COVID-19 seminar for staff working in Nursing, Residential ... · 5/14/2020 · COVID-19 Timeline of key events 31st December 2019: China reported to WHO a cluster of cases of pneumonia

COVID-19 seminar for staff working in

Nursing, Residential, Supported Living

and Domiciliary Care settings

Dr Musarrat Afza

Consultant in Communicable Disease Control

PHE West Midlands 14 May 2020

Outline of the presentation

• Coronavirus and the disease caused by COVID-19 infection

• How the disease presents and spreads

• How to stop spread of disease by infection control precautions

and use personal protective equipment

• How to prepare and deal with a single case of COVID-19

• How to manage an outbreak of COVID-19 in a Care Home

• Facilitate safe transfers in/out of care homes during COVID-19

• When to access local support arrangements available to your

Care setting.

2 PHE West Midlands – coronavirus and care homes

Using the information in this presentation responsibly

Using the slides

• The information included is correct at the time of recording but as COVID-19

is a rapidly evolving situation you are strongly advised to access current up

to date guidance online as your primary source of reference.

• Underlined text on the slides are hyperlinks – click to go straight to the link

• Slides can be shared within your workplaces

Guidance

• Gov.uk Coronavirus (COVID-19)- Guidance and support

https://www.gov.uk/coronavirus

• Gov.uk Public Health England- guidance about coronavirus (COVID-19) for

health professionals and other organisations.

https://www.gov.uk/government/organisations/public-health-england


https://www.gov.uk/coronavirus

https://www.gov.uk/government/organisations/public-health-england

What is coronavirus?

Diseases known to be caused by Coronaviruses

Mild disease

• the common cold

Severe diseases

• Severe Acute Respiratory Syndrome (SARS)- SARS- Cov1 (2002-2004)

• Middle East respiratory syndrome (MERS) – 2012

New disease- responsible for current Pandemic

• COVID-19- is caused by SARS-CoV-2 virus. This is a new virus to which

there is no known population immunity meaning that everyone is potentially

susceptible.


Electron micrograph (TEM) of a SARS-

CoV-2 coronavirus particle.


Emergence of Coronaviruses


All coronaviruses emerge from animal reservoirs

generally bats and/or civet cats, or bats to civet

cats, or bats to camels

Recombination thought to allow for this switching

from host to host……

COVID-19 – course of illness in majority

7 PHE West Midlandsdon – coronavirus and care homes

Incubation period & infectious period of COVID-19


Incubation period : The time interval between initial contact with an infectious

agent and the appearance of the first sign or symptom of the disease:

Range 1-14 days

Average- 4-6 days

Infectious period is defined as : This is the time during which an infectious

agent may be transferred directly or indirectly from an infected person to

another person.

The infectious period may begin 1-2 days before symptoms appear, but people

are likely most infectious during the symptomatic period, even if symptoms

are mild and very non-specific. The infectious period is now estimated to last

for 7-12 days in moderate cases and up to two weeks on average in severe

cases.


• Fever >37.8

• Cough – new persistent

In Care Homes

• New onset/ worsening

confusion in elderly or

dementia residents

• Worsening shortness of

breath

COVID-19 Timeline of key events31st December 2019: China reported to WHO a cluster of cases of pneumonia of

unknown cause in Wuhan City.

12th January 2020: a novel coronavirus identified (COVID-19)

25th January 2020: First person-to-person transmission identified outside China

(Vietnam) and First confirmed case in Europe(France)

31st January 2020: first two confirmed cases in the UK reported

1st March 2020: Family cluster of 4 cases (3 family members of non-travel UK case). 35

UK cases in total.

11th March 2020: WHO declared worldwide pandemic

23rd March 2020: UK government implemented lockdown measures

12th May 2020: Globally the number of cases 4,088848 cases and 283,153 deaths

12th May 2020: 229,705 UK cases in total


How the disease spreads ?


