New Aged Care Infection Prevention and Control Guide – Webinar

Department of Health and Aged Care

New Aged Care Infection Prevention and Control Guide – Thursday, 3 October 2024

PRESENTED BY:

CHAIR:

• Rhiannon Box – Assistant Secretary, Emergency Preparedness & Response, Department of Health and Aged Care

SPEAKERS:

• Professor Alison McMillan – Chief Nursing and Midwifery Officer, Department of Health and Aged Care
• Loren deVries – Senior Practitioner, Qualified Nurse Practitioner Aged Care, Aged Care Quality and Safety Commission
• Professor Peter Collignon – Senior Medical Advisor for the Australian Commission on Safety

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘New Aged Care Infection Prevention and Control Guide webinar’, ‘3 October 2024’, ‘agedcareengagement.health.gov.au’]

[The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]

Rhiannon Box:
Good afternoon and welcome to today’s webinar on the Aged Care Infection Prevention and Control Guide. I am Rhiannon Box, the Assistant Secretary of the Emergency Preparedness and Response Branch here at the Department of Health and Aged Care.

Today I begin by acknowledging the traditional custodians of the many lands on which we meet. For me here in Canberra it’s the Ngunnawal people. And I pay my respects to their Elders past, present and emerging. I extend that respect and acknowledgment to all the traditional custodians of the lands that you are joining us from today and I warmly welcome all Aboriginal and Torres Strait Islander peoples joining us today for this webinar.

I am very pleased to be joined today for this presentation by Professor Peter Collignon AM who wears many hats, amongst them being the Infectious Diseases Physician and Microbiologist at Canberra Hospital, Professor at the ANU School of Medicine and Psychology, and the Medical Advisor for Infection Prevention and Control at the Australian Commission on Safety and Quality in Health Care. I’m also joined by Loren deVries, Senior Practitioner, Nurse Practitioner Aged Care for the Aged Care Quality and Safety Commission, and Professor Alison McMillan PSM, the Chief Nursing and Midwifery Officer for the Department of Health and Aged Care.

Thank you to all of you who have sent through some questions in advance. We will be endeavouring to answer all of your questions at the end of today’s presentations. And if you think of a question during today’s update you can submit questions live in the Q&A on the right hand side of your screen and we will attempt to respond to as many questions as possible today. All questions and answers including the ones that we might not get to answer today will be published in an FAQ document on our website following today’s webinar. QR codes displayed in our presentation can assist you in locating the referenced material. The slideshow will be made available on our website along with the recording of this webinar.

So today we are here to talk about the new IPC Guide that was released by the Australian Commission on Safety and Quality in Health Care in August this year. During COVID-19 it became very evident that there was a need for IPC Guidelines specific to the aged care context. The Australian Guidelines for the Prevention and Control of Infection in Health Care provides an overarching approach to IPC for healthcare organisations. However there are key differences between acute healthcare settings and aged care that requires additional consideration about how IPC is implemented.

The Royal Commission into Aged Care found that routine infection prevention and control practices in the aged care sector were substandard and recommended that IPC become a primary focus in the revised Aged Care Quality Standards. Because there was no specific IPC Guide for the aged care sector the Australian Commission on Safety and Quality in Health Care developed this Guide to support implementation of the new Clinical Care Standard which is Standard 5 of the strengthened Aged Care Quality Standards. There has been extensive consultation with IPC experts in the health and aged care sector and with the public to ensure this Guide meets sector needs. The new IPC Guide provides guidance on infection control for diverse client types and aged care delivery settings.

Our first speaker, Professor Peter Collignon, as I said is the Medical Advisor to the Australian Commission on Safety and Quality in Health Care and the co-chair for the IPC Guidance and Aged Care Reference Group which led development of this Guide. Professor Collignon will talk about the key components of the new IPC Guide and provide some practical information on how the sector can use this new resource. Thanks Professor Collignon.

Professor Peter Collignon:
[Visual of slide with text saying ‘Australian Commission on Safety and Quality in Health Care’, ‘The Aged Care Infection Prevention and Control Guide’, ‘Professor Peter Collignon AM’, ‘Medical Advisor, Infection Prevention and Control (IPC) Program’, ‘Australian Commission on Safety and Quality in Health Care’]

Thank you very much for having me and for being given this opportunity to talk about this guideline which I think is important. By way of background which has already been said in part we’ve got infection control guidelines for the healthcare sector but it’s mainly designed for the acute care sector, hospital. And the major difference with aged care is it’s where people live. So they’re not there for just short periods of time, a few days, a couple of weeks. It’s where they live. It's their home, both in the community and in the aged care nursing homes etcetera. So it was important that we came up with something that more was in tune and practical for that situation.

