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Residential Aged Care COVID-19 Pandemic Plan
5 May 2020
Version 3
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Infection Prevention Service 22/4/2020
Residential Aged Care COVID-19 Plan
Contents
Page
Background 4
Objectives 4
Recognition of illness 4
Contact tracing 5
Placement of cases 6
Management of a resident/s with suspected/ confirmed COVID-19 6
Care of a resident requiring nebuliser therapy or non-invasive ventilation (CPAP or BIPAP)
7
Release from isolation of a confirmed case 7
Staff 7
Physical distancing measures 8
Communication 8
Management of Equipment 8
Signage 8
Cleaning 9
Waste Management 9
Handling of Linen 9
Food Services 9
Supply 9
Communal Activities 9
Visitors 9
Admission and transfer 10
Medical Management 10
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Care of deceased 10
COVID-19 Outbreak 11
Monitor outbreak progress 11
Ending outbreak 11
Reporting to Dept. of Health and Human Services 11
References 12
Letter to GPs – COVID-19 Outbreak – Appendix 1 13
Letter to Families – Preventing Spread of COVID-19 – Appendix 2 15
Initial Report to Department of Health and Human Services Template – Appendix 3 17
Outbreak Management Checklist – Appendix 4 18
Care Plan Suspected/Confirmed COVID-19 – Appendix 5 20
Cleaning Reusable Eye Protection COVID-19 – Appendix 6 23
Respiratory Swab collection for COVID-19 – Appendix 7 24
Residential Aged Care Facility COVID-19 Communication Response Record – Appendix 8 25
Sample COVID-19 Outbreak Case List – Appendix 9 26
Resident Management Process for Suspected COVID-19 – Appendix 10 27
COVID-19 Staff Screening Log Book – Appendix 11 28
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Background:
The Novel Coronavirus outbreak represents a significant risk to Australia. It has the potential to cause high levels of morbidity and mortality in residential aged care. This Residential Aged Care (RAC) COVID-19 Plan is to be used in conjunction with the Barwon Health COVID-19 Pandemic Plan (BH COVID-19 PP).
COVID-19 is a contagious viral infection that generally causes respiratory illness in humans. Presentation can range from no symptoms (asymptomatic) to severe illness with potentially life-threatening complications, including pneumonia. COVID-19 is spread by contact with respiratory secretions and fomites.
There is a high risk of an outbreak of COVID-19 in RAC facilities. The elderly, who may also have co-existing illnesses, are at increased risk of serious complications if they contract COVID-19. Infection can spread rapidly through residential and aged care facilities if not managed appropriately.
Objectives:
1. Reduce the morbidity and mortality associated with COVID-19 infection through an organised response that focuses on containment of infection.
2. Rapidly identify, isolate and treat cases, to reduce transmission to contacts, including residents, staff and visitors.
3. Characterise the clinical and epidemiological features of cases in order to adjust required control measures in a proportionate manner.
4. Minimise risk of transmission in RAC facilities, including minimising transmission to residential aged care workers.
a. Optimise hygiene and infection control processes within facilities. 5. Ensure all staff and residents of facilities are vaccinated and protected against influenza. 6. Prepare facilities to reduce their risk from influenza-like illness (ILI), and to detect and manage ILI outbreaks
safely and efficiently. 7. Prepare a workforce plan, ensure business continuity and promote self-sufficiency within facilities. 8. Continue to ensure residents, and their families, are involved in decisions, and respect resident preferences
and values in order to maximise quality of life and wellbeing.
Recognition of illness
Daily monitoring of all residents temperature, heart rate and respiratory rate. Any observations deviating from baseline for that resident are to be reported to nurse in charge, and to be actioned as clinically appropriate.
Clinical signs and symptoms o The most common signs and symptoms include:
fever (though this may be absent in the elderly) acute respiratory infection (shortness of breath, dry cough, sputum production, sore throat, with
or without a fever); tiredness or fatigue; less common symptoms may include headache, myalgia/arthralgia, chills, nausea and vomiting,
nasal congestion, diarrhoea, haemoptysis, and conjunctival congestion. o Older people may also have the following symptoms:
increased confusion worsening chronic conditions of the lungs loss of appetite
Elderly patients often have non-classic respiratory symptoms; RAC facility should consider testing any resident with any new respiratory symptom.
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The GP is informed immediately that a resident has a fever / influenza like illness (ILI) and may be a suspected case of COVID-19. Inform the GP if there is an outbreak or suspected outbreak within the facility. If it is afterhours, contact the afterhours or locum service as per standard processes. Provide them with a comprehensive clinical history, current clinical observations and facility details. Testing for COVID-19 can be carried out in RACF and involves taking an oropharyngeal / nasopharyngeal swab from the suspected case.
Notify Infection Prevention Service (IPS) on ext.55947, or Infectious Disease Registrar after hours on 42152379, of any resident with fever / ILI.
Testing o PCR COVID-19, PCR multiplex respiratory per Appendix seven - Respiratory Swab collection for COVID-19
Influenza vaccination up to date and entered into Platinum 5 (P5), RAC electronic record.