Coronavirus – risk of transmission in health and

social care settings

Patient/resident care

• Exposure to respiratory droplets e.g. when undertaking tasks close to a

coughing resident

• Aerosol generating procedures (e.g. tracheostomy care, suctioning, chest

physiotherapy, BiPAP, CPAP) increase the risk of aerosol spread

Environment

• The virus can survive on environmental surfaces – the amount of surviving

virus reduces dramatically after 72 hours, but may last up to 9 days on hard

surfaces

• The virus is easily inactivated on surfaces using bleach containing solutions

(where appropriate) and standard detergents

• The virus is easily inactivated on hands by washing with soap, water and

drying, or by using alcohol-based hand gels


General COVID-19 prevention measures

1. Self-isolating – stay at home if you or a household member has COVID-19

symptoms, or if a care home resident develops symptoms

2. Social distancing – to reduce to the spread of COVID-19; both for staff in

our day-to-day lives, and for everyone (staff and residents) in the care home

3. Shielding – to protect extremely vulnerable people (see the list of people

falling into this extremely vulnerable group)

https://www.gov.uk/government/publications/guidance-on-shielding-and-

protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-

and-protecting-extremely-vulnerable-persons-from-covid-19

These measures should be implemented alongside:

• Cough hygiene (‘catch it, bin it, kill it’)

• Frequent handwashing


https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Moderate risk of developing complications from

coronavirus (COVID-19) infection

Residents who meet the criteria that make them eligible for the annual flu vaccination:

• aged 70 or older (regardless of medical conditions)

under 70 with an underlying health condition

• chronic (long-term) respiratory diseases, such as asthma, chronic obstructive

pulmonary disease (COPD), emphysema or bronchitis

• chronic heart disease, such as heart failure

• chronic kidney disease

• chronic liver disease, such as hepatitis

• chronic neurological conditions, such as Parkinson’s disease, motor neurone disease,

multiple sclerosis (MS), a learning disability or cerebral palsy

• Diabetes

• those with a weakened immune system caused by a medical condition or medications

such as steroid tablets or chemotherapy

• being seriously overweight (a BMI of 40 or above)

• those who are pregnant.


Standard Infection Control Precautions

These are the basic infection prevention and control measures necessary to reduce the

risk of transmission of infections in care settings.

• Hand hygiene

• Personal protective equipment (PPE) – disposable gloves & aprons

• respiratory hygiene/cough etiquette

• Cleaning and Disinfection

• Safe disposal of waste

They should be followed by all staff, in all care settings, at all times, for all patients

whether infection is known to be present or not to ensure the safety of those being

cared for, staff and visitors in the care environment


When and how to wash your hands?




Personal Protective Equipment (PPE):

providing personal care


PPE for tasks within 2 metres of but no direct contact

with resident(s) (i.e. no touching)


PPE: When working in communal areas with

residents (Note: residents with respiratory symptoms should remain in their room)



Guidance COVID-19: putting on and removing PPE –a guide for

care homes (video) Updated 27 April 2020

23 PHE West Midlands– coronavirus and care homes

Linen and laundry

• All linen used in the direct care of patients with suspected and confirmed

COVID-19 should be managed as ‘infectious’ linen

• Linen must be handled, transported and processed in a manner that

prevents exposure to the skin and mucous membranes of staff,

contamination of their clothing and the environment

• Disposable gloves and an apron should be worn when handling infectious

linen

• All linen should be handled inside the patient room/cohort area. A laundry

receptacle should be available as close as possible to the point of use for

immediate linen deposit.


Staff uniform/clothes

It is best practice to change into and out of uniforms, or dedicated work

clothing, at work and not wear them when travelling

Uniforms should be transported home in a disposable plastic bag. After

emptying contents, dispose of the bag into the household black bag waste

stream.

Uniforms should be laundered:

• separately from other household linen;

• in a load not more than half the machine capacity;

• at the maximum temperature the fabric can tolerate, then ironed, line dried

or tumbled-dried.

NB. This does not apply to community health workers who are required to travel between

patients in the same uniform.


Environmental cleaning

Domestic/cleaning staff performing environmental decontamination should:

• ideally be allocated to specific area(s) and not be moved between COVID-19

and non-COVID-19 care areas

• be trained in which personal protective equipment (PPE) to use and the

correct methods of wearing, removing and disposing of PPE.

• Patient isolation rooms, cohort areas and communal areas must be

decontaminated at least daily.

• ‘frequently touched’ surfaces such as medical equipment, door/toilet handles

and locker tops, patient call bells, over bed tables and bed rails should be

cleaned at least twice daily and when known to be contaminated with

secretions, excretions or body fluids


Waste management

Personal waste of suspected cases (e.g. used tissues, continence pads, other

items soiled with bodily fluids), used PPE, and disposable cleaning cloths

should be stored securely within disposable rubbish bags.

