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Aged Care and Disability Services
MAY 2021 AUTUMN
NEWSLETTER
Message from the Director
Megan Reilly
As I write this message, WA remains in a post-lockdown
transition period which we anticipate will conclude at
12.01am on Saturday 8 May. This together with the
recent 3-day lockdown has caused disruption for many,
however, we have all once again risen to the challenge.
Particularly challenging has been coordinating COVID-
19 and influenza vaccination clinics in a timely way.
Our team has been busy scheduling and administering some 250 influenza
vaccination clinics for our healthcare and corporate clients across
metropolitan Perth and regional areas. Thank you to everyone for your
assistance and support through this process. To assist us with delivering the
program to you, our Immunisation Nurses Catherine Zeevarder and Sandra
Peroni have re-joined the team in 2021. It is great to have everyone beavering
way delivering our advisory, education and immunisation services to our
clients throughout Australia, despite the Pandemic. How fortunate we are to
live in Australia.
World Hand Hygiene Day will be celebrated on Wednesday 5 May with the
theme Effective hand hygiene at the point of care, now more than ever! This is
an opportunity to review how you will ensure effective hand hygiene action
does occur at the point of care. We have provided several links to key
resources to assist in supporting your Hand Hygiene strategy, a critical
element of every infection prevention and control program.
This edition of the newsletter provides a focus article on Scabies. Over the last
6 – 12 months we have experienced an increase in activity in residential care
facilities in metropolitan Perth resulting in protracted outbreaks which have
proven very challenging to manage and contain. These infestations have
highlighted how important it is to investigate any individual with an itchy raised
rash and to be conscious that skin scrapings do not provide a definitive
diagnoses in every case. Early clinical recognition is imperative and if
necessary or cases are ongoing, consult with a Dermatologist.
Happy Hand Hygiene Day for the 5th May!
Kind regards
Megan
In this issue
Coronavirus (COVID- Final Report of the
19) Royal Commission
into Aged Care
Quality and Safety
In Focus: Scabies Influenza
Vaccinations
5 May 2021
World Hand Hygiene Day
The SAVE LIVES: Clean Your Hands global campaign, launched in 2009 and
celebrated annually on 5 May (World Hand Hygiene Day) aims to maintain
global promotion, visibility and sustainability of hand hygiene in health care
and to ‘bring people together’ in support of hand hygiene improvement
around the world.
For World Hand Hygiene Day 2021, WHO calls on health care workers and
facilities to achieve effective hand hygiene action at the point of care.
The point of care refers to the place where three elements come together: the
consumer, the health care worker, and care or treatment involving contact
with the consumer or their surroundings. To be effective and prevent
transmission of infectious microorganisms during health care delivery, hand
hygiene should be performed when it is needed (at 5 specific moments) and in
the most effective way (by using the right technique with readily available
products) at the point of care. This can be achieved by using the WHO
multimodal hand hygiene improvement strategy.
Hand Hygiene Resources:
World Hand Hygiene Day | Australian Commission on Safety and Quality
in Health Care
World Hand Hygiene Day 2021: Seconds save lives - clean your hands!
National Hand Hygiene Initiative | Australian Commission on Safety and
Quality in Health Care
COVID-19 Vaccination Updates
For people with clotting conditions:
The Australian Technical Advisory Group on Immunisation (ATAGI) has
released an update for healthcare providers on the suitability of the
AstraZeneca COVID-19 vaccine for people with a history of clotting conditions.
Global reviews have found no link between the AstraZeneca vaccine and
general clotting disorders. However the EMA and others are conducting
investigations in Europe regarding reports of a specific clotting condition
(cerebral venous sinus thrombosis, or CVST) following AstraZeneca vaccine.
For the time being, ATAGI recommends that vaccination with any COVID-19
vaccine should be deferred for people who have a history of the following rare
conditions:
people with a confirmed medical history of CVST, and/or
people with a confirmed medical history of heparin induced
thrombocytopenia (HIT).
This is until further information from ongoing investigations in Europe is
available and is only a precautionary measure. For more information read
ATAGI's full statement here.
For under 50s:
CMO Professor Paul Kelly has advised that the ATAGI recommend that the
COVID-19 Pfizer vaccine for adults under the age of 50 instead of the
AstraZeneca vaccine.
The recommendation was based on the increasing risk of severe outcomes
from COVID-19 in older adults and a potentially increased risk of “thrombosis
with thrombocytopenia” following AstraZeneca vaccination among those aged
under 50.
The AstraZeneca vaccine can be used in adults aged under 50 where the
benefits clearly outweigh the risk for that individual and the person has made
an informed decision based on an understanding of the risks and benefits.
