Rapid review of public health guidance for residential care facilities in the context of COVID-19 [v5.12]

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:
\n Vaccine related exceptions: The CDC, England, Ireland and Prince Edward Island, Canada have IPC guidance specific to fully vaccinated individuals. Scotland have stated that existing IPC guidance apply regardless of vaccination status (Table 1).
\n 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. The US CDC recommends 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. Ontario recommends immediate testing of all staff and residents in an infected area when one case of a variant of concern (VOC) is suspected or confirmed. British Columbia require unvaccinated staff to be tested before each shift.
\n 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.
\n Admissions and transfers: Australia does not permit admission of new residents with COVID-19 compatible symptoms to enter the facility. Northern Ireland has added questions relating to vaccination status in the pre-admission and admission risk assessment form. England no longer requires people admitted to a RCF from the community to self-isolate for 14 days on arrival after undergoing enhanced testing.
\n Isolation: The CDC and CMS (US) provide considerations for post-vaccination for HCWs and residents relating to symptoms and testing including quarantine.
\n Cohorting: Quebec advises RCFs to use colour coded zones to indicate units that have confirmed cases, possible cases, or no cases. Ontario recommends that residents can freely socialise and interact with each other outdoors within and across cohorts, including during planned or organised group activities. This recommendation also applies in indoor settings with the additional requirement of a mask and maintaining a physical distance.
\n Controls to minimise risk of inadvertent introduction of virus: Northern Ireland and England ask RCFs to consider live in arrangements for staff, in situations where it can be safely done. England has agreed legislation, pending parliamentary approval, for a requirement of all staff including professional visitors to be fully vaccinated from October. England has changed the duration for which restrictions must remain in place following an outbreak, reducing care home restrictions from 28 days to 14 days after recovering tests detect no news cases. However, if a test results confirm a variant of concern in the outbreak then 28 days with no new cases is required. NSW (Australia) excludes visitors and staff from entering a RCF if they are on the contact tracing list or if they have been in an area identified with a cluster in the community, such as shopping centres, in the previous 14 days. NSW also advises 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. NSW advises that staff clean their phones and place them in a new, clear zip lock bag at beginning of each shift. Multipurpose facilities that include non older person sections are recommended to prioritise and consolidate HCWs tasks in the older person section, before other areas. The CDNA of Australia requires RCF to maintain records of staff locations of work internal and external to the RCF. During an outbreak, staff who are working at the facility should not work in other residential facilities.
\n Physical distancing: Northern Ireland encourages the restriction of residents to their rooms, even for mealtimes where this is practical.
\n Visitations: Quebec requires visitors that have tested positive wait 21 days if they were admitted to ICU or 28 days if on immunosuppressing medication. England requires named visitors to provide a negative test result on the day for each visit (Lateral flow devices), while essential caregivers have the same PPE and testing requirements as RCF staff. Essential caregivers are able to visit residents during their isolation period. Scotland offers lateral flow tests to a range of visitor types including professional visitors. Quebec recommends RCFs provide a test, on demand, to any informal or family caregiver or visitor who so wishes. The CMS (US) encourages facilities in medium or high-positivity counties to test visitors, if feasible, and prioritise those visitors that regularly visit the facility for testing. England recommends 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. Scotland recommends that all RCFs, 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. NSW advises all staff (including contractors, but excluding people entering the premises in response to an emergency) and visitors to residential aged care facilities to check-in using the Service NSW QR code app. The CDC and CMS (US) provide considerations for post-vaccination for HCWs and residents relating to visitations and close contact. Prince Edward Island advise that physical distancing is not required between a resident and individuals who visit a resident primarily for social or other supportive reasons and may include family and friends (designated visitor).
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\n Personal protective equipment (PPE): Hong Kong encourages staff to wear eye protection when escorting residents to hospitals. The CDC (US) recommends that HCWs should wear well-fitting source control at all times while they are in the facility. New South Wales requires all staff to wear a surgical mask inside the facility. Ontario recommends patients with severe COVID-19 requiring treatment in an intensive care unit or patients with severe immunocompromised can be removed from Droplet and Contact Precautions 20 days from the onset of symptoms. NSW recommends the use of powder-free latex or nitrile gloves instead of vinyl gloves for the clinical care of patients in the context of COVID-19, as they are less likely to be breached and cause an exposure to body fluids or COVID-19 contaminated surfaces.
\n 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.
\n Immunisation: Australia requires all visitors including children to have had the 2020 flu vaccine. COTA Australia supports the mandating of COVID-19 vaccination for workers in RCFs in line with infection prevention and control measures (and with appropriate exemptions). Visitors, volunteers, regulators and service people including allied health care workers are excluded. New South Wales requires all visitors aged six months and over, and staff entering a residential aged care facility to provide evidence that they received a dose of the 2021 influenza vaccination. British Columbia strongly recommends that visitors age 12 and older are fully vaccinated for COVID-19 and provide proof vaccination status prior to entry.
\n Caring for recently deceased: Northern Ireland advises that once the person has died, all visits to the deceased person must stop. This includes visits from close family and friends.
\n 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, decision making relating to 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 considering the balance between safety and needs of the entire group of residents, and the safety and needs of individual residents. Scotland now archives all guidance to facilitate the statutory duty to collect, preserve and make them publicly accessible on a permanent basis.

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