Now I was involved and chaired a number of the previous acute care ones but again it’s obvious we needed something different. And to put this in perspective after we published this we got a few comments back or I got comments back from people in England, Ireland and Canada who were involved in infection control saying this is probably a world’s first. As far as we’re aware there’s no guideline like this just if you like made or directed to the aged care sector. But that also means there’s always room for improvement. So I’m sure all of us will take any suggestions anybody has on how we can make it better.

And to put it in perspective this was just not done by – I call myself an academic – doctors in particular. This was predominantly nurses and predominantly those working in the aged care sector. So we were trying to make it as practical as possible but without compromising basic infection control principles. So that’s where we’re coming from. Next slide please.

So the purpose I guess I’ve gone over a bit but from a more formal point of view is to support the aged care organisations to be able to meet the requirements to strengthen aged care quality standards but also as a supplement to the Australian Guidelines in Prevention and Control of Infection in Health Care which as I said are mainly made for the acute sector rather than the aged care sector, and also to try and help everybody who’s involved with infection prevention and control – which I might say should be everybody, both the resident, their family and all the staff at all levels, administrators as well as the people on the ground – to try and help them come up with something that will work basically in the aged care setting and on the ground and be practical. Next slide.

So how do you use this guide? Well I guess it’s 200 pages long so I wouldn’t suggest you just go in there and read it from cover to cover. But it’s designed to inform daily practice and education, to help the policy development and review at a local level as well within organisations, to support the understanding of IPC obligations and what you need to do, the basic principles, and it’s to be used in combination with other guidelines to inform a risk assessment. Because one of the big deals about this is we’re not being black and white. We’re saying you’ve got to make a risk assessment and modify depending on the circumstances. Next slide please.

So this is basically as I said a 200 page document but it’s in ten chapters and it’s designed to be able to if you like get to something in a hurry. So each of the chapters has got its own heading where you can go just to that chapter for what you want to look up. But within those chapters there’s a summary at the beginning. I think it’s always just one page. But there’s practice points. There’s community and home care for instance to make it more practical not just for aged care homes but for those in the community. Essential knowledge, and also if people want to go further, what resources and other links there are as well. So it’s designed as a whole document but it’s also designed to try and get people to be able to go to one spot quickly, get what they need without having to read 200 pages so to speak. Next slide.

So what is an infection prevention and care system in aged care? Well there is not one size fits all. Circumstances of people living at home is different to aged care and even in aged care institutions it’s quite different. So that’s why we’re not being black and white. We’re trying to give the principles and we’re saying look you’ve got to put this into context of where you’re going to use this and that’s why we’ve tried to make it as practicable as possible also. So it’s the service context, it’s what resources are available, the availability of those resources. There’s certain resources we think should be available all the time I might say but there are issues there. The older person’s care needs and the workforce that is looking after them has to be considered. And one of the issues here is family is often workforce as well. So trying to take that into account. 

And any infection prevention and control system needs to include a few core components and one is the actual infection prevention and control related guidelines and policies. This is part of that. But education and training. And remember people come and go. So this is an ongoing issue. You can’t do it once and say that’s the end of it. You’ve got to monitor infections and you’ve got to do audits and feedback. And this is designed to be part of a quality improvement system. And for any quality improvement system you need to know what you’re doing, measure what’s happening, look at what you’re doing, and then if things aren’t 100% how do you modify to get improvement in the future. So this is a process that requires lots of different components. These guidelines are just one part of that. But it’s the whole process we’re trying to promote with these guidelines. Next slide please.

Now when we get to actual infection control precautions so to speak and prevention there’s basically standard precautions and then transmission-based ones. And standard precautions are what we should do all the time. And that actually means you’ve got to assume there may always be infections there. What can you do to make the risk as low as is reasonable. A big part of that is hand hygiene. A lot of bugs are passed from person to person or between people or from the environment by hand. So basic cleaning, hand hygiene. But basically also if you’re doing any sterile practices making sure you’ve got good knowledge and you implement them so that you do that as your standard so to speak. But on top of that there can be some extra ways certain bugs or worrying bugs transmit. And essentially if we put this into two broad categories this is contact just from your hands with some multi-resistant organism for instance, but also respiratory, what people breathe in. And that’s basically the basis here. Next slide.

