COVID-19 Guidance for Healthcare Staff in Disability
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COVID-19 Guidance for Healthcare Staff in Disability
Services ( 5th February 2021)
HSE Antimicrobial Resistance and Infection Control (AMRIC) Team
Prof. Martin Cormican, HSE Clinical Lead for HCAI &AMR
Mary McKenna, IPC Asst. Director of Nursing , AMRIC Team
What we will discuss today • Implications of new variant strain of COVID -19 • COVID-19 IPC measures revisited • The Safety Pause • Vaccination in Disability Services • Visiting Guidance • Scenarios • Live chat box discussion
It is acknowledged that the recent 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
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
A variant 501Y.V2 has been reported by South Africa on December 18th.
January 2021: another new variant strain was first detected in travellers
from Brazil (tested on arrival in Japan)
This VOC appear to spread more effectively than other variants of SARS-
CoV-2 because of increased transmissibility
There is not an 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 more than half 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)
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 facility do not
Note – it is of course not
have COVID-19 and are not COVID-19
possible to
contacts
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 residents and
recognize that they have COVID service users, 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 time
•
Safety Pause: helping teams provide safe quality care
How safe is the service today- lets stop and talk!
• Is everyone feeling OK today?
• Has everyone received COVID awareness and IPC training?
• Any new staff here today - what support do they need ?
• Have we any risks or concerns in our service today?
• What is working well for us ?
• What is not working so well us?
• Is there one thing we can improve for people in our service today ?
Reminder on preparedness advice for managers
• Ensure all staff are trained with standard and transmission based precautions
• Ensure all staff have undertaken awareness training around COVID-19
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
appropriate cleaning materialsAdditional 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 equipment•
Memo re COVID-19 new variant strain from HSE Chief Clinical Officer 26/1/2021
Available on the following link:
https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventionandcontrolguidance/#d.en.19743
Healthcare workers in community and hospital settings should have access to a
well-fitted respirator mask (FFP2) and eye protection when in contact with possible
or confirmed COVID-19 cases and COVID-19 contacts
In the context of a ward or facility based outbreak or a COVID-19 assessment hub
it is appropriate to consider all patients in the setting as suspected or confirmed COVID-19
casesCleaning equipment and the environment query received
Some unusual practices have been raised to AMRIC which are not recommended
Q. Hanging curtains outside a service on a clothes line to ‘decontaminate’ them?
A. No they need to be machine washed before being dried – clothes line or drier afterwards
Q. Cleaning a house with ‘ionised water’ misting/fogging and use of UV technology
A. Use of most newer technologies e.g. fogger machines, air purifiers, etc. marketed for disinfection of
surfaces or decontamination of air is not required
Remember to clean surfaces routinely with detergent and water. Wipes may be used on small surface
areas or equipment (check manufacturers recommendations)
Clean first and then disinfect environment surfaces and COVID or other transmissible infections are
suspected or confirmed•
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 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
•The current visiting recommendations remain as the vaccine programme is being
rolled outCOVID-19 Vaccine
•
Key points on the COVID-19 vaccine
1. Three vaccines now available (BioNTech/Pfizer and
Moderna and AztraZeneca)
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 ( vaccination programme)
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•
Sequencing of COVID-19 Vaccination of Frontline Healthcare Workers
The following are guiding principles for the sequencing of vaccination of healthcare workers
by the HSE(updated version 1.1 January 19 2021)
https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/covid-19-vaccine-materials/sequencing-of-covid-19-vaccination-of-
frontline-healthcare-workers.pdf
1. The sequencing process needs to be practical and transparent
2. Sequencing should be based on the best practical estimate of exposure risk
3. 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
4. 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
5. The vaccination programme has to be practical to administer No dose should be wastedQuery on fever post vaccination (be clear on difference fever and all symptoms) Q. “The Guidance from the HSE and NIAC is not to isolate unless symptoms last longer than 48 hours or begin 48 hours after vaccination. However, we are concerned with this guidance within our residential houses and would be inclined to increase our IPC measures should a person become symptomatic within that 48hrs time frame”?? A. National immunisation guidance refers to fever post immunisation “If your fever starts more than 2 days after you are vaccinated, or lasts longer than 2 days, you should self-isolate and phone your GP to arrange a COVID-19 test.” You are therefore applying contact and droplet precautions until clinical diagnosis of COVID is out ruled For further information on COVID Immunisations : https://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines
•
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•
Reference to support evidence of vaccination efficacy
Figure 1: From Polack FP et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine.
https://www.nejm.org/doi/full/10.1056/NEJMoa2034577Discussion on IPC queries received
You may listen to the audio recording
on www.hpsc.ie to hear these
discussed and other chat box queries
that were raised during the webinarQ Cathal lives in a residential house and has received the COVID vaccine together with all his house companions and the staff who work there He wishes to know if the restrictions in visiting still apply and can family and friends visit more frequently ? A Restrictions and IPC precautions continue to apply and will be reviewed in line with public health measures
Q. Martin had the COVID vaccine. Does he still need to be tested and restrict movements on return after he goes to visit family overnight? A. This recommendations on testing continues and will be reviewed in line with pubic health measures and including implementation of the vaccination programme
Q. Ann would like to know what additional IPC measures are advised to prevent transmission of the
new variants strains of COVID -19?
A. Continue IPC recommendations at all times and in addition follow the AMRIC guidance re use of
FFP2 masks included in the memo from CCO updated in the AMRIC guidance for PPE as which
includes the following advice:
Healthcare workers in community and hospital settings should have access to a
well-fitted respirator mask (FFP2) and eye protection when in contact with possible
or confirmed COVID-19 cases and COVID-19 contacts
In the context of a ward or facility based outbreak or a COVID-19 assessment hub
it is appropriate to consider all patients in the setting as suspected or confirmed COVID-19 casesQ. We are anxious to use high level disinfectant foggers and UV products as we notice some other services are using them – is this necessary? A.Use of most newer technologies e.g. fogger machines, air purifiers, etc. marketed for disinfection of surfaces or decontamination of air is not required Clean surfaces routinely with detergent and water, wipes may be used on small surface areas or equipment (check manufacturers recommendations)
Q. The transmission between staff in some of our services is alarming. What can we do better? A. This is a challenge and evidence suggests congregation e.g. staff breaks in communal areas may be a factor in transmission amongst staff. Important not to drop your guard with IPC and public health measures both outside and inside of the immediate working environment
Q. Lorraine didn’t receive the vaccine when scheduled due to an outbreak Has Lorraine missed out on the vaccine or will she have access to the vaccine when the outbreak ends? A. Lorraine will be eligible to have the vaccine and this will be arranged through the local vaccine implementation plan
Are consultants that are moving between acute hospitals where they have been working in COVID wards and community disability services required to wear full gowns to protect vulnerable adults with disabilities? Long sleeved gowns are indicated in the AMRIC guidance for PPE use in line with standard, contact and droplet precautions. It is advised that each situation for delivering care is risk assessed for use of appropriate PPE The recommendations do not recommend that staff travelling across different healthcare settings are required to wear long sleeved gowns routinely.
Some 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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