Rapid review of public health guidance for infection prevention and control measures in residential care facilities in the context of COVID-19 [v5.3]

Recommendations and measures for residential care facilities (RCFs) featured in Irish guidance are largely reflected in the recommendations of other national and international agencies. However, some variations in guidance have been observed. These variations in recommendations fall under the themes of:  Vaccines: Ontario, British Columbia, Scotland and Northern Ireland explicitly state that all guidelines must continue to be followed regardless of vaccine status.  Testing: Northern Ireland tests all asymptomatic care home residents on a 28 day cycle and asymptomatic staff on a 14 day cycle. US includes the use of point of care (POC) testing and routine testing as part of their testing strategy. CDC recommend performing expanded viral testing of all residents in a RCF if there is a new SARS-CoV-2 infection in any HCW or resident, if resources allow.  Monitoring: Residents or staff identified as other contacts (that is, not close contacts) are to be monitored for 28 days in Hong Kong. England suggests use of scoring systems (such as the RESTORE2 (Recognise Early Soft signs, Take Observations, Respond, Escalate)) as a way of monitoring residents with symptoms.  Admissions and transfers: Australia does not permit admission of new residents with COVID-19 compatible symptoms to enter the facility  Cohorting: Quebec (Canada) advises RCFs to use colour coded zones to indicate units that have confirmed cases, possible cases, or no cases.  Controls to minimise risk of inadvertent introduction of virus: Northern Ireland asks RCFs to consider live in arrangements for staff, in situations where it can be safely done. NSW (Australia) excludes visitors and staff from entering a RCF if they have been in an area identified with cluster in the community, such as shopping centres, in the previous 14 days. Staff and visitors who are on the contact tracing list, are also excluded from entering the facility for 14 days South Australia. NSW also advise that for RCFs when it is not possible to cease staff working across facilities or multiple settings (such as in home care and residential care), then records of staff and work locations must be maintained.  Physical distancing: Northern Ireland encourages the restriction of residents to their rooms, even for mealtimes where this is practical.  Visitations: A number of countries and provinces (n=4) require visitors that have travelled abroad to fulfil any self-isolation requirements. Quebec have additional requirements for visitors that have tested positive which includes waiting 21 days if they were admitted to ICU or 28 days if on immunosuppressing medication. Visitors are also required to wear clean clothes when going to the facility, and are recommended to eat and hydrate before visiting. England recommend for indoor visits the use of screens between residents and visitors, use of speakers or assisted hearing devices and that visitors enter directly from outside to the visiting area, where possible. England and Scotland are introducing lateral flow tests for visitors. Northern Ireland requires that any decision to deny visiting rights must be made following a risk assessment and must be communicated clearly with the resident and their family or next of kin or carer. Prince Edward Island (Canada) does not limit the number of visitors that may be at the bedside for end of life situations. However, visitors must wear a medical grade mask during indoor visits. Scotland permits travel into and out of Levels 3 and 4 to visit family or close friends in RCFs – this is exempt from the national restrictions. All RCFs – regardless of Tier – and except in the event of an active outbreak – should seek to enable indoor visits where the visitor has been tested and returned a negative result. Quebec recommends RCFs provide a test, on demand, to any informal or family caregiver or visitor who so wishes. In addition visitors are required to wear clean clothes when they go to the facility and change and wash their clothes when they get home. New South Wales encourages the use of electronic check-in methods (such as QR codes) for recording visitor contact details. CMS (US) encourage facilities in medium or high-positivity counties to test visitors, if feasible, and prioritise those visitors that regular visit the facility for testing.  Personal protective equipment (PPE): Hong Kong encourage staff to wear eye protection when escorting residents to hospitals, for example, if the residents are unable to wear a mask. England advises HCWs to wear fluid-repellent surgical masks (FRSMs) when providing close personal care or if within 2 metres of a resident that is coughing.  Environmental cleaning: Hong Kong requires cleaning staff to wear eye protection. Residents identified as other contacts (that is, not close contacts) should have their room disinfected at least once daily. England advises RCFs to ensure domestic staff should clean the isolation room(s) after all other unaffected areas of the facility have been cleaned.  Immunisation: Australia requires all visitors including children to have had the 2020 flu vaccine.  Governance: England advises RCF managers to update capacity related data daily via online portal for use by national support capacity planning and response, and locally to help localities manage discharge planning. Scotland recommends the use of the Safety Huddle Tool to identify factors that may impact on the health, safety and wellbeing of residents. In addition, in Scotland decision-making relating to the care home visits policy during the pandemic is conducted at a local level by an oversight group (consisting of experts in public health, nursing, infection prevention, health protection, and social work). The care home manager makes decisions about visiting for their individual home and considers the balance between the safety and needs of the entire group of residents, and the safety and needs of individual residents.

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