Being COVID ready is all in the planning

If you were to google COVID-19 in Residential Aged Care you would be overwhelmed by the amount of information available. For this reason, in this article I will be referencing the Communicable Diseases Network Australia (CDNA) National Guidelines for The Prevention, Control and Public Health Management Of COVID-19 Outbreaks in Residential Care Facilities in Australia (last revised March 2021).

In discussion with friends, who in the early days of the pandemic had been seconded to residential aged care homes to manage an outbreak, these auspicious few observed that aged care providers were simply not prepared.

Many thought it would be like managing an influenza or gastro outbreak. How wrong they were! In their words it was 24/7 chaos, a war-like zone, madness!

When asked why they experienced this, they all said it was simply a failure to understand COVID-19 and its insidious aetiology, which resulted in the subsequent under-estimated planning. 

Applying lessons learned

We are now many months down the track and there have been some amazing lessons learnt. Again, talking with friends who are now in the trenches, in their words the key to managing an outbreak is PREPAREDNESS and even then, you may still not nail it completely.  So, it is important to constantly update your plans.

There is no need for me to reiterate the CDNA manual by chapter and verse; it is an easy to read and comprehensive guide and should be by your bedside (or desk, if you prefer).

I have, however, made note of key considerations when preventing and managing an outbreak of COVID-19. In fact, I joined a webinar on the 30 August facilitated by the Aged Care Quality and Safety Commission – Being Ready for COVID-19 outbreak.

It was informative and a gentle reminder on how important it is to be prepared. It will be available via this link if you missed it. https://www.agedcarequality.gov.au/events

C is for control

To control the spread of the virus from doing harm: know the signs and symptoms and how it spreads. Ensure your teams are well versed with the use of PPE and are provided with constant and consistent information and education. 

• Know the incubation and infectious periods and routes of transmission.
• Understand the difference between quarantine and isolation and consider how you will implement these.
• Know the complications associated with COVID-19. 
• Communicate with not only teams but with residents and their families, contractors and external agencies: make the public health unit (PHU) and the Commission your partners and keep the channels of communication open. Know what letters of notification need to be written and who will be responsible.
• Review clinical governance: have systems in place to support and promote safe quality care such as policies, guides, position descriptions, incident management, investigation framework and reporting. Look to continually improve as lessons are learnt. It is a dynamic environment.

O is for operational preparedness

Operationally be prepared: have a comprehensive plan, know it and test it over and over! Do not be afraid to have the PHU review your plans.

• Consider every part of your business and every member, their role and responsibilities. Your plans need to include everyone.
• Have a plan if you have to rapidly furlough team members, and have your surge team plans ready to go.
• Have a vaccination plan for both residents and your teams.
• Plan how you would cohort/zone residents and deploy staff to reduce the risk of cross-contamination.
• Plan to transfer residents.
• Communicate with not only teams but with residents and their families, contractors and external agencies – make the PHU and the Commission your partners and keep the channels of communication open.

V is for vigilance

Be vigilant – being COVID ready means keeping up to date, knowing the hot spots, applying real time directives, watching, listening and taking action.

• Ensure teams know their residents and report changes immediately.
• Know when you will be able to admit or re-admit residents.
• Know how to declare an outbreak over and who has the authority to do so.
• Communicate with not only teams but with residents and their families, contractors and external agencies. Make the PHU and the Commission your partners and keep the channels of communication open.

I is for infection control

Infection control – identify your Infection Prevention Control Leads and your Outbreak Management Team.

• Identify risks, know your gaps and implement strategies to mitigate these risks.
• Know your vaccination rates and participants.
• Consider preventative measures such as screening protocols, rapid antigen testing, education and training requirements, methods to monitor practices, and pathology management.
• Communicate with not only teams but with residents and their families, contractors and external agencies. Make the PHU and the Commission your partners and keep the channels of communication open.

D is for documentation

Document and share your plans: include roles and responsibilities, escalation protocols, communication strategies, reporting requirements and record keeping.

• Monitor and document COVID positive cases.
• Document team members and residents who have been screened.
• Communicate with not only teams but with residents and their families, contractors and external agencies. Make the PHU and the Commission your partners and keep the channels of communication open.

Bringing it all together

Each one of these points is well explained in the CDNA manual. It has been my experience that establishing an outbreak management team is crucial. When considering members, do not forget to have a person from your local PHU, as well as your IPC lead in the team.

This is a good place to start, then you can develop your terms of reference. Be strict with meeting times and minute taking.

The PHU will provide you with a robust preparedness checklist and will be prepared to review your plans.

Being COVID ready and the Standards

I hate to have to say this, but it is important, so please consider it as a reminder. As a registered nurse working for an aged care provider, you have a social and professional obligation to minimise infection. Not only that, but under the Aged Care Act 1997 – Quality of Care Principles 2014 and its subsequent amendments, you have a legal obligation to adhere to organisational systems and processes that promote both a culture and practice that supports infection control.

It is the Aged Care Quality and Safety Commission (ACQSC) that monitors compliance with this requirement via The Aged Care Standards 2019, specifically under the following standard:

Personal care and clinical care- Standard 3.
Requirement (3) (g) Minimisation of infection-related risks through implementing:
a. standard and transmission-based precautions to prevent and control infection; and
b. practices to promote appropriate antibiotic prescribing and use to support optimal care and reduce the risk of increasing resistance to antibiotics.

During the webinar the Commission spoke of the importance of having a system to closely monitor the well-being of residents – so include in your planning and documentation how you will consider managing the risks as mentioned by the Commission:

• Psychosocial – there may be a decline in a person’s wellbeing as a result of isolation and loneliness.
• Physical deconditioning – resulting from reduced capacity to move freely in an environment reducing the opportunity to both socialise and exercise.
• Nutritional decline – this may be a result from social isolation, eating meals in their rooms alone, depression or reduced assistance because of staff capabilities.

I know there is a lot to think about and do, but remember the start of this article “by failing to prepare, you are preparing to fail”. These words do ring true. But here is something else for you to consider:

A leader is one who knows the way, goes the way, and shows the way.

John Maxwell

Taking charge your facility’s infection control is a big job, and sometimes you need extra help. Bug Control membership provides you with expert IPC advice from infection control specialists when you need it. Not only that, but it also provides access to our education platform, which streamlines staff education in all things infection control. Contact us today to find out more.

Emilia Graham is a quality compliance operations innovation and improvement clinical governance consultant.