residential aged care covid-19 pandemic plan · 2020-03-25 · covid-19 is a contagious viral...

Residential Aged Care COVID-19 Pandemic Plan

24 March 2020

Version 2

2

Infection Prevention Service 24/3/2020

Residential Aged Care COVID-19 Plan

Contents

Page

Background 4

Objectives 4

Recognition of illness

Contact tracing

4

5

Placement of cases 5

Management of a resident/s with suspected/ confirmed COVID-19 8

Staff 8

Communication 9

Management of Equipment 9

Signage 9

Cleaning 9

Waste Management 10

Handling of Linen 10

Supply 10

Communal Activities 10

Admission and transfer 11

3


Medical Management

Care of deceased

11

12

Monitor outbreak progress

Ending outbreak

Reporting to Dept. of Health and Human Services

12

12

12

References

Letter to GPs – COVID-19 Outbreak – Appendix 1

Initial Report to Department of Health and Human Services Template – Appendix 2

13

14

16

Residential Aged Care Facility COVID-19 Communication Response Record – Appendix 3

Resident Management Process for Suspected COVID-19 – Appendix 4

18

19

4


Background:

The Novel Coronavirus outbreak represents a significant risk to Australia. It has the potential to cause

high levels of morbidity and mortality in residential aged care. This Residential Aged Care (RAC) COVID-

19 Plan is to be used in conjunction with the Barwon Health (BH) COVID-19 Pandemic Plan (BH COVID-

19 PP).

COVID-19 is a contagious viral infection that generally causes respiratory illness in humans.

Presentation can range from no symptoms (asymptomatic) to severe illness with potentially life-

threatening complications, including pneumonia. COVID-19 is spread by contact with respiratory

secretions and fomites.

Objectives:

1. Reduce the morbidity and mortality associated with COVID-19 infection through an

organised response that focuses on containment of infection.

2. Rapidly identify, isolate and treat cases, to reduce transmission to contacts, including

residents, staff and visitors.

3. Characterise the clinical and epidemiological features of cases in order to adjust required

control measures in a proportionate manner.

4. Minimise risk of transmission in RAC facilities, including minimising transmission to

residential aged care workers.

Recognition of illness

Daily monitoring of all residents temperature, heart rate and respiratory rate. Any observations

deviating from baseline for that resident are to be reported to nurse in charge, and to be

actioned if clinically appropriate.

Clinical signs and symptoms

o The most common signs and symptoms include:

fever (though this may be absent in the elderly)

dry cough

o Other symptoms can include:

shortness of breath

sputum production

fatigue

https://onepoint.barwonhealth.org.au/clinical/infectionprevention/Documents/COVID-19%20Pandemic%20Plan.pdf

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o Less common symptoms include:

sore throat

headache

myalgia/arthralgia

chills

nausea or vomiting

nasal congestion

diarrhoea

haemoptysis

conjunctival congestion

o Older people may also have the following symptoms:

increased confusion

worsening chronic conditions of the lungs

loss of appetite

Elderly patients often have non-classic respiratory symptoms; RCF should consider testing any

resident with any new respiratory symptom.

Testing

o 1 x respiratory swab – PCR COVID-19, PCR multiplex respiratory (Transmission Based

Precautions (TBP) per BH COVID-19 PP)

Influenza vaccination up to date and entered into platinum 5 (P5), RAC electronic record.

Documentation of cases (confirmed or suspected cases)

o Case list for residents and staff will be updated daily by nurse in charge/infection

prevention nurse consultant (IP CNC)

o P5 infection report documented by care staff

Transmission based precautions (TBP) – droplet and enhanced contact (BH COVID-19 PP).

All personal protective equipment (PPE) should be single-use and disposed of into clinical waste

when removed.

For hand hygiene, use an alcohol-based hand rub if hands are visibly clean, soap and water when

hands are visibly soiled.

Maintain a record of all persons entering the patient’s room including all staff and visitors on the

‘Contact Register - High Consequence Infectious Disease’ form (BH COVID-19 PP).

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Ensure treatment management choices of residents are documented and current.

