COVID-19 Guidance for Healthcare Staff in Residential Care
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COVID-19 Guidance for Healthcare Staff in Residential Care
Facilities 26th February 2021
HSE Antimicrobial Resistance and Infection Control (AMRIC) Team
Prof. Martin Cormican ( Clinical Lead)
Mary McKenna IPC Nursing
Dr. Anne Sheahan, Consultant in Public Health Medicine
What we will discuss today • Overview of COVID-19 position • Review of IPC and PPE requirements • Visiting Guidance • Outbreak management issues • Vaccinations update • Scenarios • Live chat box discussion
What we will discuss today Challenges that continue are respectfully acknowledged Thank you for your feedback and comments “This often feels like an uphill battle” “Every measure is still needed to keep the virus from getting in and spreading infection to our residents however sometimes we see staff becoming more complacent now after everyone in the service is vaccinated” “Current challenges feel tough as ever with recent big surge and new variants” “Visiting restrictions and level 5 framework feels like a long time” “Prioritising and meeting additional measures 24/7 is a challenge” “Outbreak prevention and management are still an issue with sometimes staff shortages and we thought this would have all come to an end with vaccination”
There is some encouraging signs following the recent surge 14 day incidence rate in Europe is on the decline Ireland has seen a large decrease in incidence rates in recent weeks
•
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
•
Safety Pause: helping teams provide safe quality care
How safe is the service today- keep connected!
• Is everyone feeling OK today?
• Has everyone received COVID awareness and IPC training?
• Any new staff -what support do they need in the service?
• Have we any risks or concerns in our service today and do our staff know
who to speak to?
• 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 ?
•
Transmission of COVID-19
Route of transmission of the new variants considered as predominantly droplet and contact
transmitted from someone who is infected
Risk of airborne spread has always been recognised as a concern particularly in the context
of aerosol generating procedures ( AGPs) in healthcare settings
Some experts are concerned about a greater risk of airborne spread in other settings with
some new variants
Existing Public Health and IPC measures based on interrupting contact and droplet routes of
transmission remain highly effective in protecting against the new variants of the virus
- if strictly adhered to (very hard to do all the time but critically important)
•
New variants and travel
Risk of introduction of more new variants from other
countries is now driving more restrictions on international
travel right across the world
Have a think about the following scenarios based on queries submitted and reflect on your practice- we will revisit them later in the webinar
Examples of some scenarios based on your queries - what do we need to consider?
All staff and residents have been vaccinated in the Mary is feeling relieved to be vaccinated, can she now
service, when will we see revised guidance with resume her weekly day trips to out family.
lifting of restrictions?
She would like to know when visiting restrictions will be
Are pods still required for residents? lifted ?
Anne is a staff member who has received her 2
Ellen ( nurse manager) wishes to know if
COVID vaccines, she is now a household
outbreaks could occur even if all staff and
contact , does she need to restrict her
residents are vaccinated?
movement and get tested?
Will reduced measures in the RCF be affected if some
How long will serial testing for staff continue staff don’t avail of the vaccine and how do we
to be carried out in residential care facilities?
overcome this?
Has there been many serious side effects Is there a template to be completed and returned
attributed to the vaccine in Ireland? for staff not availing of the vaccine?
Have a think about what IPC and public health measures are needed and we will revisit these queriesPreparedness 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 materialsStandard Precautions always : used when delivering care routinely
Cleaning your hands: using an alcohol hand rub or by hand washing using “5 moments in hand hygiene ”
Wearing PPE to protect yourself when there is a possibility of coming in contact with blood and body fluids.
Gloves and apron are a common example
Empty a catheter/ commode or assisting with incontinence
Performing a wound dressing
Wear eye protection and face mask/visor when there is a risk of splashing to the eyes, nose and mouth
Clean environment frequently and equipment after use with detergent and water / detergent wipes or
follow manufacturers instructions, use disinfectant to clean blood /body fluids
Surgical face mask : now Public health measures that apply Segregate and dispose of household and healthcare risk
during pandemic with social distancing of 2m where waste
possible Single use mops or launder by workplace arrangements
( not at home)Additional measures to prevent transmission of possible/confirmed COVID-19
standard, contact and droplet precautions
• Appropriate placement ( single room /cohort) of residents in line with
period of isolation
• Additional wearing of PPE for type of care based on:
- type of activity
- level of contact with the person you are assisting
• Additional cleaning and disinfection of surfaces and equipment
• Healthcare risk waste in COVID-19 areasWhat is the most appropriate PPE to wear and when?
