IPC and the Aged Care Royal Commission

During 10–13 August 2020, the Royal Commission’s inquiry focused on:

• The role and responsibilities of state, territory and federal governments in responding to such crises in aged care services
• What should be done, and by whom, in the future to support the aged care sector to respond to pandemics, infectious disease outbreaks or other emergencies
• The balance between managing risks posed by a future pandemic or infectious disease outbreak and maintaining the overall health and wellbeing of aged care recipients, including their mental health and quality of life
• The measures taken by the health and aged care sectors to respond to the pandemic, including transporting infected residents to hospital
• The impact of those measures on older Australians receiving aged care services, their families, and their carers
• Challenges faced by the aged care sector including those relating to management, workforce, and access to personal protective equipment
• Any other related matters.

Key points of the Aged Care Royal Commission:

• The Commission was told there was a “stand-off” about moving infectious residents to the hospital
• Infection Control Specialists are to be assigned in every aged care home
• Aged care homes should be very “stringent with environmental cleaning”

How Well Prepared Was the Aged Care Sector for COVID-19?

Mr Rozen, as counsel assisting, doubted Minister for Health Greg Hunt’s statement that the aged care sector was “immensely prepared” for COVID-19.

His presentation to the Aged Care Royal Commission noted that communication with the sector was not sufficient:

1. The Australian Health Protection Principal Committee is the primary source of information about COVID-19 in Australia. Still, it did not provide any update to its guidance between 19 June 2020 and 3 August 2020. 
2. The lessons learnt from the two aged care outbreaks in Sydney at Newmarch House and Dorothy Henderson Lodge were not “appropriately refined and communicated to the sector at all”. 

Quality Commission Survey “Very Optimistic”

The “very optimistic” results from the Aged Care Quality and Safety Commission’s (ACQSC) survey of aged care providers about their preparedness for COVID-19 was seriously evaluated.

The survey found more than 99 per cent of respondents said they:

• had an infection control/respiratory outbreak plan,
• had an idea for communicating with staff, residents, volunteers and family members in the case of an outbreak, and
• have assessed their readiness for a COVID-19 outbreak as either ‘satisfactory’ (56.8%) or ‘best practice’ (42.7%).

The Royal Commission will hear from Professor Joseph Ibrahim this week, who is expected to be “highly critical” of this survey. We will be eagerly waiting for the hearing on Wednesday (19 August). 

Indecision Between State and Federal Government

Mr Rozen also described the difficulties seen in delegating responsibilities between the provider, the state government, and the Federal Government. He said equal access to the hospital system was a fundamental right of all Australians, irrespective of age.

“To put it very directly, older people are no less deserving of hospital treatment because they are old, such an approach is ageist.”

It is a fascinating fact that in Australia we still have this battle. Mr Rosen posed:

“Who would call the shots?. For example, who would decide when it is appropriate for a COVID-19 positive resident to be transferred from an aged care home, which falls under the jurisdiction of the Commonwealth, to a hospital which falls under the state system?”

Opinions among experts and state health departments vary on the question of whether to hospitalise residents who test positive to COVID-19. Prof McLaws, who is an epidemiologist with a public health standpoint, believes that for aged care residents who are positive for COVID-19: “Transfer to the hospital is the only appropriate solution that may improve their survival rate and reduce the risk of infection in the remainder of residents”.

Dr Branley, an infectious diseases doctor with a focus on what is clinically indicated for individual patients, treated a number of residents at Newmarch House. He believes that this is not the best practice’s approach. 

Differing perspectives

Let’s discuss these different perspectives. 

• South Australia’s Health Department has a policy that hospitalisation is the most appropriate public health response.
• The approach in New South Wales is to treat residents on a case-by-case basis. 

On 24 July 2020, the WHO released a policy brief: ‘Preventing and managing COVID-19 across long-term care services’. The recommendations are to:

• Ensure there is no selection based on age or disease in such protocols, but that people’s needs and preferences determine care decisions.
• Ensure that all long-term care facilities are supported by a primary care service.

“There is no vaccine, so you have to be very stringent with environmental cleaning”. 

It was a good discussion during the Aged Care Royal Commission between Mr Rozen and Prof McLaws about what can be done now, particularly in the absence of vaccinations against COVID-19. Maintaining social distancing, scrupulous hand hygiene culture and environmental cleaning with airflow change are challenging tasks in all aged care homes.

“You can catch COVID-19 from high touch areas that have been contaminated with the virus. This virus can live on hard surfaces, such as metals and bed railings, for example, for up to three to six hours.”  

“… residential aged care facilities are basically a shared home. They may have heating to keep the levels of temperature at a comfortable rate. They will not be opening up windows to get good airflow and decontamination … if they don’t have the airflow that hospitals have where they will be looking after COVID patients.  

“Aged care homes got workers, carers, that are basically caring for the elderly as if they are family members. … they do not see a risk between themselves and the elderly necessarily. They have got a bond, and they may fail to hand hygiene as often and as scrupulously, so it takes a lot of training and awareness.”

Infection Control Specialists in Every Aged Care Home

Mr Rozen spoke of the need for infection control specialists in aged care facilities. 

He said Kathy Dempsey from the NSW Clinical Excellence Commission and another expert in infection control were deployed from day one of the outbreak at Dorothy Henderson Lodge, help that was described as “invaluable”. 

However, infection control expertise was not brought into Newmarch House until two weeks into the outbreak. On 12 August 2020, the ACQSC released a statement regarding alleged delays in the provision of a report from the NSW Health Clinical Excellence Commission on Newmarch House.

In their recently released policy, the WHO tells us to:

“Ensure that long-term care facilities have an IPC focal point to lead and coordinate IPC activities, ideally supported by an IPC team with delegated responsibilities and advised by a multidisciplinary committee.[RF2] ”

So what does this mean for you as a facility manager or outbreak/infection prevention and control coordinator?

Tips for evaluation and consideration:

1. Consistently evaluate a facility COVID-19 suspected/confirmed case or outbreak management plan. Ask yourself honestly: If COVID-19 is suspected:
   1. Are you ready to provide the safety and security of emergency care in an area that is separate for ill residents to temporarily move to?
   2. What would you do if you have a situation where a COVID-19 case is suspected or confirmed?
   3. What would be your actions if a resident requires a higher level of care?
2. Aged care managers should assign at least one individual with training in infection prevention and control (IPC) to provide consistent on-site management of their COVID-19 prevention and response activities because of the extensive activities. for which an IPC program is responsible. This includes:
   1. developing IPC policies and procedures
   2. performing infection surveillance
   3. providing competency-based training of HCP, and
   4. a broader scope of internal auditing compliance to recommended IPC practices.
3. A high-level infection control review to be conducted at each aged care home by an external (independent) auditor.
4. Coronavirus (COVID-19) can be easily inactivated. However, that means constant cleaning of the environment, air decontamination and constant cleaning of high touch areas. Do you have very good hand hygiene training and constant cleaning of the environment in your aged care home?

For more information you can visit the ACQSC website and watch the latest webinar for NSW/QLD providers at this link.

If you’re interested in an external, independent audit, why not consider Bug Control? Their clinicians have decades of experience and have performed over a thousand audits across facilities in Australia and New Zealand. You can read more about our audits here — why not invest in your future?