Documentation of cases (confirmed or suspected cases) o Case list for residents and staff will be updated daily by nurse in charge/Infection Prevention Nurse
Consultant (IP CNC) o P5 infection report documented by care staff
Transmission based precautions (TBP) – droplet and enhanced contact COVID-19 Pandemic Plan.
All personal protective equipment (PPE) should be single-use and disposed of into clinical waste when removed.
Reusable eye protection, when used, to be cleaned per procedure Appendix Six
For hand hygiene, use an alcohol-based hand rub if hands are visibly clean, soap and water when hands are visibly soiled.
Maintain a record of all persons entering the patient’s room including all staff and visitors on the ‘Contact Register - High Consequence Infectious Disease’ form COVID-19 Pandemic Plan .
Ensure treatment management choices of residents are documented and current.
Cases suspected or confirmed for COVID-19 must be tested and notified to the Department of Health and Human Services (DoHHS) by calling 1300 651 160, 24 hours a day. This will be done by infectious Disease Registrar.
A confirmed case is a person who tests positive to a validated SARS-CoV-2 nucleic acid test or has the virus identified by electron microscopy or viral culture.
Confirmed cases must be reported to mailto:[email protected].
Contact tracing:
This includes staff, other residents, or visitors who were in the same closed healthcare space as a case.
Contact needs to have occurred within 48 hours of the onset of symptoms in the confirmed case, until the confirmed case is no longer considered infectious, in order to be considered a contact.
Contact tracing will be coordinated by Infection Prevention Service.
Definition of close contact: for the purposes of testing, the department advises a precautionary understanding of close contact. In keeping with definitions of close contact developed in other jurisdictions, close contact means greater than 15 minutes face-to-face, cumulative, or the sharing of a closed space for more than two hours, cumulative, with a confirmed case without recommended personal protective equipment (PPE). Recommended PPE includes droplet and contact precautions.
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Placement of cases
A. Confirmed case A person tested for COVID-19 and found to have COVID-19 infection. • Cases will be cared for in droplet and enhanced contact TBP in single room with own bathroom (if
possible) • Residents sharing a confirmed case’s room shall be moved to a single room (if available) and managed as
a suspected case • It may be necessary to cohort residents, this will be in consultation with IPS.
B. Suspected case People without symptoms should not be tested. Residents or staff who meet the following clinical criteria should be tested:
Fever ≥ 37.5 C or chills in the absence of an alternative diagnosis that explains the clinical presentation – how should this be defined for the elderly? OR Acute respiratory infection that is characterised by cough, sore throat or shortness of breath
Note: In addition, testing is recommended for people with new onset of other clinical symptoms consistent with COVID-19* AND who are close contacts of a confirmed case of COVID-19 or who have returned from overseas in the past 14 days.
*headache, myalgia, runny or stuffy nose, anosmia (loss of sense of smell), nausea, vomiting, diarrhoea
• Cases will be cared for in droplet and enhanced contact transmission based precautions (TBP) in a single room with own bathroom (if possible)
• Residents sharing a confirmed case’s room shall be moved to a single room (if available) and managed as a suspected case
• It may be necessary to cohort residents, this will be in consultation with IPS. • Suspected cases will be kept separate from confirmed cases (no sharing rooms)
C. Casual contact • This includes staff, other residents, or visitors who were in the same closed healthcare space as a case,
but for shorter periods than those required for a close contact. • Contact needs to have occurred during the period from the onset of symptoms in the confirmed case
until the confirmed case is no longer considered infectious, in order to be considered a casual contact. Casual contacts do not need to restrict their movement. However, they require close monitoring. On the first confirmation or suspicion of a COVID-19 case in a facility all residents will have haemodynamic monitoring including heart rate, respiratory rate and temperature attended twice daily, until COVID-19 result is available. Twice daily observations may cease if COVID-19 result is negative.
Management of residents with suspected/confirmed COVID-19
Immediate droplet and enhanced transmission based precautions (TBP) and infection prevention and control measures if a resident is identified with respiratory illness.
If COVID-19 PCR is negative, continue droplet TBP until influenza is excluded and resident is asymptomatic.
Unwell residents require medical review by their GP regardless of whether an outbreak is present or not. Maintaining the health and wellbeing of residents, and ensuring their care needs are met, continues to be the responsibility of the RAC facility.
Four times daily monitoring of temperature, heart rate and respiratory rate, until reviewed by nurse manager or GP.
Transfer of resident must be discussed with treating GP or admitting officer in Emergency Department first.
No visitors, unless discussed with IPS.
Encourage families to provide communication tools such as mobile phones with data packs to facilitate communication.
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No nebulisers to be used, unless an exclusion (per nebuliser care notes below), as it aerosolises the virus. Spacers are the alternative.