These bags should be placed into another bag, tied securely and kept separate

from other waste within the room.


3 categories of waste:

• Black = domestic

• Yellow/black stripe =offensive

• Orange = infectious

Preparing your care home for COVID-19

• Nominate a COVID-19 co-ordinator per shift

• Ensure 100% staff adherence rate with up-to-date infection prevention and

control policies

• Deliver/reinforce staff education on hand and respiratory hygiene

• Ensure adequate supplies – tissues, soap, alcohol based hand gels paper

towels, cleaning materials

• Ensure adequate PPE is available – disposable gloves, aprons, fluid repellent

face masks and eye protection

• Ensure appropriate linen management systems and clinical waste disposal

systems are in place

•Consider isolation facilities – either single bedrooms with en-suite/commode,

or well-ventilated multi-occupancy rooms with designated toilet facilities if

individuals cannot be isolated in their own rooms (i.e. need to be cohorted)


Dealing with a single case of COVID-19

Care of suspected/confirmed

resident-case

• Monitor temperature and other vital signs

• Discuss care with GP or NHS111

• Arrange testing

• Supportive management- rest, keep warm, plenty of fluids.

Isolate case

• Single room

• PPE

• Observe hand and respiratory hygiene

• Safe disposal of waste

Protect other residents

• Isolate and monitor contacts of the case for 14 days from date of last exposure

• Good infection control practices

• Use of PPE by staff to limit the spread of infection.



Dealing with an outbreak of COVIDIf an outbreak is suspected, care home staff should:

1. For residents who require medical attention, please phone and discuss with

their GP or NHS 111. In an emergency call 999 and inform the ambulance

provider and receiving hospital of any outbreak.

2. Inform the PHE HPT on 03442253560 option 0 and option 2 in and out of

hours or electronically through the select survey link below:

https://surveys.phe.org.uk/TakeSurvey.aspx?SurveyID=n4KL97m2I

3. Adhere to all infection prevention and control measures

4. Implement Social Distancing measures and the Shielding guidance for the

extremely vulnerable group.

5. Implement regular monitoring of COVID-19 symptoms amongst residents

and care home staff – assess each resident twice daily, looking for fever or new

respiratory symptoms, and report any new suspected cases to GP practice.

6. Consult the PHE West Midlands toolkit checklist and FAQs for further

information, keep a log of cases using ‘Details of Suspected/Confirmed

COVID-19 Cases’ sheet.


https://surveys.phe.org.uk/TakeSurvey.aspx?SurveyID=n4KL97m2I

Transfers from hospital to care home

• Hospitals around the country need as many beds as possible to treat

seriously ill COVID-19 patients.

• This means the NHS will seek to discharge more patients into care homes

for their recovery.

• Table in the next slide summarises what care is required for the patients

discharged from hospitals to the Care Home.

If there is an outbreak of COVID-19 going on in the Home and a resident

requires hospital admission for COVID or other clinical reasons inform the

receiving hospital if they are showing symptoms of COVID-19 or are contact of

a case.


COVID-19: PHE guidance


Table 1: Care needs of residents being discharged from hospital






PHE West Midlands toolkit and FAQs


Additional measures for coronavirus

Give meals to well residents at increased risk of infection before others

Order of cleaning – clean symptomatic client rooms last

Consider bundling of activities to minimise the number of times a room is

entered (within safe limits) to conserve PPE stocks

Strict visitors policies – minimal numbers/no children/supervise handwashing

pre signing in and pre signing out (visitors only around end of life)

Staff exclusion – as per national guidance - ensure good liaison with care

manager to support return to work

Maintain routine immunisation programmes for residents and staff


Testing – General approach

Social care staff

All symptomatic care workers can be swabbed through regional testing centres,

using home testing or mobile testing centres.

Residents at the point of outbreak in a social care setting

Care Home should contact the local PHE Health Protection Team (HPT) who

will arrange testing for all residents who are symptomatic at that time.

Testing of residents post outbreak

Piloting this approach in a limited number of nursing homes.

On admission to a care setting from the NHS

For those arriving from hospital, testing will be arranged in hospital before

discharge.

