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Infection Prevention and Control guidance for Disability Services during COVID-19 Pandemic AMRIC Webinar 10th July 2020
Presented by HSE Antimicrobial Resistance and Infection Control (AMRIC) Team Prof. Martin Cormican, HSE Clinical Lead fro HCAI & AMR ([email protected]) Mary McKenna, Infection Prevention and Control Nursing ([email protected])
Infection Prevention and Control (IPC) is about supporting safe care
How to do what we need to do with the
lowest risk for everyone
NOT creating barriers to care
Infection Prevention and Control (IPC)
Barriers to care can do as much or more damage as infection
but always consider individual needs and
vulnerability
Understanding how IPC measures can be implemented within Intellectual Disability Services
Background In Ireland there are currently over 8300 people with disabilities living in 1302 HIQA registered designated centres • community houses • single apartments campus-based bungalows • shared accommodation/residential care facilities
Ref: Interim Rights-based Guidance on implementing Infection Prevention Control Measures and mitigating risk 9th July 2020
There is a need to balance the risks/care associated with COVID-19 and the rights/care of people with disabilities COVID-19 Guidance for RCFs: important in congregated settings ( which reflect more as healthcare setting) • High dependency needs • Often older persons who are more frail with increased underlying illness Increased shift towards independent living which may reflect more as social care settings • Often younger persons with good mobility and lower care needs-( mainly assistance and
support) • Lower levels of underlying illness • strive towards optimal independent living
“One size doesn’t fit all” – individual risk assessment is important
What we know about COVID-19 transmission
Lipid Coat with protein spikes Attaches to mucosa of respiratory tract
Direct spread: respiratory droplets from coughing or sneezing
Airborne spread when - certain aerosol generating procedures are being performed
Indirect contact - contaminated surfaces thought to live for several hours
plastic : up to 72 hours stainless steel : up to 48 hours Copper: up to eight hours
Contaminated hands ( not cleaned) touch eyes/face or mouth
• Processes to identify people (service users and staff) with communicable
infection (including COVID-19) before they access services/attend work or as soon as possible after they access services/attend work
• Processes to minimize the risk of spread of infection from people (service users and staff) who access services/attend for work with unrecognized infection (Standard Precautions)
• Early detection of spread of infection in the service and immediate response to limit harm
The key overarching elements of managing the risk of infection
Standard Precautions applies to all patients, residents and clients all of the time in every setting where healthcare is delivered ( including day services) These are measures to minimise the risk of any infection transmission in the first instance, especially: • Good hand hygiene practice • Respiratory etiquette • Appropriate use of correct PPE when it helps (not when it doesn’t: for example gloves are for contact with blood or other body fluids) • Frequent environmental cleaning • Equipment cleaning ( single use or cleaned between patients) • Appropriate segregation and disposal of domestic & healthcare risk waste
Standard Precautions First
Additional measures to prevent the spread of COVID-109
Current National Public Health recommendations • Social distancing (2 metres) where possible • Wearing of surgical face mask when in close contact with patients/residents/clients (Where practically possible). If face mask is not appropriate consider a full face visor
Wearing of surgical face mask when close contact with another healthcare worker exceeds 15 minutes
Where a patient/resident is suspected or confirmed with COVID-19: •Standard , contact and droplet precautions
Continue to ensure all staff are trained with standard and transmission based precautions – including
• Early recognition of COVID-19 symptoms • Process to manage suspected and confirmed COVID-19 that applies locally and is
suitable to support the needs of individuals with disabilities
Increase staff awareness - Assessment and monitoring of patients for symptoms • What to do :
• If staff themselves develop symptoms • Daily reporting at commencement of shift & ( temperature check) • When and how to get tested
Staff awareness- getting the basic things right
Overview of IPC measures in Intellectual Disability Residential Services
If the person can tolerate wearing a mask this may help to reduce risk of exposure for others. Consider how the person can be cared for in ways that maintain a distance of 2m (or at least 1m) from other patients and from staff to the greatest extent possible - for example if there is a living space where the person has as little contact as possible with others – communication is key. If more than one person with COVID-19 is in setting: consideration should be given to locating persons with COVID-19 in proximity to each other to the greatest degree possible. (Please refer to cohorting section in the guidance)
When single room options are unsafe/impractical to apply
Type of PPE to wear is based on risk assessment
PPE use when managing
suspected/confirmed COVID-19
Section 3: Key points PPE – Low Contact examples
The tasks being performed are unlikely to provide
opportunities for the transfer of virus/other pathogens to
the hands and clothing. Examples include:
Initial clinical assessments
Taking a nasopharyngeal ( COVID-19) swab
Recording temperature
Checking urinary drainage bag
Inserting a peripheral IV cannula
Administering IV fluids
Assistance with feeding
Type of PPE required
Hand hygiene
Disposable single use nitrile gloves
Disposable plastic apron
Surgical facemask
Eye protection*
*Eye protection is required to be worn as part of
standard infection control precautions when there is a
risk of blood, body fluids, excretions or secretions
splashing into the eyes
Individual risk assessment must be carried out before
providing care to include whether patients are coughing
If wearing of a mask by staff creates practical difficulties in interacting with the patient, wearing a clear full face visor will substantially reduced exposure of staff to droplets though this is not generally accepted as equivalent to use of a surgical mask. Access to a safe outdoor location for periods (where possible) may be helpful in reducing risk of exposure of other patients and staff .