Cases confirmed for COVID-19 must be tested and notified to the Department of Health and Human

Services (DoHHS) by calling 1300 651 160, 24 hours a day. A confirmed case is a person who tests

positive to a validated SARS-CoV-2 nucleic acid test or has the virus identified by electron microscopy

or viral culture.

Contact tracing:

This includes staff, other residents, or visitors who were in the same closed healthcare space

as a case.

Contact needs to have occurred within 24 hours of the onset of symptoms in the confirmed

case until the confirmed case is no longer considered infectious, in order to be considered a

contact.

Contact tracing will be coordinated by Infection Prevention Service.

Placement of cases

A. Confirmed case

A person tested for COVID-19 and found to have COVID-19 infection.

• Cases will be cared for in droplet and enhanced contact TBP in single room with own

bathroom (if possible)

• Residents sharing a confirmed case’s room shall be moved to a single room (if available)

and managed as a suspected case

• It may be necessary to cohort residents, this will be in consultation with IPS.

B. Suspected case

People without symptoms should not be tested.

Residents who meet at least one clinical AND at least one epidemiological criteria should

be tested.

Clinical criteria:

Fever ( 38)

OR

Acute respiratory infection (for example, shortness of breath or cough) with or without fever

AND

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Epidemiological criteria:

Close or casual contact with a confirmed case of COVID-19 in the 14 days before onset of

illness

OR

Healthcare workers and residential aged care workers meeting clinical criteria

OR

Aged and residential care residents meeting clinical criteria

• Cases will be cared for in droplet and enhanced contact TBP in single room with own

bathroom (if possible)

• Residents sharing a confirmed case’s room shall be moved to a single room (if available)

and managed as a suspected case

• It may be necessary to cohort residents, this will be in consultation with IPS.

• Suspected cases will be kept separate from confirmed cases (no sharing rooms)

C. Casual contact

• This includes staff, other residents, or visitors who were in the same closed healthcare

space as a case, but for shorter periods than those required for a close contact.

• Contact needs to have occurred during the period from the onset of symptoms in the

confirmed case until the confirmed case is no longer considered infectious, in order to

be considered a casual contact.

Casual contacts do not need to restrict their movement. However, they require close monitoring.

On the first confirmation or suspicion of a COVID-19 case in a facility all residents will have

haemodynamic monitoring including heart rate, respiratory rate and temperature attended twice

daily.

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Management of residents with suspected/confirmed COVID-19

Four times daily monitoring of temperature, heart rate and respiratory rate, until reviewed by

nurse manager or GP.

Transfer of resident must be discussed with treating GP or receiving medical staff first.

No visitors, unless discussed with IPS.

Encourage families to provide communication tools such as mobile phones with data packs to

facilitate communication.

No nebulisers to be used, as it aerosolises the virus. Spacers are the alternative.

Release from isolation of a confirmed case

Deciding when a confirmed case no longer requires to be isolated, will be in consultation with the

treating clinician and Infectious Disease Registrar. This will be actively considered when all of the

following criteria are met:

The patient has been afebrile for the previous 72 hours, and

Al least ten days have elapsed after the onset of the acute illness, and

There has been a noted improvement in symptoms, and

The treating GP and infectious disease team have reviewed the case.

Staff

Highlight importance of hand hygiene.

PPE education of all staff caring for patients with COVID-19, requires training in the correct use

of PPE by either or both:

GROW module for Personal Protective Equipment for Infection Prevention and Control

In-service training provided by an Infection Prevention Service Clinical Nurse Consultant.

Education in assessment of respiratory illness.

Prevention, recognition and management of influenza like illness and respiratory outbreaks.

Staff are advised to self-monitor and if they develop symptoms consistent with COVID-19

infection they should isolate themselves and notify the DoHHS on 1300 651 160 so they can be

tested and managed as a suspected COVID-19 case.

Staff may work across Barwon Health sites.

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Communication

Staff can access novel coronavirus information on the Barwon Health Onepoint intranet site.

RAC facility managers are to communicate Novel Coronavirus – memos to staff.