So first of all let’s get to respiratory precautions. Now there were a few if I say controversial things about these guidelines and this is one of them. Basically with COVID in particular but even before that there was a lot of controversy about how much spread is through small particles called aerosols and how much through larger particles called droplets. Now the reality is there’s a continuum and there’s high risk procedures for lots of small particles and there’s more ordinary situations. So for the first time we came up with a term called respiratory precautions instead of aerosol or droplets. So that’s different in this and we did that because we wanted to make these more practicable. And respiratory precautions include what some people would call airborne and other droplets. And basically if you believe you need any sort of respiratory precautions the minimum you need is a surgical mask, eye protection which is often forgotten, and the reason eye protection is so important is if people cough, sneeze, do anything, it can go over people’s face and yes you can breathe it in but it also deposits in their eyes. And your eyes via your lacrimal duct go to your nose. So basically if you don’t protect your eyes you’re leaving a lot of your respiratory tract unprotected. So that’s why the eye protection is there. And it also means you do standard precautions all the time. Next slide.

Now this is where one of the controversies come in. Some people believe that you need respirators, N95 masks at all times. We consciously made a decision to say this is going to be on a risk basis. Most of the time if there is a respiratory concern we believe surgical masks with eye protection and other standard things will give you very high levels of protection. But there are situations where you will want to take higher levels of protection or potentially because we don’t know. And some of it is to do with the virulence of the organism and the low numbers you need to get infected such as tuberculosis for instance. There is also increased risk depending on the circumstances. An older person has got a respiratory infection but they’re also on a nebuliser or something that produces high levels of smaller particles. That’s where we think particularly healthcare workers need to take an increased level of protection. The other thing is is the room well ventilated, engineering issues, and also if people are cognitively impaired. If you’ve got a whole lot of people who are infected with dementia wandering around everywhere unable to if you like follow directions etcetera then there is an increased risk. So they’re all factors that you take into account in your risk assessment.

Now just another thing to put in perspective. There is a lot of controversy about this but when you look at all the available evidence from Cochrane reviews, a recent review done by Greenhall et al and one done at the end of the last year by WHO, at least in acute medical situations you can’t actually show if you like that N95 respirators end up with less disease in staff compared to surgical masks. Now having said that we still believe masks are of benefit and we believe in higher risk situations for the moment we would recommend them. But this is an area where we need a lot more research to be able to answer these questions properly. So we’re going a bit further necessarily than the literature says but we think it’s what the expectation is at the moment and a reasonable assessment of the risk. Next slide.

Now this whole thing with risk management and assessment, aged care settings differ both within the organisation and what happens locally. And essentially the best thing you can do to not have an infection risk is to eliminate it. Well that’s not always very practical. So one of the things you have to do is have a risk acceptance. In other words while we try and get it down to as low as possible we can’t make it zero. We have to do the best we can. And just as an example on this, this hierarchy of controls, things like – if you look at the bottom of that right hand of the slide the least protective is personal protective equipment. All the others are more important. And I might say vaccination comes into this as well. You get much more protection by being appropriately vaccinated, both staff and residents, than you will very likely from whatever PPE you have put in place. But this is all a risk assessment and it’s different in different situations. Next slide.

What was very important in this is this was person-centred care. So they differ from acute care services and that’s why while we’re not compromising we think basic infection control principles, the practical suggestions may end up different to what you see in a hospital. And there needs to be a balance. Maintaining the environment that minimises further infection but also the impact of those residents that are in that situation and making sure they have a life and this is their home and they continue to live reasonably. So we must ensure that the charter of aged care rights and workers’ rights as well are prioritised. And this particularly comes in with isolation which was a very other controversial issue. Isolation should only be implemented when the benefit from the isolation is far greater than the risk of psychological, emotional and physical harm. Next slide.

And this was another controversial issue. We basically thought this prolonged isolation should never happen. There should be at least one person that can visit somebody, whatever. I mean during COVID so many people died without family there when they were dying. Now we need to decrease the risk of infection but isolating people for a prolonged period of time we thought we got the balance wrong if we did that excessively. Next slide.

The other thing is vaccination. We think vaccination is very important both for staff and for residents. And it should be encouraged, very much encouraged, and make it easy for people to get vaccinated by having on site vaccination for instance wherever that’s feasible. But unless it’s required by state or public health regulation we didn’t think it should be mandated. Now that’s another controversial issue but we thought it should be promoted but not mandated for a whole lot of reasons, both for residents and even for staff. So workforce screening and vaccination should be there and they should significantly reduce the transmission of vaccine preventable diseases. So we think vaccines are very important and obviously the older you are and the more underlying factors you have the bigger your risk, and therefore 80 year olds with underlying disease we really need to promote it and make it available for them. Next slide.