Wearing of face masks
Section 3: Key points on PPE High contact activities (examples)
High contact patient care activities that provide
increased risk for transfer of virus and other pathogens
to the hands and clothing of healthcare workers.
Examples:
Close contact for physical examination/
physiotherapy
Changing incontinence wear
Assisting with toileting
Device care or use
Wound care
Providing personal hygiene
Bathing/showering
Transferring a patient
Care activities where splashes/sprays are anticipated
Examples of PPE
Hand hygiene
Disposable single use nitrile gloves
Long sleeved gown
Surgical facemask
Disposable Eye protection*
*Eye protection is recommended as part of standard
infection control precautions when there is a risk of
blood, body fluids, excretions or secretions splashing
into the eyes.
Individual risk assessment must be carried out before
providing care. This assessment will need to include
• Whether patients are coughing
• The task you are about to perform
Testing for COVID-19 When and why?
Testing of People who have previous positive COVID-19
People who have COVID-19 - Generally Do Not Retest Detects a part of the virus The test stays positive for many weeks in some people The test is not a useful way to tell if a person is still infected Retesting for patients/clients who are known to have COVID-19 is very rarely useful 14 days post onset with no fever for 5 days - no longer infectious
Testing of People who have NOT had a previous positive test
1. People with symptoms Diagnostic testing because they have symptoms Remembers “not detected” is not negative 2. People with no symptoms Recommended for all patients who are for admission to RCF (large congregated setting) Coming from acute general hospital to RCF in-patient service– test before transfer Coming from home – test on arrival/soon after arrival at residential care setting Why Test ? It an extra check to identify people with COVID-19 who might have been missed But testing will not detect everyone with infection If test reported not detected – still recommend 14 days in own room as much as possible after admission in a large RCF/NH and consider needs of resident Note – consider if this is appropriate in small group assisted living facilities and for respite care
Testing of People who have not had a positive test
What if test is positive on a person for admission ? Admission can go ahead where risk is assessed and plan in place (likely to be difficulty in small group assisted living settings) It is not always easy to know if the person is still infectious but err on the side of caution and take appropriate advice. If there is a any problem or suspected outbreak later knowing the person was positive coming in makes results easier to understand what is happening.
Transfers and admissions
Recommendation for isolation Clients and residents transferred /admitted should have a single room & own bathroom for 14 days and monitoring for any symptoms regardless of COVID -19 test result not detected
• A patient /resident who has been 12 hours or more in an acute hospital (for Emergency
Department) including overnight stay • Residents who are transferring from hospital to RCF and recovering from COVID-19 within
the 14 day period from onset of symptoms and are medically fit for hospital discharge Recommendation does not apply to : • A person attending hospital day appointments/day procedures of less than 12 hours • A person who has recovered with confirmed COVID-19 ( 14 days since onset of symptoms
and no fever for the last 5 days) • Consider applicability in small group assisted living settings & short term respite (what is
practical and what is appropriate ?)