Ongoing surveillance testing of care settings

By invitation to swab and test selected residents and staff as part of public

health surveillance work.


Testing residents for COVID-19:

PHE- Health protection team will arrange swabbing for all symptomatic

residents at the time of notification of case/s and outbreaks.

If you get any subsequent cases of suspected COVID-19 in residents, please

contact your local adult social care team who will arrange swabbing.


Local support pathways

Please contact your local adult care team regarding:

• Testing Staff for COVID-19

• PPE supply issues

• Staffing and other operational issues

• Further infection control advice

• Access to testing for all residents

• Clinical support for COVID-19

• End of life training

• Mental health and wellbeing support


Training & resources

A list of additional guidance relevant to care homes can be found at the end of

this slide set; please do take some time to have a look through these.

Infection prevention and control training for care homes is now available online:

https://www.skillsforcare.org.uk/Learning-development/ongoing-learning-and-

development/infection-prevention-control/Infection-prevention-and-control.aspx


https://www.skillsforcare.org.uk/Learning-development/ongoing-learning-and-development/infection-prevention-control/Infection-prevention-and-control.aspx

PPE guidance and suppliesAll homes should make sure they monitor PPE stocks daily. If you are unable to

obtain PPE supplies through normal routes, and your supply falls below three

days contact the National Supply Disruption Response Helpline to request

support

The National Supply Disruption Response (NSDR) helpline on 0800 915

9964 or Email: [email protected]


mailto:[email protected]

PPE guidance and supplies

Explore all supplier options on a regular basis – please ask for advice if

needed.

The following are known PPE supplier contacts:

Careshop [email protected] [email protected]

DeliverNet https://www.delivernet.co.uk/

Blueleaf [email protected]

Countrywide Healthcare https://shop.countrywidehealthcare.co.uk/

Gompels 0345 450 2420

Medisave.co.uk

https://www.ppeexchange.co.uk

Work with others to ‘Bulk buy’ – the commissioners can share details when

they have them.




https://www.delivernet.co.uk/


https://shop.countrywidehealthcare.co.uk/

https://www.ppeexchange.co.uk/

Resources on mental health and wellbeing

Every Mind Matters

https://www.nhs.uk/oneyou/every-mind-matters/

https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-

on-mental-health-and-wellbeing

Skills for Care also has some good resources.

https://www.skillsforcare.org.uk/Leadership-management/managing-

people/resilience/Building-resilience.aspx


https://www.nhs.uk/oneyou/every-mind-matters/

https://www.gov.uk/government/publications/covid-19-guidance-for-the-public-on-mental-health-and-wellbeing

https://www.skillsforcare.org.uk/Leadership-management/managing-people/resilience/Building-resilience.aspx

Useful resources

• https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-

care-homes


care-homes/covid-19-putting-on-and-removing-ppe-a-guide-for-care-homes-

video

• https://assets.publishing.service.gov.uk/government/uploads/system/uploads

/attachment_data/file/880274/Admission_and_Care_of_Residents_during_C

OVID-19_Incident_in_a_Care_Home.pdf


domiciliary-care

• RCNi Infection Prevention and Control: https://rcni.com/hosted-

content/rcn/first-steps/infection-prevention-and-control

• https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-

guidance

• https://www.nhs.uk/conditions/coronavirus-covid-19/


https://www.gov.uk/government/publications/covid-19-how-to-work-safely-in-care-homes

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/880274/Admission_and_Care_of_Residents_during_COVID-19_Incident_in_a_Care_Home.pdf

Acknowledgements

With grateful thanks for sharing and contributing to content:

“based on a webinar training model developed by PHE London, including

presentation preparation, delivery, Q&A forum and evaluation. The PHE

London webinar training team are Sarah Lang, Bharat Patel and Rebecca

Cordery”.

Dr Merav Kliner and Dr Dr Anna Trelfa- PHE North West Health Protection

team

All staff working in the West Midlands Health Protection Team, and our

colleagues in Local Authority Public Health and Adult Social Care.

Special thanks to Kate Duffield and Sally James (HEE) for organising and

hosting the session.


Documents

COVID-19 seminar for staff working in Nursing, Residential ... · 5/14/2020 · COVID-19 Timeline of key events 31st December 2019: China reported to WHO a cluster of cases of pneumonia