So there are a lot of resources in this document and this is just some of them. Some of them can be used for consumers but we purposely tried in the document to make it available in a way that we thought people could take in without having to read page to page. So I won’t go on that further but there are lots of things there. Next slide.

Well that’s the end of my talk. So thank you very much and hopefully there will be time at the end for questions.

Rhiannon Box:
Thank you very much Professor Collignon. Our next speaker today is Loren deVries. Loren is going to talk about how the new IPC Guide can assist aged care homes to meet infection prevention and control requirements under the strengthened Aged Care Quality Standards. Thanks Loren.

Loren deVries:
[Visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Aged Care Quality and Safety Commission’, ‘The Aged Care Infection Prevention and Control Guide’, ‘Loren deVries’, ‘Senior Practitioner’, ‘Nurse Practitioner Aged Care’, ‘3 October 2024’]

Thank you so much. Today I’m just going to talk to you about the key components of the new Aged Care Infection Prevention and Control Guide and how the Guide actually intersects with the strengthened Standards and how it can be used to support providers to meet their obligations under the Aged Care Act. So next slide.

So just some information that I’m sure you’re all aware of. Older people receiving aged care are typically much more frail than other older people. Often they have chronic progressive health conditions and their health is not robust. They tend to be more vulnerable to infection, both contracting infectious diseases and being seriously affected by them. Infection prevention and control is a critical component of delivering safe and quality care to older people. And aged care providers have a responsibility to ensure that their policies, practices and processes are current and up to date and that staff have the required level of training competence and supervision to manage infection prevention and control. And of course it’s not just about COVID-19 but obviously that really concentrated our minds to this issue. Next slide.

So we can see and I think the Aged Care Infection Prevention and Control Guide really does outline the principles and supports the implementation of the strengthened Aged Care Quality Standards. So we really need to understand and know about this Guide. Next slide.
So I just included the current Standards. I’m sure you’re all very familiar with those. But I think it’s important too to understand that this applies currently as well not just for the Strengthened Standards. Next slide.

So the current Standards. We know that infection prevention gets looked at against the Standards and we can see in particular 3(3)(b), 3(3)(g), 8(3)(d) and 8(3)(e) where it really becomes quite focused in what we’re looking at. All right. Thank you.

What we expect from providers all of the time is that genuine partnership with older people that respects and really animates the individual’s rights. We also expect that the provider is meeting obligations and reaching for that high quality care. And we’re always looking to see if providers are looking for opportunities to improve. What we expect when things go wrong is a remedy and then the provider to restore and then the provider to look at prevention as well. All right. Next slide.

So getting ready for the new legislative provisions. The Commission is supporting sector readiness for the new Aged Care Act and the new strengthened Aged Care Quality Standards and regulatory framework. Through our education, information and targeted communications we aim to support older people to understand what to expect from their care and how the Commission can help when their aged care experience falls short. We want providers to understand their obligations and we want providers to understand what they need to expect to see in the delivery of care and how we will assess performance and how we will regulate. We want workers to also understand their obligations. Workers need to understand what is important in delivering safe, quality care and how the Commission can help them to raise their concerns. We know that the new Aged Care Act will put the rights of older people at the centre of our aged care system. Obviously subject to Parliamentary processes the Act is expected to commence on the 1st of July 2025.

The new Act creates a simple, single entry point to make access to the aged care system for older people easier. It includes a fair, culturally safe, single assessment process. It includes rules on supported decision making to ensure that the older person has choice and control. The new Act provides additional protections for whistleblowers to allow reporting without fear or reprisal. It introduces a new approach to regulating aged care providers to ensure the delivery of safe, quality aged care. And it also strengthens the power of the regulator, so that’s the Aged Care Quality and Safety Commission, so that we can manage the risk, ensure integrity and support aged care. The new regulatory model will improve outcomes and protections for older people. And it responds to the 18 recommendations from the Royal Commission into Aged Care Quality and Safety.

This model delivers a universal provider registration and renewal of registration across six different categories. There’s clear, targeted and streamlined aged care provider obligations and it’s a system that is easier for older adults and aged care providers to access and navigate. It provides support to aged care providers to build their capability.

It’s going to be a consistent way to provide feedback and promptly address complaints and concerns with a focus on resolving issues respectfully and adequately and provides that stronger regulatory power for the Aged Care Quality and Safety Commission.

