COVID-19 Infection Prevention and Control Guidance for Vulnerable Group Settings

HSE Antimicrobial Resistance and Infection Control (AMRIC) Team Prof. Martin Cormican, National Clinical Lead, AMRIC Mary McKenna Infection Prevention and Control Nursing lead, AMRIC 14th May 2020

An introduction to COVID-19

COVID-19 is a new respiratory virus that belongs to the family of Coronaviruses It was first reported to the WHO from Wuhan in China in December 2019 The World Health Organization declared a global pandemic of the virus in March 2020 Spread from people with symptomatic infection is the greatest risk Spread from people who are infected but who do not have symptoms at the time also occurs

COVID-19

How does COVID-19 Spread?

Common routes of spread:

• Direct spread: by an infected person who coughs or sneezes on another person who is very close to them • Generally infectious droplets fall onto floors or surfaces fairly quickly so the virus doesn't travel very far in the air • Indirect contact from contaminated surfaces

Someone touches contaminated surfaces with their hands and don't clean them Then touches their the eyes, mouth or nose with unclean hands The virus gets into the body

COVID-19 – and skin

The virus has to stick to the mucosa (mouth/nose/eyes) to cause infection

It does not infect through skin contact with another persons skin

So

Try not to touch you face with your hands

Perform hand hygiene to clean the virus from your hands before you touch your face or eat

COVID-19

Period of infectivity and recommendations for isolation

• Individuals are most infectious around the time when they become symptomatic, depending on

severity of symptoms

• 14 days self isolation is the recommendation for symptomatic individuals to recover.

• Isolation can stop after 14 days if the person is fever free for the final 5/14 days

• Contacts of symptomatic should be advised to self monitor and contact the staff if any symptoms

develop

Incubation period The time between exposure to the virus and developing symptoms is most often five to six days but can range from 1 to 14 days

COVID-19 – Period of infectivity

Signs and symptoms of COVID-19

The most common symptoms include • fever – often absent in older people • dry cough • shortness of breath • sputum production • fatigue • loss of appetite • unexplained change in baseline condition

Less common symptoms include: • sore throat • headache • chills • nausea or vomiting • nasal congestion • diarrhoea • loss of taste and smell

Staff provide support in many different ways to vulnerable groups with different levels of contact

Through your work there are different levels of contact with residents and families in their living accommodation. This includes: •Supervisors •Catering •Cleaning •Security •Laundry staff •Transport providers The main aim is for everyone to:

• Prevent COVID-19 infection transmission to residents and their family • Protect themselves from acquiring COVID-19

•Identify a designated lead for COVID-19 management in the facility

•Have a COVID Preparedness plan in place to include:

•What to do when a resident becomes ill with COVID-19 symptoms

•Who to contact for immediate medical advice and follow up (GP) •Who to contact in Dept of Justice •Who to contact in Public Health •Who to contact in the HSE on where and how to get testing arranged •Who to contact if interpreter supports are needed to assist the residents

Plan with Public Health for dealing with people who are close contacts of a confirmed case of COVID-19 Suspend any volunteer services and explain the reason to residents

COVID-19 Preparedness Plan

information readily available for residents on COVID-19 in the facility

Social distancing advice and signage should be in place including restricted communal areas

Cocooning information should be available to residents with underlying medical illness

Education and information on good hygiene measures including:

• Hand hygiene • Respiratory etiquette • Personal hygiene

Provide information on restrictions around travel distance out of the centre

Display signage prominently displayed around restricted visiting at the entrance

Advice and guidance information should be available for residents on what to do if they develop COVID-19 symptoms

including staff member to contact and self isolation

Provide surgical masks for residents who need to come out of the isolation facility ( e.g.. to attend a test centre)

Communication is important

Speak to the person at the door entrance or by remote communication if possible

If you need to enter the room

• Clean your hands

• Put on facemask, apron and gloves

• Avoid any unnecessary contact with the resident/s

• Maintain social distancing ( 2 metres)