People who have had the first dose of the AstraZeneca vaccine without any
serious adverse effects can be given the second dose, including adults under
50 years. Read the statement here, and the updated TGA advisory; 'Updated
safety advisory – rare and unusual blood clotting syndrome (thrombosis with
thrombocytopaenia)'.
For over 50s:
States and territories will begin vaccinating people in Phase 2a in May starting
with all adults 50 years and over:
From 3 May 2021, people 50 years and over can receive the AstraZeneca
vaccine at General Practice Respiratory Clinics and state and territory
vaccination clinics, and;
From 17 May 2021, people 50 years and over can receive the
AstraZeneca vaccine at a participating general practice.
COVID-19 vaccine update for in-
home, community and residential
aged care.
The government advises that it is a priority to deliver choice and flexibility in
accessing COVID-19 vaccinations for aged care staff and In-home and
community aged care consumers as safely and quickly as possible. The
Australian Government has revised the COVID-19 vaccine pathways for
workers in residential aged care, as agreed at the National Cabinet meeting on
22 April 2021. The revised rollout aims to make it as easy as possible for
workers and in-home and community aged care consumers to get vaccinated
quickly and safely.
In-home and community aged care recipients aged over 70 can access
an AstraZeneca COVID-19 vaccine:
GP clinics, GP respiratory clinics or Aboriginal Community Controlled
Health Services
State and territory AstraZeneca COVID-19 vaccine clinics.
In-home and community aged care recipients aged 50-69 can access an
AstraZeneca COVID-19 vaccine:
From 3 May 2021 at GP respiratory clinics and state and territory
vaccination clinics
From 17 May 2021 at GP clinics.
Aged care workers over 50 can access an AstraZeneca COVID-19 vaccine
at:
Currently available: GP clinics, GP respiratory clinics or Aboriginal
Community Controlled Health Services.
State and territory clinics coming on-line progressively: State and
territory AstraZeneca COVID-19 vaccine clinics.
Aged care workers under 50 can access a Pfizer COVID-19 vaccine at:
State and territory clinics coming on line progressively: State and
territory Pfizer COVID-19 vaccination clinics.
Clinics commencing from May: Commonwealth Pfizer COVID-19
vaccination clinics dedicated to residential aged care and disability
workers only. Information on these clinics will be sent directly to
facilities.
Information on state and territory vaccination clinics and participating GPs can
be accessed through the COVID-19 Vaccine Eligibility Checker (listings will be
updated as clinics become available).
A factsheet is available for all residential aged care workers here. A webinar
on COVID-19 vaccine roll out in aged care was also recorded and is available
here.
COVID-19 Links & Resources
COVID-19 vaccine aged care readiness toolkit
Special precautions for Covid-19 designated zones poster
Outbreak management planning in aged care
Aged care staff infection prevention and control precautions – Poster
Environmental Cleaning and Infection Prevention and Control
Infection prevention and control Covid-19 PPE poster
COVID-19 infection prevention and control risk management – Guidance
COVID-19 Infection Prevention and Control Manual
National COVID-19 Clinical Evidence Taskforce
Coronavirus (COVID-19) Easy Read resources
In Focus: Scabies
Scabies is caused by the microscopic mite Sarcoptes scabiei var. hominis. The
mite is transmitted via person-to-person contact. Children and older people
are at highest risk of scabies. Infection risk increases in settings with higher
levels of population density, including residential aged care facilities. After the
first infestation, there is a delay of up to six weeks before symptoms begin to
develop. Subsequent infections become apparent earlier after exposure. Due
to the long asymptomatic phase, scabies is often spread from person-to-
person before any diagnosis is made. As a result, a scabies outbreak indicates
transmission within the facility or home for at least several weeks.
The symptoms of scabies infection are caused by an allergic response to the
mite. Scabies is intensely itchy, typically affecting the body and limbs, but can
affect the soles, palms and scalps of children and older people. The itch is
reportedly worst at night. Most individuals present with ‘classical’ scabies
caused by a low burden of mites (5–15), with the rash typically located in the
ears, nose, hands, fingers and toes. Crusted scabies is characterised by
plaques and extensive scale and, in severe cases, deep fissures. In contrast to
classical scabies, crusted scabies may not be itchy. People with underlying
immunodeficiency from any cause, including corticosteroid treatment, are at
increased risk of crusted scabies.
Skin breaches from mite burrows and from scratching the itch often result in
co-existing bacterial skin infections such as Streptococcus pyogenes and/or
Staphylococcus aureus. Bacterial skin infection should be considered when
scabetic lesions have surrounding erythema, yellow crusting or pus. Diagnosis
of classical scabies is typically done on clinical history, while diagnosis of
crusted scabies requires confirmation by skin scrapings because of the
intensity of treatment, and because it is highly infectious and can perpetuate
infestation within a community.
