can be damaging to populations and widen health inequalities. al conditions, and health and social care worker status (thus providing NHS resilience). While prioritisation alone cannot address all inequalities in health that are rooted in social determinants, planning and implementation should as a minimum not worsen health inequalities, and present a unique opportunity to mitigate them.

Last updated on hub: 07 December 2020

Are we allowed to visit now? Concerns and issues surrounding vaccination and infection risks in UK care homes during COVID-19

medRxiv

Background: Vaccination uptake in the UK and increased care home testing are likely affecting care home visitation. With scant scientific evidence to date, the aim of this longitudinal qualitative study was to explore the impact of both (vaccination and testing) on the conduct and experiences of care home visits. Methods: Family carers of care home residents with dementia and care home staff from across the UK took part in baseline (October/November 2020) and follow-up interviews (March 2021). Public advisers were involved in all elements of the research. Data were analysed using thematic analysis. Results: Across 62 baseline and follow-up interviews with family carers (n=26; 11) and care home staff (n=16; 9), five core themes were developed: Delayed and inconsistent offers of face-to-face visits; Procedures and facilitation of visits; Frustration and anger among family carers; Variable uptake of the COVID-19 vaccine; Misinformation, education, and free choice. The variable uptake in staff, compared to family carers, was a key factor seemingly influencing visitation, with a lack of clear guidance leading care homes to implement infection control measures and visitation rights differently. Conclusions: This paper makes five recommendations to enable improved care home visitation in the ongoing, and in future, pandemics. Visits need to be enabled and any changes to visiting rights must be used as a last resort, reviewed regularly in consultation with residents and carers and restored as soon as possible as a top priority, whilst more education needs to be provided surrounding vaccination for care home staff.

Last updated on hub: 25 May 2021

As if expendable: the UK government’s failure to protect older people in care homes during the Covid-19 pandemic

Amnesty International UK

This report examines the impact of decisions, policies, and decision-making processes at the national and local level on the human rights of older people in care homes in England in the context of the COVID-19 pandemic. It is based on interviews with 18 relatives of older people who either died in care homes or are currently living in care homes in different parts of England; nine owners, managers and staff of care homes in different parts of the country; eight staff and volunteers working in non-profit organisations advocating on behalf of care home residents and staff; three members of parliament and local authorities, and four legal and medical professionals. Among the government’ failures, the report highlights discharge of patients from hospitals into care homes; denial of access to hospitals and other medical services; misuse of ‘do not attempt resuscitation’ (DNAR) forms; inadequate access to testing; insufficient PPE and poor PPE guidance; poor, late and contradictory guidance; and failure to respond to gaps in staffing. The report also discusses the suspension of visits and failure of oversight, including the failure to wear PPE, challenges of remote communications and the devastating impact of prolonged isolation. The report argues that the UK government’s response to the COVID-19 pandemic violated the human rights of older people in care homes in England and that remedial action must be taken without delay to ensure that mistakes are not repeated. It calls for a full independent public inquiry to consider the overall pandemic preparations and response in adult social care and care homes, including a full investigation into actions taken to ensure a comprehensive and timely cross-government response for social care and a review of the adequacy of the funding made available to support adult social care services and care homes in responding to the pandemic.

Last updated on hub: 05 October 2020

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