• Remove and discard all PPE upon leaving the room

• Perform hand hygiene immediately after removing PPE

When attending the residents with COVID-19

• Supply tissues and hand sanitisers in key communal areas

• Hand gel outside dining rooms

• Communal bathrooms

• At entrances to the building

• At main reception area

• In other communal areas where people congregate

• Provide reminders to perform hand hygiene ( e.g.. Prominently placed hand hygiene posters)

• Ensure hand-washing facilities, including soap and disposable towels, are well maintained

• Provide bins for disposal of tissues (preferably covered, lined with a bin bag; dispose of when three-

quarters full)

Preparedness advice for managers

Environmental Cleaning

Increase the frequency and extent of cleaning regimes. Ensure that cleaning regimes include: Cleaning and disinfection of regularly touched objects and surfaces using a household detergent and bleach Cleaning regime should include especially all hard surfaces in high-contact areas such as door handles, grab rails/ hand rails in corridors/stairwells, plastic-coated or laminated worktops, access touch pads, telephones/keyboards in offices, and toilets/taps/sanitary fittings Wearing rubber gloves when cleaning surfaces

• wash the gloves while still wearing them • then wash your hands after you take them off

Be cautious about products and devices that promise to have COVID cleaning super powers Aerosol sprays are of no benefit to improve the air quality of the environment

Catering and cooking

Communal dining room /canteen If possible stagger meal times to minimise close contact Display social distance signs at the entrance where queuing takes place Hand hygiene dispensers at dining entrances Food handlers should have social distance when serving food Reduce table numbers to minimise close contact Disposable crockery and cutlery practical if residents taking food out of the facility Crockery and cutlery may be reused and placed in hot dishwasher cycle Arrange for meals to be delivered to the room of a resident with COVID-19 Cover any food provided that is being taken out of the dining room Staff: perform hand hygiene and maintain social distancing in the dining room Designated communal self catering areas Plan separate allocated times for residents/families to cook and eat All cooking equipment should be fully washed in detergent and hot water between families

Laundry for when dealing with COVID-19 positive

Provide alginate bags and ask the residents to put personal laundry inside before collecting

Store the laundry in a dedicated area before washing – away from residents and communal

areas

Staff- wear gloves and apron when handling laundry- do not shake the linen

Clothing may be laundered in personal or communal washing machine at the hottest cycle the

fabric can tolerate

Dedicate the machine wash for individual residents laundry

Hot air driers may be used

Ensure social distancing in the laundry room with signage and allocated times to use the

facility

Provide alcohol hand gel, gloves and aprons

Standard measures to prevent infection spreading at all times Hand Hygiene- know when and how to clean your hands

Respiratory Cough Etiquette –coughing directly into a tissue or bent elbow

Appropriate use of recommended PPE including aprons, gloves and face masks

Environmental /equipment cleaning & appropriate cleaning/ disinfection

Extra measures when disposing of waste when someone has symptoms or is confirmed to have COVID-19

COVID-19 guidance for Staff

COVID-19 guidance for Staff

Increase staff awareness of COVID-19 including:

What to do If they develop symptoms

The procedure for going off work if unwell including self isolation for 14 days

Who to contact for advice about testing

Ensure staff are aware of signs /symptoms of COVID-19 when who to contact if they

have a concern that a residents condition causes a concern about COVID-19

What to do if a residents condition deteriorates in the facility

Key points on Personal protective Equipment (PPE)

Hand hygiene is the best measure to protect yourself and others from COVID-19

Avoid any unnecessary contact with the resident and maintain social distancing where possible

Where no contact is required hand hygiene alone is sufficient

Assess type of PPE based on the level of anticipated contact with someone who has suspected/confirmed

COVID-19–

Apply gloves , apron and facemask when close contact cannot be avoided or handling contaminated items

All PPE should be put on immediately upon entering and removed and discarded upon leaving the

accommodation

Hand hygiene should be performed immediately after removing PPE

Online resources and links

www.hpsc.ie is the central hub for nationally approved infection control guidance relating to COVID19. 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

The critical guidance for all staff delivering care in a residential service is:

Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units

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

Online resources and links

4. Online resources and links; Preparedness

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/videoresources/

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/

Online resources and links

https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/

Online resources and links

This link will take you to the HSE website which contains links to translated COVID-19 materials, audio and video resources, posters and booklets