Staff access to Novel Coronavirus information is documented on the RAC facility COVID-19

communication response record –Appendix Three

Letter to be sent to GPs if a COVID-19 outbreak is suspected in a RAC facility (Appendix One)

Residents, their family members and visitors have Australian Department of Health COVID-19

Information sheet available at entrance to facility.

A letters have been sent to residents and their families.

No visitors at this time. To protect the health and safety of residents, visitors are currently not

permitted.

Management of Equipment

Preferably, all equipment should be either single-use or single-patient-use and disposable.

Reusable equipment should be dedicated for the use of the affected resident until the end of

their illness.

Any shared equipment must be cleaned and disinfected between patients. This is a 2-step clean

(aseptic wipe, then alcohol wipe) or 2-in-1 step clean (V-wipes) as appropriate for equipment

being cleaned.

Signage

No visitors at this time. To protect the health and safety of residents, visitors are currently not

permitted.

Fact sheets for resident/visitors/families on COVID-19

Cleaning

Daily 3 stage clean of all frequent touch points of all suspected or confirmed COVID-19 patient

room. Staff conducting the clean should adopt droplet and enhanced precautions, within the

resident’s room.

The exit clean will be conducted in two stages. First a neutral detergent clean stage of all

horizontal and frequent touch points. The second stage to use hydrogen peroxide vapour for

disinfection.

Segregate cleaning equipment used in affected area from unaffected area.

Twice daily cleaning of communal areas.

https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-for-residents-of-residential-care-services-family-members-and-visitors-coronavirus-covid-19-information-for-residents-of-residential-care-services-and-family-members.pdf

https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-for-residents-of-residential-care-services-family-members-and-visitors-coronavirus-covid-19-information-for-residents-of-residential-care-services-and-family-members.pdf

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Waste Management

Dispose of all waste as clinical waste. Clinical waste may be disposed of in the usual manner.

Handling of Linen

Bag linen inside the resident room. Ensure wet linen is double bagged and will not leak.

Linen to be reprocessed by the standard process.

Food services

Crockery and cutlery to be reprocessed per standard precautions.

Disposable crockery and cutlery may be used.

Supply

PPE available in RAC as per imprest stock.

Hand hygiene products as per imprest stock.

Diagnostic materials (dry sterile flocked/viral culture swabs) maintain 10 swabs per facility.

Cleaning supplies as per imprest stock.

Pack of PPE available in Aged Care Co-Director’s executive assistant’s office. This may be

accessed by after hour’s coordinator and Infection Prevention Service.

Emergency supply of PPE may be accessed per BH COVID-19 Pandemic Plan.

Communal Activities

Suspend if suspicion of a COVID-19 case.

Practice social distancing by keeping a distance of 1.5 metres between residents.

Visitors

Visiting may be approved by the facility manager.

If a visitor attends a confirmed case in the RAC facility, the visitor must wear PPE for droplet and

enhanced contract TBP. They require supervision to don and doff PPE by a person experienced in

infection prevention and control requirements.

Resident visitors will be contacted in the event of an outbreak of COVID-19

o This requires a current contact list for regular visitors.

Postpone visits from non-essential services e.g. allied health.

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Suspend volunteer support.

In the case of a visitor:

o PPE to be worn

o Enter and leave the facility directly without spending time in communal areas

o Perform hand hygiene before entering and on exit of resident’s room and the facility.

Admission and transfers

In an outbreak of COVID-19 suspend admissions, if possible.

Re-admission of cases

o Provide appropriate accommodation and infection and control measures.

Transfers

o Notify Ambulance Victoria (or health transport contracted) and receiving hospital of the

risk of COVID-19 verbally and on the resident transfer advice form.

o If transfer outside of the room is essential, the patient should wear a surgical mask

during transfer and follow respiratory hygiene and cough etiquette. All staff attending

the patient should wear the following PPE:

Surgical mask or P2/N95

Face shield or goggles

Long-sleeved gown

Disposable non-sterile gloves

Non-infected residents

o They may be transferred to family care for the duration of the outbreak.

o The family or carer must be made aware that the resident may have been exposed and

is at risk of developing COVID-19.

