COVID-19 Guidance for Healthcare Staff in Residential Care Facilities (15th January 2021)
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COVID-19 Guidance for Healthcare Staff in Residential
Care Facilities (15th January 2021)
HSE Antimicrobial Resistance and Infection Control (AMRIC) Team
Prof. Martin Cormican, HSE Clinical Lead for HCAI &AMR
Mary McKenna, IPC Nursing , AMRIC Team
What we will discuss today • Implications of new variant strain of COVID -19 • Review of PPE and current requirements • The Safety Pause • Vaccination in RCFs- what this means from IPC perspective • Visiting Guidance • Scenarios • Live chat box discussion
The scale of the current surge and the emergence
of the new COVID-19 strain has created huge
anxiety and uncertainty for everyone working in
healthcare services
•
What is different with the SARS-CoV-2 variant VOC 202012/01
A variant of SARS-CoV-2 designated as Variant Of Concern
202012/01 (VOC 202012/01) detected on December 8 2020 has
been reported by the UK authorities
It is reported that this VOC spreads more effectively than
other variants of SARS-CoV-2 because of increased
transmissibility
A variant 501Y.V2 has been reported by South Africa on December
18th. It differs from VOC202012/01 but is also reported as associated
with increased transmissibility
There is not indication that the variants cause more severe disease
•
Key points on SARS-CoV-2 variant VOC 202012/01
The SARS-CoV-2 variant VOC 202012/01 may now account for more than a third of SARS-
CoV-2 infection in Ireland
It is not clear to what extent the current surge in COVID-19 is attributable
? emergence of the variant VOC 202012/01
? increased social interaction over the Christmas period
- may be a combination of both
The current surge is associated with a high incidence of healthcare associated COVID-19 in
long-term residential care facilities and acute hospitals
•
Key points on SARS-CoV-2 variant VOC 202012/01
There is no evidence that the route of transmission of the new variants is
different from that of other variants of SARS-CoV-2
Considered as predominantly droplet and contact transmitted with the
exception of AGPs
Existing IPC measures recommended to healthcare settings which are based
on interrupting contact and droplet routes of transmission are likely to
remain effective in protecting against the new variants of the virus - if strictly
adhered to (very hard to do all the time but critically important)
•
Memo from CCO to acute and community services 14/1/21
Important: to reinforce that strict adherence to current measures is likely
to confer substantial protection against all current variants of SARS-CoV-2
Adoption of contact and droplet precautions for all patients regardless of
clinical suspicion of COVID-19 is not recommended as a general measure
Why?: Routine use of complex PPE may increase risk of contamination
when removing PPE
•
Significance of Variants of SARS-CoV-2 and current surge for Infection Prevention
and Control Guidance and Practice
https://www.hse.ie/eng/health/immunisation/hcpinfo/covid19vaccineinfo4hps/
Broader use of contact and droplet precautions may however be appropriate at unit
level for limited periods based on IPC risk assessment
Use of respirator masks for all care of patients with suspected or confirmed COVID-19 .
Not Recommended as a general measure but a lower threshold for use based on
personal risk assessment is reasonable during periods of intense transmission
•
Safety Pause
Helping teams provide safe quality care
The safety pause aims to:
1. Enhance communication, prioritise patient safety and experience and
embed quality improvement in daily practice.
2. Enable the team to proactively anticipate any risks to the quality of
patientcare; prioritise and plan actions based on resident need and available
resources.
3. Attend to team morale: Acknowledge recent achievements, compliments
from patients and what works well.