Care of a resident requiring nebuliser therapy or non-invasive ventilation (CPAP or BIPAP)
Barwon Health directs nebulisation therapy should NOT be used for any resident (regardless of COVID-19 status), with the following notable exclusions:
Critical asthma requiring nebulised bronchodilators; or
Specific patients requiring nebulise therapy for tracheostomy care; or
Non-invasive ventilation e.g. CPAP or BIPAP. If this is unavoidable: o Airborne and enhanced contact precautions (i.e. P2/N95 mask, eye protection, long-sleeved gown and
non-sterile gloves) o Single room with the door closed o These precautions are required for the duration of, and up to 30 minutes after, the non-invasive
ventilation ceases o Clean frequently touched points with V-wipes e.g. bedside table, phone, door handle after procedure
When nebuliser therapy is utilised, staff attending to the patient must adhere to the following infection prevention precautions:
o Airborne and enhanced contact precautions (i.e. P2/N95 mask, eye protection, long-sleeved gown and non-sterile gloves)
o Single room with the door closed o These precautions are required for the duration of, and up to 30 minutes after, the nebuliser therapy o Clean frequently touched points with V-wipes e.g. bedside table, phone, door handle after procedure
Management of a resident using a nebuliser or non-invasive ventilation will be documented as an acute/specialised nursing care plan in Platinum 5.
Release from isolation of a confirmed case Deciding when a confirmed case no longer requires to be isolated, will be in consultation with the treating clinician and Infectious Disease Registrar. This will be actively considered when all of the following criteria are met:
The patient has been afebrile for the previous 72 hours, and
At least ten days have elapsed after the onset of the acute illness, and
There has been a noted improvement in symptoms, and
The treating GP and infectious disease team have reviewed the case.
Staff
Staff Self-assessment of their health prior to attending a Barwon Health facility: o Temperature testing at least once a day
Preferably at home, but may be done at work on arrival o Checking for any signs and symptoms of COVID
o Shortness of breath o Cough and/or o Sore throat and/or
o Fever i.e. temperature ≥ 37.5C o Checking for any close contact with a confirmed case of COVID-19, without the use of full PPE
Staff with temperature ≥ 37.5C or symptoms of an acute respiratory infection will not attend work and must call Staff Clinic on 4215 3220
ANUM on each ward will maintain Appendix 11 - COVID-19 Staff Screening Log Book and will also assist in taking temperatures if required. All staff and contractors are required to check in with the ANUM at the commencement of their shift.
Notify DoHHS on 1300 651 160 any RAC staff tested for COVID-19, Staffcare will attend to this.
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Before 28 weeks' gestation (in the first and second trimester of pregnancy), avoid areas where there are suspected or confirmed cases of COVID-19 and clinical areas such as theatre, respiratory wards, intensive care and high dependency units or any other areas where aerosol generating procedures are performed.
After 28 weeks' gestation you should not be in roles with direct patient contact and in all situations, avoid contact with suspected or confirmed cases of COVID-19.
Highlight importance of hand hygiene.
PPE education of all staff caring for patients with COVID-19, requires training in the correct use of PPE by either or both: o GROW module for Personal Protective Equipment for Infection Prevention and Control o In-service training provided by an Infection Prevention Service Clinical Nurse Consultant.
Education in assessment of respiratory illness.
Education in Prevention, recognition and management of influenza like illness and respiratory outbreaks.
Staff may work across Barwon Health sites.
Healthcare workers and workers in aged care facilities (HCWs), who are a confirmed COVID-19 case, must meet the following additional criteria before they can return to work in a healthcare setting or aged care facility:
o PCR negative on at least two consecutive respiratory specimens collected 24 hours apart after the acute illness has resolved.
o This is further detailed in Return-to work criteria for health care workers and workers in aged care facilities who are confirmed cases (DoHHS Guidelines).
Physical distancing measures
Physical distancing is to be practiced within clinics and wards, between staff and residents, and between staff and staff. This includes:
• staff room chairs separated by at least 1.5 metres • direct interactions between staff conducted at a distance • staff and residents to remain at least 1.5 metres apart with the exception of clinical examinations and
procedures • Cafe may only provide takeaways.
Communication
Staff can access novel coronavirus information on the Barwon Health One Point intranet site.
RAC facility managers are to communicate Novel Coronavirus – memos to staff.
Staff access to Novel Coronavirus information is documented on the RAC facility COVID-19 communication response record –Appendix Eight
Letter to be sent to GPs if a COVID-19 outbreak is suspected in a RAC facility (Appendix One)
Residents, their family members and visitors have Australian Department of Health COVID-19 Information sheet available at entrance to facility.
Letters have been sent to residents and their families.
No visitors at this time. To protect the health and safety of residents, visitors are currently not permitted.
Management of Equipment
Preferably, all equipment should be either single-use or single-patient-use and disposable.
Reusable equipment should be dedicated for the use of the affected resident until the end of their illness.
Any shared equipment must be cleaned and disinfected between patients. This is a 2-step clean (aseptic wipe, then alcohol wipe) or 2-in-1 step clean (V-wipes) as appropriate for equipment being cleaned.
Signage
No visitors at this time. To protect the health and safety of residents, visitors are currently not permitted.
Fact sheets for resident/visitors/families on COVID-19
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Cleaning
Twice daily cleaning of communal areas and frequently touched surfaces.
Routine clean of unaffected resident rooms.
Daily 3 stage clean of all frequent touch points of all suspected or confirmed COVID-19 case room.
Staff conducting the clean should adopt droplet and enhanced precautions, within the COVID-19 case’s room.
