COVID-19 resources on Infection control

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Rapid review: what risk factors are associated with COVID-19 outbreaks and mortality in long-term care facilities and what strategies mitigate risk?

McMaster University

This rapid review was produced to support public health decision makers’ response to the COVID-19 pandemic. It seeks to identify, appraise, and summarise emerging research evidence to support evidence-informed decision making. The review includes evidence available up to October 5, 2020 to answer the question: What risk factors are associated with COVID-19 outbreaks and mortality in LTC facilities and what strategies mitigate risk? Across studies, incidence in the surrounding community was found to have the strongest association with COVID-19 infections and/or outbreaks in LTC settings. Several resident-level factors including, racial/ethnic minority status, older age, male sex, receipt of Medicaid or Medicare were associated with risk of COVID-19 infections, outbreaks and mortality; severity of impairment was associated with infections and outbreaks, but not mortality. Most guideline recommendations include surveillance, monitoring and evaluation of staff and resident symptoms, and use of personal protective equipment (PPE). Other interventions demonstrating some effect on decreased infection rates within syntheses and a small number of single studies include promotion of hand hygiene, enhanced cleaning measures, social distancing, and cohorting. Technological platforms and tools (e.g., digital contact tracing, apps, heat maps) are being developed and show potential for decreased transmission through efficient case and/or contact identification that further informs infection control planning strategies.

Last updated on hub: 22 December 2020

Readying the NHS and social care for the COVID-19 peak

House of Commons

An examination of the health and social care response to COVID-19 in England and of the challenges to the services that the outbreak posed. The NHS was severely stretched but able to meet overall demand for COVID-19 treatment during the pandemic’s April peak; from early March to mid-May, the NHS increased the quantity of available ventilators and other breathing support, which are essential for the care of many COVID-patients. The report suggests that it has been a very different story for adult social care, despite the hard work and commitment of its workforce. Years of inattention, funding cuts and delayed reforms have been compounded by the Government’s slow, inconsistent and, at times, negligent approach to giving the sector the support it needed during the pandemic – responsibilities and accountabilities were unclear at the outset and there has been a failure to issue consistent and coherent guidance throughout the pandemic; 25,000 patients from were discharged from hospitals into care homes without making sure all were first tested for COVID-19; and the Government failed to provide adequate PPE for the social care sector and testing to the millions of staff and volunteers through the first peak of the crisis. The report argues that there are many lessons that the government must learn, not least giving adult social care equal support to the NHS and considering them as two parts of a single system, adequately funded and with clear accountability arrangements.

Last updated on hub: 03 August 2020

Real-time digital contact tracing: development of a system to control COVID-19 outbreaks in nursing homes and long-term care facilities

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can spread rapidly in nursing homes and long-term care (LTC) facilities. Symptoms-based screening and manual contact tracing have limitations that render them ineffective for containing the viral spread in LTC facilities. Symptoms-based screening alone cannot identify asymptomatic people who are infected, and the viral spread is too fast in confined living quarters to be contained by slow manual contact tracing processes. Objective: We describe the development of a digital contact tracing system that LTC facilities can use to rapidly identify and contain asymptomatic and symptomatic SARS-CoV-2 infected contacts. A compartmental model was also developed to simulate disease transmission dynamics and to assess system performance versus conventional methods. Methods: We developed a compartmental model parameterized specifically to assess the coronavirus disease (COVID-19) transmission in LTC facilities. The model was used to quantify the impact of asymptomatic transmission and to assess the performance of several intervention groups to control outbreaks: no intervention, symptom mapping, polymerase chain reaction testing, and manual and digital contact tracing. Results: Our digital contact tracing system allows users to rapidly identify and then isolate close contacts, store and track infection data in a respiratory line listing tool, and identify contaminated rooms. Our simulation results indicate that the speed and efficiency of digital contact tracing contributed to superior control performance, yielding up to 52% fewer cases than conventional methods. Conclusions: Digital contact tracing systems show promise as an effective tool to control COVID-19 outbreaks in LTC facilities. As facilities prepare to relax restrictions and reopen to outside visitors, such tools will allow them to do so in a surgical, cost-effective manner that controls outbreaks while safely giving residents back the life they once had before this pandemic hit. Citation: Wilmink G et al. (2020) Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities. JMIR Public Health Surveill 2020;6(3):e20828

Last updated on hub: 13 November 2020

Recasting social workers as frontline in a socially accountable COVID-19 response

International Social Work

The COVID-19 pandemic has seen the engagement of a wide range of professionals in responding to clinical, social and economic issues. While the clinical expression of the pandemic has generated strong media portrayal of physicians and nurses as frontline workers, social workers – who play a key role in helping individuals and families in crisis – have not been similarly highlighted. The pandemic within a social accountability framework highlights important roles of both public officials and civic society in containment efforts. This article recognizes social workers as important actors in their representative and supportive role for civil society during COVID-19.