Recent guidance updated for PPE 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 cases
Type of PPE to
wear is based
on risk OR
assessment
FFP2 facemaskDifferent types of Masks Surgical face masks to protect the mouth and nose from blood/body fluid splashes including respiratory secretions (and also to reduce potential shedding from you) • Must be donned properly to cover nose and mouth • Shouldn’t dangle around the neck or be pulled up and down or touched once in place • Should be discarded once removed e.g. for a drink or to answer telephone
Respirator Masks ( FFP2) Respirator mask ( e.g. FFP2) recommended as a suitable option to a surgical mask when caring for a patient with possible/confirmed COVID-19 Essential for associated aerosol generating procedures in suspected/confirmed COVID-19 Fit testing for respirator masks wearers is required to ensure mask fits properly to the wearers face shape Carried out by someone with specific training in performing fit testing using qualitative and quantitative tests Reminder: FFP2 masks do not work for bearded/unshaven people as a proper mask seal cannot be achieved on the wearers face and an alternative respirator (e.g. PARPS hood) is needed
Fit check every time you wear a mask
Fit check is undertaken by the wearer and is essential each time a respirator mask is worn
to ensure there are no gaps between mask and face for unfiltered air to enter
Video and
resources on
undertaking a fit
check available on
www.hpsc.ieOutbreak Management- key points Dr. Anne Sheahan, Consultant in Public Health Medicine
Opportunities for transmission in residential care
Transfer from Staff to staff
Risk from staff Exposure
hospital, respite exposure
& new during
admissions working
practices
Staff
Residents
Contact outside
work from
Visiting exposure risk family & friends
Assumption that vaccination provides immediate immunity may lead to outbreaksPrevention is key: Public Health reminders
good hand hygiene at all times
social distancing – at all times and especially in corridors, at break times
and in
changing areas
travelling to and from work alone
limiting contacts
staying at home and contacting the GP : if you develop respiratory/COVID-
like symptoms
monitoring residents for symptoms and managing them as per the national
guidance
appropriate use of PPE when giving care to residents
limiting crossover of staff throughout the residential care facility
Please continue to reinforce this message with your staff in order to ensure
the continued safety and welfare of all Residents and StaffVisiting
UNDER REVIEW•
Visiting Guidance Currently aligned with Framework level 5
•Visiting guidance is under review and remains suspended other than on critical and compassionate grounds
•Garden walks may be undertaken with staff using the measures in line with guidance
•Day trips out- advised on compassionate grounds but not generally recommended at present
•There is a need for clear communication and preplanning on individual visiting issues with residents and
families
• Risk assessment needs to be undertaken before each visit and IPC /PH measures continued including
•assessment of wellness before visiting and on arrival
•Hand hygiene appropriate PPE
•Physical distancing as appropriate depending on circumstances of visit
•In all circumstances the wishes of those residents who may feel safer not seeing visitors at any time should be
respectedCOVID-19 Vaccine Three vaccines now available: (BioNTech/Pfizer Moderna AztraZeneca)
There is some encouragement
There is some encouragement
There is some encouragement
•
•
•
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 vaccinatedYou may listen to the webinar recording on the link below to hear the
webinar and discussion on IPC queries received on as outlined in the
next slide
https://www.hpsc.ie/a-
z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreve
ntionandcontrolguidance/webinarresourcesforipcExamples of some scenarios based on your queries - what do we need to consider?
All staff and residents have been vaccinated in the Mary is feeling relieved to be vaccinated, can she now
service, when will we see revised guidance with resume her weekly day trips to out family.
lifting of restrictions?
She would like to know when visiting restrictions will be
Are pods still required for residents? lifted ?
Anne is a staff member who has received her 2
Ellen ( nurse manager) wishes to know if
COVID vaccines, she is now a household
outbreaks could occur even if all staff and
contact , does she need to restrict her
residents are vaccinated?
movement and get tested?
Will reduced measures in the RCF be affected if some
How long will serial testing for staff continue staff don’t avail of the vaccine and how do we
to be carried out in residential care facilities?
overcome this?
Has there been many serious side effects Is there a template to be completed and returned
attributed to the vaccine in Ireland? for staff not availing of the vaccine?
Have a think about what IPC and public health measures are needed and we will revisit these queries•
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•
Webinar Recording and Slide set
Webinar slide set and audio recording will be available and may be
accessed on the following link next week.
Thank you for engaging
Next week webinar ( 5th March) for acute and Community Mental
Health Services from 12-1pmSome more online resources and links - preparedness
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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