So we see the new – I’ve just included the strengthened Aged Care Quality Standards will not apply to all registration categories and I think that’s important to understand. They will only apply to providers in specific registration categories. And there is further information on our website in regards to that but I think it’s really important to know that the standards apply to both home care and residential care services as well. All right. Next slide.

So we know that the strengthened Aged Care Quality Standards aim to be simplified, to provide comprehensive and measurable Standards. We’re going from eight to seven Standards. There’s going to be strengthened focus areas. And each Standard has an intent and expectation statement and has outcomes and actions that are clear. All right. Next slide.

So if we focus in more on the Standards we see the new Standard, Standard 1, the person. So firstly at a more general and overarching level the person, particularly 1.1 person-centred care, is a fundamental concept where providers need to recognise that the safety, health, wellbeing and quality of life of the older person is the primary consideration in the delivery of care. We can see that outcome 1.3 ensures that providers must ensure that older people are supported to exercise dignity of risk. And it’s really important to remember that all adults have the right to make decisions about their care and to have those decisions respected, even if this is something that creates a risk to the individual themselves. Dignity of risk means respecting this right and care and services need to strike a balance between respect for the older person, their autonomy and the protection of other people’s rights. So that’s really important to remember. The Guide that we’re talking about today aligns with this concept and provides advice to consider the needs of older people and place them at the centre of infection prevention and control.

It also describes the importance of enabling older people to start to take part in their own care with careful consideration to balancing their needs in relation to mental health and social wellbeing whilst also minimising the spread of infection and the impact on others receiving care in that area. The Guide recognises the unique context of aged care and how this differs from the acute sector, focused on minimising infection related risks in aged care which require careful consideration to ensure quality of life to older people. All right. Next slide.

Thank you. So Standard 2 is the organisation and providers need to demonstrate that they have the right systems and processes and workforce to deliver safe, quality care. We can see in outcome 2.2 quality and safety culture where providers need to ensure the health and wellbeing of older people and the workforce. Chapter 7 of the Guide talks to the important aspects of staff health and safety covering IPC workplace hazards, worker screening and vaccination programs. Chapter 8 of the Guide covers infection prevention, immunisation and the wellbeing of the older person. There is also alignment with outcome 2.4 which is risk management where providers must use a risk management system to identify, manage and assess and continuously review the risks to older people, workers and the provider’s operation. Chapter 2 of the Guide describes risk management and risk assessment for infection prevention and how to apply it in aged care. So next slide please.

So Standard 4, the environment. So we can really see that the environment outcome 4.2 is infection prevention and control and there are 11 very specific actions which include having appropriate infection prevention and control systems implemented and ensuring that workers take appropriate infection prevention precautions when providing care and services. These enhancements all expand upon the existing IPC requirements in the current Standards. But in relation to the Guide particularly Chapters 4 and 5, they provide advice and guidance to support the provider to demonstrate compliance within the strengthened Standards.
And the last Standard that we’ll highlight is Standard 5, clinical care. So of course if we move to Standard 5 this is focused on ensuring providers can demonstrate they are delivering safe and quality care to older people. We can see in 5.1 we’ve got clinical governance and this has significant importance related to IPC. Chapter 1 of the Guide looks and describes the importance of clinical governance and your IPC systems. In outcome 5.2 preventing and controlling infections in clinical care, this is where providers need to demonstrate or have implemented an evidence-based practice antimicrobial stewardship system relevant to the specific context where they provide care and services, be that residential or home care settings. There is definitely an uplift from the current standards and this new IPC Guide covers various aspects of antimicrobial stewardship touching on antimicrobial resistance in aged care and the main components of an antimicrobial system. All right. Next slide.

So IPC and Commission campaigns. So should the Commission turn up and conduct an infection control spot check Commission staff will use the infection control monitoring checklist which is available on our website so I would encourage you to go and have a look at that. Over the past four quarters more than half of our onsite assessment visits in residential care have been focused on risks that we consider are broadly present across the sector. So particularly COVID 19 and infection prevention and control. In response to low COVID-19 vaccination rates and a growing number of COVID-19 outbreaks in residential aged care the Commission started some unannounced targeted assessment contacts at 107 services and included 21 onsite activities in the last quarter. Some services were subject to both an offsite and onsite activity and there were a small number of providers who were found to be non-compliant with vaccine related requirements under the current Aged Care Quality Standards. These services are now under case management and they have been required to advise the Commission of their proposed actions to address the non-compliance which include immediate staff vaccinations, training, updated policies and procedures and increasing communication with residents and representatives and we continue to engage with these providers and other providers to make sure that the actions taken continue and deliver the intended outcomes. All right. Next slide.

