Influenza and COVID-19 Planning for Aged Care Facilities

The Aged Care sector is facing dual threats from Influenza and COVID-19 in 2020. This briefing emphasizes the importance of prevention and preparedness activities for Residential Aged Care Facilities. National guidelines are available to assist in planning, recognizing outbreaks, and implementing infection control measures. The approach combines strategies for both influenza and COVID-19, incorporating incident management principles to address the current pandemic threat and future seasonal challenges.

• Aged Care
• Influenza
• COVID-19
• Planning
• Preparedness

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1. Influenza and COVID-19 Planning and preparedness for residential aged care facilities Metro North Public Health Unit Updated 1stApril 2020 Aged Care Sector Briefing COVID19, 19 March 2020

2. Influenza and COVID-19 Aged care sector is facing dual communicable disease threats in 2020: oInfluenza oCoronavirus disease 2019 (COVID-19) Numbers of cases are currently small in Australia, and in Queensland NB: this situation will change rapidly at any time Residential aged care facilities are being urged to prioritise prevention and preparedness activities 2 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

3. National guidelines National guidelines available to assist planning and preparedness activities o Influenza: Guidelines for the prevention, control and public health management of influenza outbreaks in residential care facilities Communicable Diseases Network Australia (Mar 2017) https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-flu-guidelines.htm o COVID-19: Coronavirus (COVID-19) guidelines for outbreaks in residential care facilities Communicable Diseases Network Australia (first version published 13 Mar 2020) https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-outbreaks-in- residential-care-facilities o COVID-19 guidelines state: ..the principles are applicable to many settings including residential facilities for people with physical and mental disabilities, other community based health facilities (e.g. Drug and alcohol services, community mental health), detention and correctional centers, military barracks, boarding schools, hostels and any other setting where residents sleep, eat and live either temporarily or on an ongoing basis . 3 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

4. Planning approach for RACFs Both the national guidelines for influenza and COVID-19 guidelines: o Recognise an outbreak as an incident requiring a coordinated facility-wide approach o Advise the use of Droplet and Contact Precautions to prevent further spread of disease Infection control and outbreak management strategies used for influenza will ALSO be effective to manage COVID-19 This approach to influenza and COVID-19 planning incorporates incident management principles: o Implementing a comprehensive, all-hazards approach to planning and preparedness o Developing emergency responses based on existing processes and practices COVID-19 is the current pandemic threat, but influenza will remain a seasonal threat every year 4 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

5. Outbreak management plan Integral to an effective outbreak response is an Outbreak Management Plan Metro North Public Health Unit has developed a suite of documents to assist RACFs with their influenza planning and preparedness activities oDistributed to RACFs within the Metro North Hospital and Health Service in 2018 and 2019 These documents have been updated and published on the Metro North Public Health Unit web site: https://metronorth.health.qld.gov.au/hospitals-services/public-health-unit/cdc/aged- care-facilites 5 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

6. Influenza outbreak management plan (OMP) Appendices include: OMP template includes: - roles and responsibilities of stakeholders-template - governance arrangements - outbreak notification process-template - communications - contact details of stakeholders-template - management of staff, residents and families - facility alert sign - infection control measures - handwash/rub and respiratory etiquette signs - pathology testing - Droplet and Contact Precautions sign - antiviral medications - antiviral dosages - maintaining stock levels of relevant consumables - oseltamivir fact sheet - review of the plan COVID-19 specific appendices: - Novel respiratory disease of public health The OMP template is designed to significantly decrease the time required to develop a comprehensive plan. concern-COVID-19 (including a template) - Airborne and Contact Precautions sign - Principles of fit checking P2/N95 masks 6 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

7. Further influenza resources available on MNPHU website Influenza planning guide o This document is a resource which provides links to influenza resources and outlines objectives, strategies and tactics to assist your facility to complete an Influenza Outbreak Management Plan. o It can also be used as a check list if desired. Influenza vaccination registers (spreadsheet templates) o Maintaining separate electronic registers for annual staff and resident influenza vaccinations is recommended. o These templates automatically generate the percentage of staff and residents who have been vaccinated or who have declined. Influenza vaccination declination form o Benefits of using declination forms may include: - assisting staff to make an active choice about whether or not to be vaccinated - identifying areas within your facility where targeted education may be required to approach universal acceptance of influenza vaccination. - The template can be amended, should you choose to adapt it, according to the needs of your facility. 7 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

8. Planning guide comprehensive planning approach Planning phase Objective Strategy Prevention Undertake activities to decrease the risk of an ILI outbreak occurring 1. Increase facility-wide influenza vaccination coverage to at least 95% by 1st June Implement a facility-wide vaccination policy Implement a resident influenza vaccination program Implement an onsite staff influenza vaccination program Promote influenza vaccination for contractors who provide services to the facility (i.e. will have, or potentially have contact with residents and staff) Promote influenza vaccination for families/friends 2. Increase capability to monitor for ILI in residents, staff and contractors Implement heightened facility-wide ILI surveillance from April to October 3. Exclude people with ILI from the facility Implement a facility-wide ILI exclusion policy Preparedness Prior to an ILI outbreak occurring, assess risks and develop plans and pre-planned responses 1. Document response activities in an ILI outbreak management plan Implement governance arrangements to manage the outbreak Implement a communications strategy to staff, families, contractors and residents Manage staff to prevent further spread and maintain business continuity Manage residents to prevent further spread Implement infection control practices to prevent further spread Manage contractors and families to prevent further spread Test residents with ILI to confirm the diagnosis Provide antiviral treatment and prophylaxis for residents Maintain adequate stock levels to manage an ILI outbreak response Review the application of Standard and Transmission-based Precautions with all staff from April to October and during an ILI outbreak Provide information about hand hygiene and respiratory etiquette for residents and families from April to October 2. Develop and maintain a high level of knowledge and competency re: the infection control practices required to manage ILI Response Minimise the impact of an ILI outbreak and ensure appropriate responses are initiated 1. Prevent further spread of influenza within the facility Implement an early and efficient outbreak response Recovery Return to business as usual 1. Incorporate learnings to improve future responses Evaluate the outbreak response Review the outbreak management plan 8 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

