Improving communicable disease outbreak preparedness in residential aged care facilities using an interventional interview strategy

Preparedness for viral respiratory infection pandemic in residential aged care facilities: A review of the literature to inform post-COVID-19 response

AIMS AND OBJECTIVES

To examine what was known about disaster preparedness in residential care and to consider this in the light of the current COVID-19 pandemic.

BACKGROUND

Care homes provide long-term care to vulnerable, frail older people, as well as to young people with profound disabilities. The COVID-19 pandemic has shown that the residential care sector has been seriously affected in many parts of the world and has exposed major flaws and vulnerabilities in infection control and other processes that have resulted in considerable loss of life of residents of these facilities.

DESIGN

Discursive paper informed by a systematic literature. Review was carried out in line with PRISMA reporting guidelines. The review protocol was registered with PROSPERO on 2020 [CRD42020211847].

RESULTS

The review identified six papers meeting inclusion criteria across care residential facilities in different countries. Several prevention and mitigation strategies were identified to manage and reduce the spread and severity of viral respiratory infection pandemics. These strategies include isolation, restriction of movement, personal protective and hygienic measures, health education and information sharing, monitoring and coordination, and screening and treatment. Preparedness strategies identified were contingency planning such as reporting/communication, leadership, human resource, insurance, occupational health and resource availability. The prevention/mitigation and preparedness strategies helped to achieve decline in disease severity, reduced prevalence, reduced spread of the disease, improved readiness criteria, resource usefulness and increased intervention acceptability. This paper presents a conceptual framework exploring the interconnectedness of preparedness and prevention/ mitigation strategies and associated outcomes. We discuss areas of concern in the context of workforce employment patterns in the sector. Concerns related to the unintended consequences of strategies placed on aged care facilities, which may worsen mental health outcomes for residents, are discussed.

CONCLUSIONS

Persons in residential care settings are at greater risk of infection during a pandemic, and therefore, strict measures to protect their safety are warranted. However, they are also a group who already experience social isolation and so any measures involving restrictions to visiting and social interaction, particularly over the longer term, must be accompanied by strategies to mitigate potential loneliness and mental health sequelae arising from long-term pandemic restrictions.

RELEVANCE TO CLINICAL PRACTICE

Though there was evidence of activity in preparedness for disasters within the residential care sector, various contextual factors affecting the sector were clearly not adequately considered or addressed in pre-pandemic disaster planning, particularly in the areas of staff movements between care homes and the length of time that social isolation and restriction measures would need to be in place. Future pandemic planning should consider the nature of the workforce model in the care home sector, and factor in strategies to better support the mobile and highly casualised workforce.

Understanding barriers to effective management of influenza outbreaks by residential aged care facilities

OBJECTIVE

To identify the perceived barriers to the implementation of the Australian national guidelines on influenza outbreak management with Sydney Local Health District (SLHD) residential aged care facility (RACF) staff.

METHODS

All SLHD RACFs were invited to participate in a telephone interview. The questionnaire collected information about demographic characteristics and participants' level of agreement with statements regarding perceived barriers to implementing the national guidelines for influenza outbreak management.

RESULTS

Twenty-eight of 61 RACFs (46%) participated in the study. The three most common barriers identified were as follows: scepticism towards staff influenza vaccination (n = 13, 46%); the effort required to read the national guidelines (n = 11, 39%); and lack of infrastructure to physically separate residents during an outbreak (n = 10, 36%).

CONCLUSIONS

We recommend implementing and evaluating programmes which address misconceptions about influenza vaccination amongst RACF staff. Further, all RACF staff, including care staff, should receive targeted education on the role of infection control in influenza outbreak management.

The Burden of Infectious Gastroenteritis in Elderly Residents and Staff of Long-Term Care Facilities, Australia

We estimated the incidence of gastroenteritis in 16 Australian long-term care facilities. During 12 months' surveillance, 245 (96%) of 254 episodes of gastroenteritis among long-term care residents were associated with 17 outbreaks in 11 facilities. Incidence in long-term care residents was 0.64 episodes per 1,000 bed-days (95% confidence interval, 0.29-1.42).