The exit clean will be conducted in two stages. First a neutral detergent clean stage of all horizontal and frequent touch points. The second stage to use hydrogen peroxide vapour for disinfection.
Segregate cleaning equipment used in affected area from unaffected area.
Waste Management
Dispose of all waste as clinical waste. Clinical waste may be disposed of in the usual manner.
Handling of Linen
Bag linen inside the resident room. Ensure wet linen is double bagged and will not leak.
Linen to be reprocessed by the standard process.
Food services
Crockery and cutlery to be reprocessed per standard precautions. Food trays from resident rooms must be placed immediately in food trolley.
Disposable crockery and cutlery may be used and will be disposed of as clinical waste.
Supply
PPE available in RAC as per imprest stock.
Hand hygiene products as per imprest stock.
Diagnostic materials (dry sterile flocked) maintain 10 swabs per facility.
Cleaning supplies as per imprest stock.
Pack of PPE available in De Forrest House. This may be accessed by after hour’s coordinator and Infection Prevention Service.
The Commonwealth Department of Health has advised they will ensure the availability of PPE for aged care services. RACF should contact the Commonwealth regarding PPE supplies. Information and access to Commonwealth PPE for RACF is currently through: [email protected]. This will be managed by the Clinical Director of Aged Care.
Communal Activities
Suspend if suspicion of a COVID-19 case.
Practice social distancing by keeping a distance of 1.5 metres between residents.
Visitors
Visiting may be approved by the facility manager.
Resident visitors will be contacted in the event of an outbreak of COVID-19
o This requires a current contact list for regular visitors. o Re-emphasise the importance of postponing visitation, o Any visitors (that are permitted after screening) should wear a surgical facemask whilst in the facility.
Postpone visits from non-essential services e.g. allied health.
Suspend volunteer support.
Family and loved ones will be able to provide support to a resident who is dying. Restrictions on the number and age of visitors will not apply when support is being provided to a dying resident.
In the case of a visitor who does visit a resident: o Only visit the resident
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o Enter and leave the facility directly without spending time in communal areas o Perform hand hygiene before entering and on exit of resident’s room and the facility.
If a visitor attends a confirmed case in the RAC facility, the visitor must wear PPE for droplet and enhanced contact TBP. They require supervision to don and doff PPE by a person experienced in infection prevention and control requirements.
Admission and transfers
Criteria for admission to hospital o Resident’s wishes have requested active treatment (as detailed in an advance care directive) o Clinical status would benefit from hospital admission as discussed with medical team- i.e. respiratory
support o Discussion with admitting hospital; capacity to accept has been confirmed and they are aware
resident is a suspected or confirmed COVID-19 case o Discussion with ambulance to confirm they are aware resident is a suspected or confirmed COVID-19
case.
In an outbreak of COVID-19 suspend admissions, if possible.
Re-admission of cases o Provide appropriate accommodation and infection and control measures.
Transfers o Notify Ambulance Victoria (or health transport contracted) and receiving hospital of the risk of COVID-19
verbally and on the resident transfer advice form. o If transfer outside of the room is essential, the patient should wear a surgical mask during transfer and
follow respiratory hygiene and cough etiquette. All staff attending the patient should wear the following PPE:
Surgical mask or P2/N95 Face shield or goggles Long-sleeved gown Disposable non-sterile gloves
o Physical distancing rules apply during all stages of the transfer.
Non-infected residents o They may be transferred to family care for the duration of the outbreak. o The family or carer must be made aware that the resident may have been exposed and is at risk of
developing COVID-19.
Medical Management
The resident’s usual general practitioner will be primarily responsible for medical treatment of the resident.
Infectious Disease registrar will be involved in medical management of residents.
Clinical management of confirmed COVID-19 cases currently is supportive care only.
Exclude other respiratory diagnoses.
Treat clinical illness per resident’s treatment plan.
Care of the deceased if COVID-19 is suspected or confirmed
The same level of infection prevention and control precautions should be used for the management of a deceased person as were used before their death. As such, droplet and contact precautions should be used when handling deceased persons for whom COVID-19 infection is suspected or confirmed.
Refer to Prompt Procedure Death of a Patient, Client or Resident from COVID-19 or Suspected COVID-19
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COVID-19 Outbreak
A potential COVID-19 outbreak is defined as two or more cases of acute respiratory illness (ARI) in residents or staff of an RACF within three days (72 hrs).
A confirmed COVID-19 outbreak is defined as two or more cases of ARI in residents or staff of an RACF within three days (72 hrs) AND at least one case of COVID-19 is confirmed by laboratory testing.
If a COVID-19 outbreak is present, all visiting GPs should be informed at the start of the outbreak. A sample letter for GPs can be found at Appendix 4. If any deaths occur during the outbreak, the department must be notified within 24 hours.
A case list will be commenced when an outbreak is suspected, updated and sent to the department daily, and this needs to detail any hospitalisations and deaths. Appendix nine – Sample COVID-19 Outbreak Case List. All GPs and healthcare providers (including transport / ambulance staff) must be informed before attending the RACF.
Monitor outbreak progress
Twice daily haemodynamic observations of unaffected residents are to include temperature, heart rate and respiratory rate.