9. Public health assumptions to consider As outlined in the Coronavirus disease 2019 outbreaks in residential care facilities (CDNA, Mar 2020): o A COVID-19 pandemic will affect the entire health care system and the community - Hospitals, local public health units and other services may have limited capacity - RACFs may not be able to rely on the same level of support they receive now - This might include caring for residents who would usually be managed in the hospital setting o Number of RACF staff may reduce by up to one third o Usual source of supplies will be disrupted or unavailable o Infection prevention and control practices (e.g. hand hygiene, PPE, isolation, etc,) will be the main line of defence as: - A COVID-19 vaccine will not be available for at least 12 months - The efficacy of antivirals is currently unknown o Care protocols may change and new practice may have to be adapted o Communications with families will need to meet their needs for information and reduce the demands on staff 9 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

10. Planning and preparedness activities Planning and preparedness activities advised to commence now: (Checklist available via the Queensland Health coronavirus page) o Develop/review your influenza outbreak management plan o Entry screening: consider a single entry to the facility, screen for ARI and take temperature o Implement an active surveillance program to monitor all residents for: - influenza-like illness (ILI) - fever or acute respiratory symptoms (ARI) in the context of confirmed local transmission of COVID-19 o Advise staff to monitor themselves for fever or ARI and to report immediately to their supervisor o Advise families and visitors to exclude themselves from the facility if they develop a fever or acute respiratory symptoms o Ensure all staff are trained in the 5 Moments for Hand Hygiene o Ensure all staff are trained to use the appropriate PPE correctly, including the application and removal sequence o Coordinate an onsite facility-funded influenza vaccination program for ALL residents, staff and volunteers - aim to achieve maximum vaccination coverage - consider making the vaccine available over a longer period of time and increasing access over all working arrangements (evenings, nights, weekends) - NB: from 01 May, staff and visitors who have not been vaccinated against influenza should not be permitted to enter the facility 10 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

11. Infection control precautions signs 11 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

12. Modifications to the ILI response due to COVID-19 Surveillance for fever or acute respiratory illness (ARI): o ARI: e.g. shortness of breath, cough, sore throat (with or without fever) o To be used in the context of confirmed local transmission of COVID-19 Airborne and Contact Precautions indicated: o When caring for severely ill residents who are coughing excessively o When conducting aerosol-generating procedures, including nasopharyngeal/oropharyngeal swabs from a severely ill resident o Use a room where the air doesn t circulate to other rooms, keep door closed whilst collecting the specimen and leave the room vacant for at least 30 mins NB: Contact and Droplet Precautions indicated: o When caring for residents with suspected or confirmed COVID-19 PPE indicated for Airborne Precautions: o Use of a P2/N95 mask -> staff should receive training in correct use o Fit check is indicated each time the mask is applied 12 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

13. Modifications to the ILI response due to COVID-19 cont. Outbreak definition: o Potential OB: 2 or more cases of acute respiratory infection (ARI) in residents or staff within 3 days o Confirmed OB: as per potential definition PLUS one case is confirmed COVID-19 by lab testing Case management: o Staff are required to remain excluded until cleared by 2 x PCR negative NP swabs o Swabs to be collected no earlier than 7 x days from illness onset o To further reduce the risk of transmission, it is preferable to allocate specific RACF staff to the care of residents in isolation Contact management: o Current public health practice involves advising close contacts to stay in quarantine for 14 x days o This may significantly impact staffing levels Declaring outbreak over: o Can be declared over if no new cases occur within 14 x days of the last case s illness onset date 13 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

14. COVID-19 resources Australian Government sites Aged Care Quality and Safety Commission: o COVID-19 information: https://www.agedcarequality.gov.au/coronavirus-covid-19-information Department of Health: o COVID-19 health alert: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health- alert?utm_source=health.gov.au&utm_medium=redirect&utm_campaign=digital_transformation&utm_ content=health-topics/novel-coronavirus-2019-ncov o Advice for the health and aged care sector: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus- covid-19-advice-for-the-health-and-aged-care-sector o National COVID-19 Guidelines for public health units: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm 14 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020

15. COVID-19 resources cont. Queensland Health: o COVID-19: https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19 Metro North Hospital and Health Service: o COVID-19: https://metronorth.health.qld.gov.au/extranet/coronavirus Metro North Public Health Unit: o Influenza planning and preparedness resources: https://metronorth.health.qld.gov.au/hospitals-services/public-health-unit/cdc/aged-care-facilites 15 Metro North Public Health Unit Influenza and COVID-19: Planning and preparedness for RACFs, 1st April 2020