The delay between infection and symptoms results in many asymptomatic
infected contacts of the source case at time of first diagnosis. Therefore, it is
important in all instances to treat all close contacts of cases. Once scabies
treatment has commenced, it is common for the itch to increase in the short
term. The itching associated can be managed with moisturisers, mild topical
corticosteroids or oral antihistamines. If treatment is successful, symptoms will
resolve within four weeks, although itchy persistent nodules may occur for
months after treatment in cases of hypersensitivity to the mite antigens.
There are a number of key elements to the infection control management of
scabies outbreaks. Early detection and implementation of infection control
measures are key in preventing further transmission. Early identification of
any case of crusted scabies is important. Once a case is diagnosed, or is
suspected, the person should be isolated in a single room until 24 hours after
the first treatment has been completed, if possible, and staff and visitors
should use contact precautions during this period. The index case should be
treated, along with staff or visitors who had direct contact with them. Most
guidelines recommend some form of environmental disinfection, including hot
laundering of bedding, clothing and towels used by people with infestations
any time during the three days before treatment, and routine cleaning and
vacuuming of furniture and carpets in resident rooms.
Key points
Scabies should be considered in any resident with an itchy raised rash,
especially if multiple staff, family members or residents are affected.
Diagnosis is often based on clinical recognition of a rash in a typical
distribution.
All contacts should be treated.
Environmental cleaning should be performed.
For more information:
Scabies Factsheet | WA Health
RACGP clinical update by Hardy et al. (2017)
Scabies Management in Care Facilities | SA Health
Scabies: Management in Residential Care Facilities| QLD Health
Review of the Royal Commission Report
Translating aged care reform
recommendations to action
A Perspectives Brief from the Deeble
Institute offers a review of the Final
Report of the Royal Commission into
Aged Care Quality and Safety. The
Brief reviews the 148
recommendations, particularly those
pertaining to the Australian
government and proposes a way
forward. The authors suggest that the
May 2021 Commonwealth budget is
an opportunity to start the shift from
a market-oriented approach to the
human rights approach advocated by
the Royal Commission. Read the
review here.
Influenza Vaccination
Flu vaccination in 2021
Vaccination against influenza (flu) remains important this year. Flu is a highly
contagious viral infection that can cause widespread illness and deaths every
year. Vaccination is our best defence against flu viruses.
Can I get a flu vaccine at the same time as a COVID-19
vaccine?
Vaccination experts recommend waiting 14 days between getting a flu vaccine
and a COVID-19 vaccine. Given this, it will be important to plan both
vaccinations. See the government advice on influenza vaccinations here.
It doesn’t matter in what order you get the vaccines. However:
if you are in earlier roll-out phases for COVID-19 vaccination, you should
get the COVID-19 vaccine as soon you can. You can then plan your flu
vaccination.
if you are in later roll-out phases for COVID-19 vaccination, you should
get the flu vaccine as soon as you can. This will ensure you are ready to
get your COVID‑19 vaccine when it is available to you.
When you book in for your flu vaccination, remember to tell your vaccination
provider or clinic if you have received the COVID-19 vaccine (and when you
received it). This will help them to plan your vaccination.
COVID-19 and Influenza Vaccination in Aged Care Facilities
The timing of residential aged care facilities’ COVID-19 vaccination clinics and
influenza clinics has required careful consideration to maintain the
recommended minimum 14 day interval.
Flu vaccinations for residents and staff should occur:
14 or more days before their first Pfizer dose;
14 or more days after their second (and final) Pfizer dose;
14 or more days before or after their first AstraZeneca dose, or;
14 or more days before or after their second (and final) AstraZeneca
dose.
Where services have already scheduled an in-reach influenza vaccination
program for residents and staff, this can be considered in the scheduling of a
COVID-19 vaccination clinic. This is to ensure the preferred minimum interval
between the two.
Residential aged care facilities that have scheduled their flu vaccinations, but
have not yet been scheduled for a COVID-19 vaccine in-reach clinic, should
immediately contact their Primary Health Network (PHN). Your PHN will liaise
with the vaccine workforce suppliers on your behalf.
Quick Links
Aged Care Quality ACNAPS COVID-19
& Safety Antimicrobial Information &
Commission prescribing & infections Resources
Newsletter Subscription in Australian residential Australian Commission
Sign-up Page aged care facilities on Safety & Quality in
Health Care
Hands-On Infection Control +61 8 9227 1132
info@handsoninfectioncontrol.com.au
Unit 1 / 120-122 Lake Street, Perth 6000
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