Last updated on hub: 19 November 2020

Recommendations for safe visiting in care homes during the Covid-19 pandemic

Dementia UK

This flowchart describes the steps residential care providers need to take to ensure safe visiting during the pandemic.

Last updated on hub: 08 October 2020

Recommendations for the management of COVID-19 pandemic in long-term care facilities

Zeitschrift fur Gerontologie und Geriatrie

Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3–66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. The authors are confident that their recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.

Last updated on hub: 15 March 2021

Recommendations in covid-19 times: a view for home care

Brazilian Journal of Nursing (Revista Brasileira de Enfermagem)

Objective: To suggest recommendations for the practice of Home Nursing in the context of COVID-19. Method: Reflective study, originated from readings associated with the theme, available in current guidelines from the Pan American Health Organization, World Health Organization and the Ministry of Health. Results: Recommendations were developed from current scientific evidence for prevention of infections, control of epidemics and pandemics in the Brazilian home scenario. Final considerations: the reflections achieved contribute to guiding actions for better assistance to the patient, family caregivers and the community in the perspective of safe home care with COVID-19, and it is characterized as an introductory discussion on the theme, encouraging new studies to be carried out from the unfolding of the current scenario.

Last updated on hub: 19 October 2020

Reducing health inequalities associated with Covid-19

NHS Providers

This framework offers principles for a population health level approach to understanding and taking action on health inequalities which have developed or worsened as a result of the COVID-19 crisis that began in 2019/20. It focuses on what NHS acute hospital trusts and mental health and community trusts can do, working as part of an integrated health and care system. The framework is intended to help NHS provider trusts to systematically review, describe, prioritise and further develop their role in addressing health inequalities during response and recovery from the COVID-19 crisis and as part of their broader core efforts to meet the needs of their local population. The framework is designed to assist NHS provider trusts to address three main areas: the principles that should be used across the healthcare system to ensure the response to Covid-19 does not increase health inequalities; the priority actions for providers to implement, working in the context of the population and its healthcare system; the indicators that should be used to monitor the impact of Covid-19 on health inequalities. The principles for action include: supporting integrated, co-ordinated person centre care; ensuring services are accessible fo all, particularly those at risk of exclusion; health and care services should always be allocated based on healthcare need, striving in particular for equity of outcome, with a principle of proportional universalism embedded; wider determinants of health should be addressed and funded at a place-based level, harnessing available community assets; health and care staff should be valued and supported to maintain wellbeing and to enable delivery of high quality, person-centred care in all settings.

Last updated on hub: 01 December 2020

Reducing SARS‐CoV‐2 transmission in the UK: a behavioural science approach to identifying options for increasing adherence to social distancing and shielding vulnerable people

British Journal of Health Psychology

Purpose: To describe and discuss a systematic method for producing a very rapid response (3 days) to a UK government policy question in the context of reducing SARS‐CoV‐2 transmission. Methods: A group of behavioural and social scientists advising the UK government on COVID‐19 contributed to the analysis and writing of advice through the Government Office for Science. The question was as follows: What are the options for increasing adherence to social distancing (staying at home except for essential journeys and work) and shielding vulnerable people (keeping them at home and away from others)? This was prior to social distancing legislation being implemented. The first two authors produced a draft, based on analysis of the current government guidance and the application of the Behaviour Change Wheel (BCW) framework to identify and evaluate the options. Results: For promoting social distancing, 10 options were identified for improving adherence. They covered improvements in ways of achieving the BCW intervention types of education, persuasion, incentivization, and coercion. For promoting shielding of vulnerable people, four options were identified covering the BCW intervention types of incentivization, coercion, and enablement. Conclusions: Responding to policymakers very rapidly as has been necessary during the COVID‐19 pandemic can be facilitated by using a framework to structure the thinking and reporting of multidisciplinary academics and policymakers.

Last updated on hub: 07 November 2020

Regular testing for adult day care centres in England

Department of Health and Social Care

Sets out how eligible adult day care centres in England can order, test and register regular PCR and lateral flow tests for all staff and service users. Testing is available to all open day care centres that are run by paid care staff. Services must be for adults over 18 and are provided within non-residential care settings that support the health and wellbeing of adults. This includes settings such as: purpose-built day centres; day centres attached to or part of a care home or supported living; other buildings in communities specifically used for regular adult day care. [Published: 18 February 2021; Last updated: 27 August 2021]

Last updated on hub: 04 May 2021

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