Reminders re IPC practice related to COVID-19 are a key part of any safety
pause at present
We should continue to think of how we may control COVID-19 in any setting
Making sure as much as practical that staff
and people entering the RCF do not have
Note – it is of course not
COVID-19 and are not COVID-19 contacts
possible to
stop people with COVID-19
infection Hand hygiene, physical distancing,
entering places that provide respiratory etiquette wearing surgical
care face mask, clean environment,
for them – the key the is to monitoring of staff and service users,
recognize that they have COVID preparedness plan
and put in place the extra
measures
Early detection of outbreaks, early and
high quality clinical care for those with
infection, looking after general health
all the timePreparedness advice for managers
• Ensure all staff have undertaken awareness training around COVID-19
• Ensure all staff are trained with standard and transmission based precautions :
Hand hygiene & respiratory etiquette
Appropriate choice and use of PPE
Procedures for safely donning and doffing of PPE and disposal of PPE
Decontamination of the environment and equipment
Public health measures around wearing masks and physical distancing
• Ensure supplies are available to staff including:
alcohol based hand rub (ABHR)
personal protective equipment
cleaning materialsContact and Droplet Precautions with anyone suspected/confirmed
with COVID- 19 infection
Additional measures to prevent COVID-19 transmission when caring
for people with COVID-19 include:
• Additional wearing of PPE for episodes of care based on:
- type of activity
- level of contact with clients
• Additional cleaning and disinfection of surfaces and equipmentType of PPE to wear is based on risk assessment
Recommendations on Visiting Updated guidance available on HPSC website ( 11/01/21) https://www.hpsc.ie/a- z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventiona ndcontrolguidance/residentialcarefacilities/Guidance%20on%20visits%20to %20RCF.pdf
•
Visiting Guidance Currently aligned with Framework level 5
•Visiting is suspended other than on critical and compassionate grounds
•In the current climate it may not be possible to support visiting in some LTRCFs
because of constraints on staffing and outbreaks
• Risk assessment needs to factor in very high community transmission rates.
•There is a need for clear communication on these issues with residents and families
and in all circumstances the wishes of those residents who may feel safer not seeing
visitors at any time should be respected•
Other Important key elements in the guidance
1. Service providers will need to limit such critical and compassionate
visiting to times when visiting can be effectively supported by available
staff
2. Such visiting is subject to a risk assessment in each case
3. It is essential that the service providers engage with residents, involve
them in decision making and communicate clearly with each resident
and relevant others regarding visiting policy including any restrictions,
the reasons for those restrictions and the expected duration of
restrictions
4. Residents in LTRCFs and their right to have or refuse visitorsCOVID-19 Vaccine
•
Key points on the COVID-19 vaccine
1. Two vaccines now available (BioNTech/Pfizer and Moderna)
2. Government policy on provisional vaccine allocation groups
https://www.gov.ie/en/publication/39038-provisional-
vaccine-allocation-groups/•
Key points on the COVID-19 vaccine
Group Provisional vaccine allocation groups
1 People aged 65 years and older who are residents of long-term care facilities (likely to include all staff and residents
on site)
2 Frontline healthcare workers
3 People aged 70 and older
4 Other healthcare workers not in direct patient contact
5 People aged 65-69
6 Key workers
7 People aged 18-64 with certain medical conditions
8 Residents of long-term care facilities aged 18-64
9 People aged 18-64 living or working in crowded settings
10 Key workers in essential jobs who cannot avoid a high risk of exposure
11 People working in education sector
12 People aged 55-64
13 Other workers in occupations important to the functioning of society
14 Other people aged 18-54
15 People aged under 18 and pregnant women•
Vaccine roll out and availability
1. HSE Guidance on sequencing of vaccination for frontline healthcare workers has
been prepared
2. Trying to make sure that very limited supplies of vaccine are allocated and
administered to the frontline healthcare workers at most risk as quickly as possible is
very challenging
3. The principles are as follows:
The sequencing process needs to be practical and transparent
Sequencing should be based on the best practical estimate of exposure risk
Sequencing should not be based on where people work (community or acute hospital), who they work for (public
sector or private sector), category of worker or grade.
Vaccine allocated to frontline healthcare workers should be administered as promptly as possible to ensure that
the maximum possible number of frontline healthcare workers are protected as quickly as possible
The vaccination programme has to be practical to administer
No dose should be wasted•
CAUTION
DO NOT DROP YOUR GUARD
The vaccine is safe
The vaccine is effective AFTER the immune response
The vaccine is not perfect
There are lot of other infections besides COVID-19
IPC does not go away because you have been vaccinated
New England Journal of Medicine articleDiscussion on IPC queries received
“
Q. What is the Significance of Variants of SARS-
CoV-2 and current surge for Infection
Prevention and Control Guidance and PracticeQ. Will COVID vaccines stop transmission? A. Not sufficient evidence to know this yet Q. Can RCFs ease visiting restrictions once all staff and residents have been vaccinated Current visiting guidance remains in effect until revised
Peer vaccinators in RCFs Do they require additional PPE including an FFP2 mask? No FFP2 mask is not required (see earlier discussion) Do vaccinators require to be vaccinated before commencing vaccinations in RCFs? I understand that in general vaccinators are vaccinated (but can’t assume they have vaccine protection yet)
Queries Mary is in an acute hospital on day of vaccination scheduled in RCF. Does Mary the get the vaccine in the acute hospital on this date or how will she receive it? There is no programme of patient vaccination in hospital at present
•
Q. Can residents who are close contacts and are well be
vaccinated (with appropriate PPE for vaccinators)?