Immediate droplet and enhanced transmission based precautions (TBP) and infection prevention and control measures if a resident is identified with respiratory illness.
If COVID-19 PCR is negative, continue droplet TBP until influenza is excluded and resident is asymptomatic.
Update case lists twice daily.
End Outbreak
• No new cases for 14 days from onset of symptoms in last case.
• Send final detailed list to the DoHHS.
• Review and evaluate outbreak management.
Reporting to Department of Health and Human Services
A potential COVID-19 outbreak is defined as:
Two or more cases of ARI in residents or staff of a RCF within 3 days (72 hrs).
A confirmed COVID-19 outbreak is defined as:
Two or more cases of ARI in residents or staff of a RCF within 3 days (72 hrs)
AND
At least one case of COVID-19 confirmed by laboratory testing.
While the definitions provided above guidance, the DoHHS will assist facility in deciding whether to declare an outbreak.
This will be facilitated by Infection Prevention Service
Phone 1800 651 160
Details to provide DoHHS are on Initial report to DoHHS - COVID-19 Outbreak (Appendix Three)
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References
Australian Government Department of Health, Coronavirus (COVID-19) health alert accessed 18 April 2020 - https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert
Coronavirus disease 2019 (COVID-19), Guideline for health services and general practitioners, 3 March 2020, Version 11, Victorian Department of Health and Human Services accessed 18 April 2020 - https://www.dhhs.vic.gov.au/health-services-and-general-practitioners-coronavirus-disease-covid-19
Coronavirus Disease 2019 (COVID-19) Outbreaks in Residential Care Facilities, Communicable Diseases Network Australia National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia V1. 13/3/2020 Initial Release Endorsed by CDNA
COVID-19 plan for the Victorian Aged Care Sector accessed 14 April 2020 - mailto:https://www.dhhs.vic.gov.au/coronavirus-covid-19-plan-victorian-aged-care-sector
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Appendix One
Letter to GPs – COVID-19 Outbreak
……/……/……
Respiratory outbreak at [Facility Name]
Dear Doctor,
There is an outbreak of acute respiratory illness affecting residents at the facility named above. The outbreak may
involve some of your patients who may require review.
It is important to establish if the outbreak is caused by SARS-CoV-2. Coronavirus Disease 2019 (COVID-19), caused
by SARS-CoV-2, is a notifiable condition.
We recommend that you:
Establish if any of your patients are affected
Help determine if the outbreak is caused by SARS-CoV-2: - Cases meeting thee suspected case definition for COVID-19 must be tested
- Any aged care resident who has a fever (≥38C) OR an acute respiratory infection (e.g. shortness of breath, cough, sore throat) are classified as a suspected case
- Testing of residents in aged care is processed at University Hospital Geelong, by the Australian Rickettsial Reference Laboratory:
A single flocked viral swab should be used to sample the nasopharynx via both nostrils and the throat. The same swab should be used for all three sites.
A second swab for viruses other than COVID-19 coronavirus will require a second swab referred to Australian Clinical Labs with a separate pathology referral form.
Specimens for COVID-19 testing are to be submitted to Australian Rickettsial Reference Laboratory (ARRL). Infection Prevention will assist with this in RAC (ext.55947).
Specimens are to be accompanied by an ARRL pathology form and request "COVID-19 PCR." If an ARRL referral form cannot be found, an ACL form will be accepted. In such a case,
please indicate in writing that the test is being referred to ARRL and ensure that it is delivered to ARRL, not ACL.
Ensure that your patients are vaccinated against influenza, if there are no contraindications
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Ensure that you observe hand hygiene procedures and use appropriate PPE when visiting your patients.
Limit the use of antibiotics to patients with evidence of bacterial superinfection, which is uncommon. There is
significant evidence that antibiotics are over-prescribed during institutional respiratory illness outbreaks.
Control measures that the facility has been directed to implement include:
Isolation of symptomatic residents
Use of appropriate PPE when providing care to ill residents
Exclusion of symptomatic staff from the facility
Restriction/limitation of visitors to the facility until the outbreak has resolved
Promotion of hand hygiene, and cough and sneeze etiquette.
Should you require further information regarding COVID-19, please refer to the Commonwealth Department of Health website: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert
If you require any further information or advice please contact [insert details].
.
Yours sincerely,
[Name] [Position] [Facility/Organisation]
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APPENDIX TWO
LETTER TO FAMILIES – PREVENTING SPREAD OF COVID-19
[Facility Letterhead]
……/……/……
Dear family member
There is local transmission of coronavirus disease 2019 (COVID-19) in the community. While all types of respiratory viruses can
cause sickness in the elderly, COVID-19 is a particularly contagious infection that can cause severe illness and death for
vulnerable people.
COVID-19 Pandemic
COVID-19 has caused outbreaks of illness in the Australian community, and local transmission has occurred in some
communities. Residential care facilities are particularly susceptible to COVID-19 outbreaks. Even when facilities actively try to
prevent outbreaks occurring, illness in the wider community may lead to residents or staff contracting the COVID-19 and
outbreaks in residential care facilities.