Medical Management

The resident’s usual general practitioner will be primarily responsible for medical treatment of

the resident.

Infectious Disease registrar will be involved in medical management of residents.

Exclude other respiratory diagnoses.

Treat clinical illness per resident’s treatment plan.

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Care of the deceased if COVID-19 is suspected or confirmed

The same level of infection prevention and control precautions should be used for the management

of a deceased person as were used before their death. As such, droplet and contact precautions

should be used when handling deceased persons for whom COVID-19 infection is suspected or

confirmed.

Monitor outbreak progress

Twice daily haemodynamic observations of unaffected residents are to include temperature,

heart rate and respiratory rate.

Immediate droplet and enhanced transmission based precautions (TBP) and infection prevention

and control measures if a resident is identified with respiratory illness.

If COVID-19 PCR is negative, continue droplet TBP until influenza is excluded and resident is

asymptomatic.

Update case lists twice daily.

End Outbreak

• No new cases for 14 days from onset of symptoms in last case.

• Send final detailed list to the DoHHS.

• Review and evaluate outbreak management.

Reporting to Department of Health and Human Services

A potential COVID-19 outbreak is defined as:

Two or more cases of ARI in residents or staff of a RCF within 3 days (72 hrs).

A confirmed COVID-19 outbreak is defined as:

Two or more cases of ARI in residents or staff of a RCF within 3 days (72 hrs)

AND

At least one case of COVID-19 confirmed by laboratory testing.

While the definitions provided above guidance, the DoHHS will assist facility in deciding whether to

declare an outbreak.

This will be facilitated by Infection Prevention Service

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Phone 1800 675 398

Details to provide DoHHS are on Initial report to DoHHS - COVID-19 Outbreak (Appendix Two)

References

Australian Government Department of Health, Coronavirus (COVID-19) health alert accessed 18

March 2020 - https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-

alert

Coronavirus disease 2019 (COVID-19), Guideline for health services and general practitioners, 3

March 2020, Version 11, Victorian Department of Health and Human Services accessed 4 March

2020 - https://www.dhhs.vic.gov.au/health-services-and-general-practitioners-coronavirus-disease-

covid-19

Coronavirus Disease 2019 (COVID-19) Outbreaks in Residential Care Facilities, Communicable

Diseases Network Australia National Guidelines for the Prevention, Control and Public Health

Management of COVID-19 Outbreaks in Residential Care Facilities in Australia V1. 13/3/2020 Initial

Release Endorsed by CDNA

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert


https://www.dhhs.vic.gov.au/health-services-and-general-practitioners-coronavirus-disease-covid-19

https://www.dhhs.vic.gov.au/health-services-and-general-practitioners-coronavirus-disease-covid-19

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Appendix One

Letter to GPs – COVID-19 Outbreak

……/……/……

Respiratory outbreak at [Facility Name]

Dear Doctor,

There is an outbreak of acute respiratory illness affecting residents at the facility named above.

The outbreak may involve some of your patients who may require review.

It is important to establish if the outbreak is caused by SARS-CoV-2. Coronavirus Disease 2019

(COVID-19), caused by SARS-CoV-2, is a notifiable condition.

We recommend that you:

Establish if any of your patients are affected Help determine if the outbreak is caused by SARS-CoV-2:

- Cases meeting thee suspected case definition for COVID-19 must be tested - Any aged care resident who has a fever (≥38C) OR an acute respiratory

infection (e.g. shortness of breath, cough, sore throat) are classified as a suspected case

- Testing of residents in aged care is processed at University Hospital Geelong, by the Australian Rickettsial Reference Laboratory:

A single flocked viral swab should be used to sample the nasopharynx via both nostrils and the throat. The same swab should be used for all three sites.

A second swab for viruses other than COVID-19 coronavirus will require a second swab referred to Australian Clinical Labs with a separate pathology referral form.

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Specimens for COVID-19 testing are to be submitted to Australian Rickettsial Reference Laboratory (ARRL). Infection Prevention will assist with this in RAC (ext.55947).

Specimens are to be accompanied by an ARRL pathology form and request "COVID-19 PCR."