A. Yes
Q. Does this raise IPC issues if residents are then leaving
their rooms to be vaccinated?
A. Recommend management of the situation with IPC
precautions•
Q. Can residents who are close contacts be vaccinated if they are
waiting for results of a Covid-19 test and can staff can be vaccinated
who are awaiting results of serial testing?
A. Yes, there is no requirement for a Covid-19 test that reports not
detected prior to vaccination•
Q. Should RCFs where there is an outbreak be prioritised for
vaccination?
A. There is a schedule to reach all RCFs very soon•
Q. Can we continue to deliver mandatory face to face training at
present following the guidance protocol ?
A. It if is essential to maintain services and the guidance for
delivering face to face education is followed•
Can you advise on how to alleviate concerns to staff ?
Staff should be concerned (don’t alleviate too much)
Staff should be careful
We all need support to manage our fears and stress so that we can keep
going•
Q. Is there a need for additional decontamination measures – e.g. uv
light, fogging, disinfectant spraying -advice from IPC has been to
follow the national guidelines and that the virus can be easily
removed using detergent/disinfectant?
A. No additional requirement to current guidance recommendationsSome more online resources and links - preparedness
New stay safe at work poster (online version – poster will be printed and HSE services can order) · New stay safe at work staff webpages · New stay safe at work animated video https://youtu.be/ilR1ZHIMvo0 · Message from the CEO in his regular staff video · Key messages from Prof Cormican video https://youtu.be/mxOjqkLy7QU · Social media plan · Staff broadcast · RESIST newsletter feature · Inclusion in HG and Community Services news articles/staff communications · Health Matters piece
Online resources and links www.hpsc.ie is the central hub for nationally approved infection control guidance relating to COVID19. It contains a wealth of infection control guidance and resources for caring for people in their own home. You should familiarise yourself with the relevant guidance. All guidance has been approved by the COVID19 National Public Health Emergency Team (Expert Advisory Group) or the HSE Heath Protection and Surveillance Centre. The critical guidance for all staff delivering care in a person’s home is: COVID-19 Infection Prevention and Control Guidance for Health and Social Care Workers who Visit Homes to Deliver Healthcare
Online resources and links Online training programmes are available on www.hseland.ie This resource is accessible to any service public or private once they have registered online. The key infection control resources on this site include videos to demonstrate: • How to perform hand hygiene using soap and water • How to perform hand hygiene using alcohol based rub • Breaking the chain of infection – an online infection control course (with a knowledge test) • How to put on an take off PPE in a community setting (with a knowledge test) • How to put on and take off PPE in an acute hospital setting (with a knowledge test)
Online resources and links There are additional videos on HPSC relating to putting on and taking off the new coverall type PPE and masks with loops. Also included are scenarios for managing patients in a GP clinic area that are useful for other settings https://www.hpsc.ie/a- z/respiratory/coronavirus/novelcoronavirus/videoresources/ Webinars: there are a number of education webinars on infection control and reducing the risk of transmission of COVID19 in health services. https://bit.ly/34YccbT
Onlineresources
4. Online resourcesand
andlinks;
linksPreparedness
There are additional videos on HPSC relating to
putting on and taking off the new coverall type PPE
and masks with loops. Also included are scenarios
for managing patients in a GP clinic area that are
useful for primary care settings
https://www.hpsc.ie/a-
z/respiratory/coronavirus/novelcoronavirus/vid
eoresources/Online resources and links There is a considerable amount of online information for clients, families, the public. All of this information is available on the HSE website and the link is listed below. There are many pieces of translated materials, videos in Irish sign language and specific materials for patients who have intellectual disability or who have dementia. Please familiarise yourself with the range of materials accessible here: https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/
Online resources and links Some samples of online posters available for download – use this link https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/
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