Families play an important role in protecting their relatives from community viruses. Practical steps you can take to prevent
COVID-19 from entering residential care facilities are outlined below.
Avoid spreading illnesses
Washing your hands well with liquid soap and water or alcohol-based hand rub before and after visiting and after coughing or
sneezing will help reduce the spread of disease. Cover your mouth with a tissue or your elbow (not your bare hand) when
coughing or sneezing and dispose of used tissues immediately and wash your hands.
Follow any restrictions the residential care facility has put in place
Facilities will post signs at entrances and within their units to inform you if an outbreak is occurring so look out for these
warning signs when entering the facility.
It is important to follow the infection control guidelines as directed by the facility staff. This may include wearing a disposable
face mask and/or other protective equipment (gloves, gowns) as instructed. Certain group activities may be postponed during
an outbreak.
Stay away if you’re unwell
If you have recently been unwell, been in contact with someone who is unwell or you have symptoms of respiratory illness (e.g.
fever, cough, shortness of breath, sore throat, muscle and joint pain, or tiredness/exhaustion) please do not visit the facility until
your symptoms have resolved. If you have been in contact with a confirmed case of COVID-19 you must stay away until you are
released from self-isolation.
Limit your visit
If there is an outbreak in the residential care facility, we ask that you only visit the person you have come to see and keep
children away if they or your resident family member is unwell. Avoid spending time in communal areas of the facility if possible
to reduce the risk of spreading infection.
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Thank you for your assistance in adhering to these steps. These measures will greatly assist residential care facilities and protect
the health of your relatives in the event of a COVID-19 outbreak.
Should you require further information regarding COVID-19, please refer to the Victorian Department of Health and Human
Services website:
https://www.dhhs.vic.gov.au/coronavirus
Yours sincerely
[Name]
[Position]
[Facility/Organisation]
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Appendix Three - Initial report to DoHHS – COVID-19 Outbreak
Date/time: ___________________ Public Health Officer: _____________________
Contact details:
Person notifying outbreak: _______________ Position: ______________________
Telephone number: ____________________ Email: _________________________
Facility details:
Name of Facility_______________________________________________________
Address: _____________________________________________________________
Facility Manager / Director: ______________________________________________
Telephone number: _____________________ Fax number: ____________________
Email address: _________________________
Description of facility: __________________________________________________
Total number of residents: _______________ Total number of staff: ____________
Age range of residents: ___________________
Number of units / wings / areas in facility: __________________________________
Floorplan provided: Yes / No
Residents:
Unit name Resident no. Long term Short term / Respite
High Care Dementia / Secure
Other
RCF Staff:
Staff type No. of RCF staff No. agency staff No. Causal staff No. volunteers
Management
Administrator
Cleaner
Nurse
Carer / Care Assistant
Agency
Other (specify)
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APPENDIX FOUR – OUTBREAK MANAGEMENT CHECKLIST
Adapted from the RACF checklist for respiratory illness outbreak management.
Outbreak management checklist
Identify
Identify if your facility has an outbreak using the current definition
Implement infection control measures
Isolate / cohort ill residents – managed by Infection Prevention Service
Implement droplet and enhanced contact precautions
Provide PPE outside rooms
Display sign outside rooms
Identify any resident using nebulisers or non-invasive ventilation i.e. CPAP/BIPAP as they will require care with airborne transmission based precautions whilst these procedures occur and for 30 minutes following. Their room frequent touch points require cleaning and disinfection after procedure ceases.
Exclude ill staff until symptom free (or if confirmed cased of COVID-19, until they meet the release from isolation criteria)
Reinforce standard precautions (hand hygiene, cough etiquette) throughout facility
Display outbreak signage at entrances to facility
Increase frequency of environmental cleaning (minimum twice daily)
Notify
The Victorian Department of Health and Human Services on ph. 1300 651 160
Fax initial case list to 1300 651 170
Contact the GPs of ill residents for review
Provide the outbreak letter (Appendix one of RAC COVID-19 Pandemic Plan) to all residents’
GP’s
Inform families and all staff of outbreak
Restrict
Avoid resident transfers if possible
Cancel non-essential group activities during the outbreak period
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Influenza vaccination
Offer influenza vaccination for all unvaccinated staff and residents
Monitor
Monitor outbreak progress through ≥ twice daily observation of residents for fever and acute
respiratory symptoms
IPS or NUM update the case list daily at the facility and fax to the department daily
Add positive and negative test results to case list
Declare
Declare the outbreak over when there are no new cases 14 days from the date of isolation of
the most recent case (in consultation with the department if needed)
Review
Review and evaluate outbreak management – amend outbreak management plan if needed
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APPENDIX FIVE – CARE PLAN SUSPECTED / CONFIRMED COVID-19
Does person have a history of contact with a suspected/ confirmed case of COVID-19? Yes No
Date swab sent ________________Has this been confirmed with a positive swab result? Yes No
DATE: ADMISSION & ONGOING ASSESSMENT CARE PLAN
Reporting case of suspicion / confirmed
case of COVID- 19 infectious illness
Department of Health and Human Services notified on phone
number 1300 651 160
Date:
Confirmed case only: mailto:[email protected]
Date:
Advance care planning / Advance Care
Directives
Staff are clear about each about the
resident’s values and preferences for their
future care.