Transfer and Admission to Large Residential Care Service
Staff and external services attending the facility to provide sessional care/therapy or group activities ( who may be attending multiple services) are not restricted in delivering the service and should follow standard precautions and public health measures at all times including: • hand hygiene, • respiratory etiquette, • social distancing • NPHET recommendation on mask use • appropriate PPE as outlined in the main guidance for acute hospitals Dedicated rooms for family meetings and group activities in the service should be organized to meet NPHET recommendations
Supporting continuation of Disability service activity
Service users who require to go on home visits or overnight stays
are not required to isolate on return providing they have been in a home setting where there are no suspected or confirmed people with COVID-19 Communication with client and family is therefore important pre- home visit to support compliance with remaining in the home setting
Home Visits
Visiting Guidance
Key points on visiting in services with no ongoing COVID-19 outbreak
• Visits in to RCFs need to be pre-arranged at with the person in charge of the facility
• 2 named visitors may visit BUT only one visitor per person to visit at a time
where possible
• Limited number of total visitors in each area at at time (generally 2)
• Consider suitable time that reduces footfall – determine capacity • Practical application to smaller house settings with individual and family
needs should be managed by the person in charge
Check the following before access to enter :
• Has the visitor had COVID- 19 or recent symptoms?
• Close contact with a person with COVID-19 / suspected COVID-19
• Undertake symptom checking
• Visitors should sign in with own pen or be signed in by staff
• Ensure hand-hygiene is done correctly
• Wearing of a cloth face covering or surgical mask if social distancing cannot be maintained where practical (provide mask or visor if needed)
Visiting processes that apply to visitors
Key points on visiting during an outbreak of COVID-19
All but necessary and pre-arranged visiting (for example but not limited to end of life) is suspended in the interest of protecting residents, visitors and staff at this time Visitors should be advised of the risks of personal transmission to them. Any visitors with fever or respiratory symptoms will not be admitted. Visitors should declare that they have no symptoms and undergo a temperature check before being permitted to enter. Visitors are advised of the requirement for PPE to be worn as part of the visit with assistance and guidance in relation to donning and doffing. Appropriate PPE should be provided by the RCF The messages around visiting during an outbreak should be reinforced with signage
Query re visiting
Mary wants to go out to the shop and post office. Are there any additional measures she/staff needs to take She meets some friends/family along the way and shakes hands. What measures are necessary to deal with the situation? If Mary did not have a disability could she go to the shop ?
Query: What are the key lessons from the first outbreak for staff to prevent a resurgence of COVID-19? A. Standard Precautions (all patients all settings all the time) Keep your distance when you can (patients and colleagues) Know what COVID-19 looks like (its not just fever, cough and shortness of breath) Consider the possibility If in doubt implement IPC precautions, take advice and request test When the test result come back take advice on what it means Encourage your colleagues to stay at home/go home if symptomatic
Queries
Day services
Day services
Important life line for optimising independence and social interaction in over 1000 locations across Ireland. This service is important for daily respite for families Resumption of day services - assess the needs of each individual and how these can be met in line with the guidance recommendations Communication with family/carers is key to prompt early recognition and prompt intervention of symptoms in client or other family members Staff reporting symptom free before starting work
Day services
Query? Family and service anxious regarding return of client with significant underlying respiratory condition – when do you decide it is safe for this person to return First question – how safe or appropriate is for this person not to return ? Case by case – needs /risk/ expert advice /what do they want ? Query: Are temperature checks necessary for staff and clients in day services? NPHET recommend temperature check for staff in RCF AMRIC advice it may be considered in other settings but benefit is uncertain
Query- Day services – managing transport arrangements
Transport in bus, taxi or car needs to be considered in line with NPHET: Hand hygiene and use of face coverings when travelling Where possible consider having the same clients travel on each journey Challenging to maintain distance in a car. Generally best to limit the number of people you transport
Guidance is Guidance
As with all guidance it should be applied with compassion and good sense – the principles are critical but some flexibility may be needed in the context of individual patients and resident’s needs
Online resources and links
www.hpsc.ie is the central hub for nationally approved infection control guidance relating to COVID19. 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 residential service is:
Interim Public Health and Infection Prevention Control Guidelines on the Prevention and Management of COVID-19 Cases and Outbreaks in Residential Care Facilities and Similar Units 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
Online resources and links
4. Online resources and links; Preparedness
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/videoresources/
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/
Online resources and links
https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/partner-resources/
Online resources and links
This link will take you to the HSE website which contains links to translated COVID-19 materials, audio and video resources, posters and booklets