If an ARRL referral form cannot be found, an ACL form will be accepted. In such a case, please indicate in writing that the test is being referred to ARRL and ensure that it is delivered to ARRL, not ACL.

Ensure that your patients are vaccinated against influenza, if there are no contraindications Ensure that you observe hand hygiene procedures and use appropriate PPE when visiting

your patients.

Limit the use of antibiotics to patients with evidence of bacterial superinfection, which is

uncommon. There is significant evidence that antibiotics are over-prescribed during

institutional respiratory illness outbreaks.

Control measures that the facility has been directed to implement include:

Isolation of symptomatic residents Use of appropriate PPE when providing care to ill residents Exclusion of symptomatic staff from the facility Restriction/limitation of visitors to the facility until the outbreak has resolved Promotion of hand hygiene, and cough and sneeze etiquette.

Should you require further information regarding COVID-19, please refer to the Commonwealth Department of Health website: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

If you require any further information or advice please contact [insert details].

.

Yours sincerely,

[Name] [Position] [Facility/Organisation]


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Appendix Two

Initial report to DoHHS – COVID-19 Outbreak

Date/time: ___________________ Public Health Officer: _____________________

Contact details:

Person notifying outbreak: _______________ Position: ______________________

Telephone number: ____________________ Email: _________________________

Facility details:

Name of Facility_______________________________________________________

Address: _____________________________________________________________

Facility Manager / Director: ______________________________________________

Telephone number: _____________________ Fax number: ____________________

Email address: _________________________

Description of facility: __________________________________________________

Total number of residents: _______________ Total number of staff: ____________

Age range of residents: ___________________

Number of units / wings / areas in facility: __________________________________

Floorplan provided: Yes / No

Residents:

Unit name Resident

no.

Long term Short term

/ Respite

High Care Dementia /

Secure

Other

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RCF Staff:

Staff type No. of RCF staff No. agency staff No. Causal staff No. volunteers

Management

Administrator

Cleaner

Nurse

Carer / Care

Assistant

Agency

Other (specify)

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Appendix Three

Residential Aged Care Facility COVID-19 Communication Response Record

Facility name:

Source Document Distribution date Distributed to Distribution

mechanism

Signature

One point

Coronavirus

information for staff

One point

Today’s health news

Press clippings

One point Infection Prevention

Service page

Communique from the

CEO. Please print and

display to support staff

who are not frequently

accessing email.

Department of health Fact sheets

Department of health Website

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Identify suspected COVID-19 resident

• Residents who meet at least one clinical AND at least one epidemiological criteria should be tested.

• Clinical criteria:

• Fever - T≥38• OR• Acute respiratory infection (for example, shortness of breath,

cough, sore throat)

• Epidemiological criteria:

• Close contacts of confirmed COVID-19 cases with onset of symptoms within 14 days of last contact

• OR• Residential aged care workers meeting clinical criteria• OR• Aged and residential care residents meeting clinical criteria

• Confirmed case:A person who tests positive for COVID-19

Managing a suspected or confirmed COVID-19 case

• Immediately commence droplet and enhanced contact precautions

• Contact GP• Inform Infection Prevention Service ext. 55947 or

[email protected].• Testing:• 2 single flocked viral swabs*• Swab both nostrils and throat for COVID-19 PCR• 1st swab to ARRL* for COVID-19 PCR and 2nd swab to ACL* for

respiratory multiplex PCR• Send straight to respective laboratories, do not refrigerate• Cleaning - Triple clean daily

• *

• *ARRL - Australian Rickettsial Reference Laboratory at UHG• *Australian Clinical Laboratory

• Residential aged care workers - notify manager and contact Staffcare on ph. 0408 127 147

Stopping transmission based precautions for COVID-19

• A negative result for COVID-19 communicated to nurse unit manager -phone call from infectious disease registrar or Infection Prevention Nurse or BOSS

• Resident require droplet precautions to continue if an influenza like illness, await results from respiratory PCR

• Residents positive for COVID-19 may stop precautions when decided by treating GP and Infectious Disease Registrar

Appendix Four Resident Management Process for Suspected COVID-19