Staff have identified medical treatment
decision maker
https://www2.health.vic.gov.au/hospitals-
and-health-services/patient-care/end-of-
life-care/advance-care-planning/medical-
treatment-planning-and-decisions-act
Confirm advanced care planning, directives and goals of care are
current Yes No Medical treatment decision maker contact details confirmed and
available.
Yes No Advance care plans, goals of care and directives: Must be
discussed with the resident and family /representative
communicated to staff.
Consultation
Tick who has been contacted
GP RESIDENTIAL IN REACH LOCUM
Infection prevention precautions in place
Refer to this guideline
Room isolation with own ensuite Yes No
Cohorted in wing apart from other non-infected residents Yes
No
Infection control precautions are in place Yes No
Single use PPE in place
Mask
Gloves
Long sleeved gowns: Yes No
Use of nebulizer/CPAP/BIPAP Yes No If yes:
Airborne transmission based precautions during procedure and for 30 minutes following
Clean and disinfect frequent touch points of resident room following procedure
Baseline typical results for this resident include:
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Assessments
Consider both measurement of resident
observations and, timely reporting and
review of results by clinical staff
4/24 or QID observations or more frequent as per clinical status
T,P,R,BP & Oxygen saturations in Room air/on Oxygen (humidified
and warmed if possible) Reportable levels as per GP order, or may include:
T 37.5 °C, notify GP possible blood cultures required
Persistent tachycardia
Respiratory rate >30 breathes per minute
BP < 90 mmHg systolic, < 60 diastolic
O Sat < 90% humidified O2 via nasal prongs as prescribed by GP If any changes in clinical status report and escalate as soon as
possible to the Registered Nurse in charge of the Shift
Is the person symptomatic?
Risk of clinical deterioration
If any changes in clinical status report
and escalate as soon as possible to the
Registered Nurse in charge of the Shift
Sore Throat Yes No
High temperature Yes No
Cough present Yes No
Increased effort to breathe Yes No
Changed conscious state Yes No
Acute onset confusion change in behaviours Yes No
Evidence of Cyanosis (blue lips or fingers) Yes No
Secretions / Crepitation present Yes No
Audible wheeze present Yes No
Medications
Risk of acute pain and discomfort
Administered as per medication chart
Consider anticipatory medications as per goals of care
Consider increased assessment for pain and other signs and
symptoms of distress
Nutrition and Hydration
Risks of dehydration and monitor
appropriately. Ensure timely referral to
dietician and /or speech therapist
Consider resident’s current nutrition care plan including allergies,
modified diets etc., in light of current illness
Commence fluid balance chart monitoring.
Mobility
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Risk of decreased mobility and
functionality due to illness Ensure timely
referral to physiotherapist and /or
occupational therapist
Consider resident’s current mobility care plan including mobility,
transfers, etc. in light of current illness and possible functional
decline
Psychosocial
Risk of impact to health and wellbeing
including risk of increased levels of
anxiety and exacerbation of pre-existing
mental health conditions.
Consider residents current psychosocial needs, in light of current
illness and care management strategies.
Other /Allied health
Risk of DVT
Risk of development of secondary
complications
Consider implementation of measures to reduce complications of
immobility and functional decline: e.g. hourly deep breathing and
coughing, regular bed mobility
Progress notes documentation Documentation should be regular to indicate clear monitoring and
evaluation of resident’s progress and overall health status.
Name:…………………………………………………..Designation:…………………………………….
Signature:………………………………………………..
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Appendix Six
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Appendix seven - Respiratory Swab collection for COVID-19
Equipment:
Personal protective equipment (PPE) for the health care worker taking the swab, including gown, gloves, eye protection (goggles or face shield) and surgical mask.
One dry, sterile, flocked swab.nb. Two dry, sterile, flocked swabs if collecting a respiratory PCR. o Label the swabs with patient’s full name, date of birth, specimen type, date and time of collection.
Preparation: • Don PPE as per Sequence for putting on PPE • Explain the procedure to the patient and obtain consent.
• Place patient standing or sitting with head tilted at 70, supported against a bed, chair or wall.
Step one – throat swab
Stand at the side of the patient’s head and ensure their head is resting against a supporting surface.
Place your non-dominant hand on the patient’s forehead.
Ask patient to open mouth widely and say “argh”
Using the flocked swab, insert the swab into the mouth, avoiding any saliva.
Place lateral pressure on the swab to collect cells from the tonsillar fossa to ensure the swab contains epithelial cells (not
mucus)
Step two – Nasopharyngeal swab Nb. Respiratory PCR testing will only require swabbing of the nasal septum (not throat).
Remain at side of patient’s head and place your non-dominant hand on the patient’s forehead with your thumb at the tip
of the nose.
The other hand inserts the same swab used for the throat swab horizontally into the patient’s nostril, approx. 2-3 cm
Place pressure on the swab in order to collect sells from the midline nasal septum.
Rotate the swab twice (2 x 360 turns) collecting the epithelial cells (not mucus) from the nostril.
Repeat procedure in other nostril.
