Australian Health Protection Principal Committee (AHPPC) advice on residential aged care facilities
Advice from the Australian Health Protection Principal Committee (AHPPC) for residential aged care facilities about minimising the impact of COVID-19.
The advice below was provided by the AHPPC on 22 April 2020. It should be read in conjunction with the AHPPC update to residential aged care facilities about minimising the impact of COVID-19 published on 19 June 2020.
Recommendations to Residential Aged Care Facilities (RACFs)
While all respiratory viruses can cause outbreaks and significant morbidity and mortality, COVID-19 is acknowledged as a significant health risk particularly for the elderly and individuals with co-morbidities or low immunity.
While this recommendation is for RACFs, the principles are applicable to many settings including residential facilities for people with physical and mental disabilities, detention and correctional centres.
RACFs must ensure that they are prepared to manage outbreaks of COVID-19. Detailed guidance can be found at Coronavirus (COVID-19) guidelines for outbreaks in residential care facilities. There is currently no vaccination to prevent COVID-19; avoidance of exposure is the single most important measure for preventing COVID-19 in RACFs. RACFs must have, and be vigilant in implementing measures to prevent introduction of COVID-19 into their facility.
Restrictions on entry into RACFs
The following visitors and staff (including visiting workers) should not be permitted to enter the facility:
- Those who have returned from overseas in the last 14 days.
- Those who have been in contact with a confirmed case of COVID-19 in the last 14 days.
- A contact is defined as anyone who has been in contact with a known case, including the 24 hours before the case became symptomatic.
- Those with fever or symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath) symptoms.
- Those who have not been vaccinated against influenza (after 1st May 2020).
RACFs should implement the following measures for restricting visits and visitors to reduce the risk of transmission to residents, including:
- Limiting visits to a short duration;
- Limiting visits to a maximum of two visitors at one time per day. These may be immediate social supports (family members, close friends) or professional service or advocacy;
- Visits should be conducted in a resident’s room, outdoors, or in a specific area designated by the RACF, rather than communal areas where the risk of transmission to residents is greater;
- No large group visits or gatherings, including social activities or entertainment, should be permitted at this time;
- No school groups of any size should be allowed to visit RACFs.
Visitors should also be encouraged to practise social distancing practices where possible, including maintaining a distance of 1.5 metres.
Children aged 16 years or less must be permitted to visit only by exception, as they are generally unable to comply with hygiene measures. Exemptions can be assessed on a case-by-case basis, for example, where the resident is in palliative care.
Measures such as phone or video calls must be accessible to all residents to enable more regular communication with family members. Family and friends should be encouraged to maintain contact with residents by phone and other social communication apps, as appropriate.
Active screening for symptoms of COVID-19 in residents being admitted or re-admitted from other health facilities and community settings should be conducted. No new residents with COVID-19 compatible symptoms are permitted to enter the facility.
Residents admitted from other health facilities
Residents admitted from other health facilities should be assessed by appropriate medical staff prior to admission to the facility.
Appropriate infection prevention practices should be implemented for residents returning from treatment or care at other facilities.
No external excursions for residents should currently be permitted.
Managing illness in visitors and staff
RACFs should advise all regular visitors and staff to be vigilant for illness and use hygiene measures including social distancing, and to monitor for symptoms of COVID-19, specifically fever and acute respiratory illness. They should be instructed to stay away when unwell, for their own and residents’ protection.
Given the high vulnerability of this particular group, RACFs should request that staff and visitors provide details on their current health status, particularly presentation of symptoms consistent with COVID-19. Screening for fever could also be considered upon entry.
These additional measures should be implemented in order to better protect residents and prompt individuals entering the RACF to consider their current state of health prior to entry. Both individuals and management need to take responsibility for the health of visitors and staff at facilities to protect our most vulnerable community members.
Staff should be made aware of early signs and symptoms of COVID-19. Any staff with fever OR symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath) should be excluded from the workplace and tested for COVID-19. Staff must report their symptoms to the RACF.
Sick leave policies must enable employees to stay home, if they have symptoms of respiratory infection.
Signage and other forms of communication (i.e. information and fact sheets) must be used to convey key messages, including what actions the facility is taking to protect visitors, residents and staff, and explaining what they can do to protect themselves and their family members. This includes signs on appropriate hand washing techniques upon entry and throughout the facility.
RACFs must ensure that adequate hand washing facilities and alcohol based hand rub, as well as tissues and lined disposal receptacles are available for visitors to use; at the entrance of the facility and in each resident’s room. Staff should ensure visitors perform hand hygiene before entering and after leaving the resident’s room and the RACF.
The recommendations outlined may be altered according to the particular circumstance of the resident, including those who are in palliative care or residents in dementia units, which should be considered on a case-by-case basis. These situations will likely necessitate increased social contact with visitors.
Read previous statements from the AHPPC.