Place specimens in biological transport bag, preferably held by staff outside room to keep outside of bag clean.
Alternatively, clean bag with alcohol wipe after doffing PPE
Throat
swab
Nose
swab
On completion Remove PPE inside patient’s room per Sequence for taking off PPE and dispose of PPE into clinical waste receptacle. Specimen Handling and Transport Place transport tube with the COVID-19 PCR specimen (i.e. nose and throat swab) into a plastic bag and include request form. Deliver to Australian Rickettsial Reference Laboratory (ARRL) located on 3rd level of Douglas Hocking Research Institute.
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Appendix eight - Residential Aged Care Facility COVID-19 Communication Response Record
Facility name:
Source Document Distribution date Distributed to Distribution
mechanism
Signature
One point
Coronavirus
information for staff
One point
Today’s health news
Press clippings
One point Infection Prevention
Service page
Communique from the
CEO. Please print and
display to support staff
who are not frequently
accessing email.
Department of health Fact sheets
Department of health Website
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Appendix nine – Sample COVID-19 Outbreak Case List
This will be provided by Infection Prevention Services in an excel format.
DHHS Use only
PHO
Outbreak number
COVID-19 - ILLNESS REGISTER (LINE LISTING) - RESIDENTS and STAFF
DATE: 13/03/20 FACILITY: TOTAL NUMBER OF RESIDENTS: 3
TOTAL NUMBER OF STAFF: 0
Died
Resid
en
t o
r S
taff (R
o
r S
)
Lo
catio
n
Occu
patio
n (S
taff o
nly)
Su
rn
am
e
Firstn
am
e
Sex (M
o
r F
)
DO
B (d
d-m
m-yyyy)
Date of
onset of
symptoms
(dd/mm)
Date last
worked
(dd/mm)
Su
dd
en
o
nset o
f sym
pto
ms (Y
/N
)
Fever o
r T
em
p >
38°C
(Y
/N
)
Resp
irato
ry sym
to
ms (co
ug
h, so
re th
ro
at,
co
ryza, S
OB
) (Y
/N
)
Gen
eral sym
pto
ms (m
yalg
ia, m
alaise,
leth
arg
y, h
ead
ach
e) (Y
/N
)
Ho
sp
italised
(Y
/N
)
Deceased
(Y
/N
)
CO
VID
-19 P
CR
Date sw
ab
taken
(d
d-m
mm
)
Resu
lt
PC
R m
ultip
lex resp
irato
ry
Date taken
Resu
lt
Vaccin
ated
2020 (Y
/N
)
Flu
Ad
(A
)
/ o
th
er F
lu
vax (X
)
Date vaccin
ated
Pro
ph
ylaxis
Treatm
en
t
Date co
mm
en
ced
Other Comments
** (Includes swab
results)
1
2
3
4
5
6
Antivirals
Case N
um
ber
VaccinationSwabClinical
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Identify suspected COVID-19 resident
•Patients who meet the following clinical criteria should be tested:•Fever OR chills in the absence of an alternative diagnosis that explains the clinical presentation•OR•Acute respiratory infection that is characterised by cough, sore throat or shortness of breath
•Note: In addition, testing is recommended for people with new onset of other clinical symptoms consistent with COVID-19* AND who are close contacts of a confirmed case of COVID-19 or who have returned from overseas in the past 14 days.
•*headache, myalgia, runny or stuffy nose, anosmia, nausea, vomiting, diarrhoea
Managing a suspected COVID-19 case
•Immediately commence droplet and enhanced contact precautions•Contact GP•If GP unavailable - phone Infection Prevention Service ext.55947/52325between 0700 -2100 hours or ID registrar Mob. 0434 181 822 between 2100 – 0700 hours•Testing:•Single flocked viral swabs*•Swab both nostrils and throat for COVID-19 PCR•Swab to ARRL* for COVID-19 PCR •Respiratory multiplex PCR (if taken) swab to ACL* •Send straight to respective laboratories, do not refrigerate•Cleaning - Triple clean daily
•*ARRL - Australian Rickettsial Reference Laboratory at UHG•*Australian Clinical Laboratory
•Residential aged care workers who are unwell are to notify manager and contact Staffcare on ph. 0408 127 147
Stopping transmission based precautions for COVID-19
•A negative result for COVID-19 communicated to nurse unit manager - phone call from infectious disease registrar or Infection Prevention Nurse or available on BOSSnet•Droplet transmission based precautions to continue if an influenza like illness, await results from respiratory PCR•COVID-19 confirmed cases remains in droplet and enhanced contact transmission based precautions until decided by treating GP and Infectious Disease Registrar.
Appendix Ten Resident Management Process for Suspected COVID-19
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Appendix 11 - COVID-19 Staff Screening Log Book
Please complete the table – use a tick or X to indicate if you have any COVID symptoms, a high temperature or contact with a COVID case.
If any box contains an X, then please discuss with ANUM / Manager immediately before commencing work
Date Name Staff ID number
Area of work I have NO COVID symptoms
My Temperature is less than 37.5
I have had NO close contact with COVID case
Signature
9/4/2020 Florence Nightingale 007007 Percy Baxter √ √ √
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