So the Guide can really support the sector to comply with the Quality Standards. And I think that’s really important to understand that the new Standards offer greater clarity on the expectations for infection prevention and antimicrobial stewardship making it explicit what providers must demonstrate to comply with the strengthened Aged Care Quality Standards. Providers can minimise infection risk by applying evidence-based IPC strategies and following endorsed guidelines and applying this to the care delivery context. The principles of IPC are very well established and there should be no surprises. The benefit of this publication is that it has been created specifically for the aged care residential community or home care environment and takes into consideration the vulnerabilities of infection and the goals of care of older people. The Guide is particularly useful in informing the sector and also the Commission on what is available for providers to undertake to meet the Quality Standards. And this was obviously not previously addressed in Australian Guidelines before.

The Commission welcomes the Guide because it has a greater focus on supporting services to implement infection prevention, infection control and antimicrobial stewardship in aged care settings, both home care and residential care. And next slide. Thank you.

So I’ve just got a couple of examples. So the first example is how the Guide could be useful to support providers with demonstrating compliance with some of the IPC requirements in the new strengthened Standards. And we can see that in the new strengthened Standards under Standard 5, clinical care, so outcome 5.6 cognitive impairment, the provider needs to identify and respond to the complex clinical care needs of people with delirium, dementia and other forms of cognitive impairment. And we can see that providers need to ensure that they assess the risk for each older person in their care, considering the specific complex needs of that individual to assess and manage the IPC risk. The Guide supports the understanding of the basic principles of IPC and how to apply these principles using a risk-based approach to minimise infection related risk. This includes where older people are living with a cognitive impairment or dementia and may be unable to adhere to infection prevention practices. The Guide recognises that it might not be possible to eliminate all infection related risks associated with providing care for a consumer like this and that some interventions can result in prolonged restrictions such as isolation related to transmission based precautions.
The Guide uses the term ‘risk-based isolation’ to support providers and workers to understand the benefits of isolation strategies but also the risks. The Guide really is a systematic risk assessment approach to inform appropriate management. It recognises that interventions must be informed by consideration of the risks and benefits of the older person and worker. The Guide does provide suggestions on approaches to mitigate infection risks. The next example please.

So the second example is just how the IPC Guide aligns with the current strengthened Quality Standards and we can see again Standard 5, outcome 5.2 preventing and controlling infections, and our draft guidance suggests what is needed for providers to establish an antimicrobial stewardship system and that includes developing policies and procedures to promote the appropriate use of antimicrobials for older people, education and training for staff and quality improvement processes for identified antimicrobial issues. Our draft guidance also provides information about the importance of monitoring, ongoing review and improvement for antimicrobial stewardship by auditing, conducting regular surveillance, analysing the data and reporting regularly to the governing body, prescribers and older people. In this respect the Guide aligns very well with the strengthened Standards as it describes the components of an antimicrobial system and the suggested roles and responsibilities.

Just to end the final slide that we’ve got is just a reminder that the Aged Care Quality and Safety Commission does have a range of resources in relation to infection prevention and control and also a range of supports for you as a provider. Thank you.

Rhiannon Box:
Thanks very much Loren. I would now like to welcome Professor Alison McMillan who will talk about the differences between the new IPC Guide and the Communicable Diseases Network of Australia National Guideline for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Aged Care Homes, otherwise known as the CDNA ARI Guidelines, and how these resources should be applied in your settings. Thanks Professor McMillan.

Professor Alison McMillan:
[Visual of slide with text saying ‘Professor Alison McMillan PSM’, ‘Chief Nursing and Midwifery Officer’, ‘Department of Health and Aged Care’]

Good afternoon and thank you Rhiannon. So you’ve heard the key components of the IPC Guidelines and how they provide as Peter has said the practical advice, and Loren has talked to you about how the IPC Guidelines align with the current legislation and of course the strengthening Aged Care Quality Standards. So you’ve got a real sense of that.

Now we felt it was also important though to explain how the Aged Care IPC Guide can be used with other guidance. So as Rhiannon has called them, and I’ll say them again, so the Communicable Disease Network of Australia National Outbreak Management Guidelines for Acute Respiratory Infection in Residential Aged Care Homes. We really are good in the Commonwealth at making really long titles. So I’m going to call them the CDNA ARI Guidelines and talk about how these and of course the new Quality Standards, these are all synergistic approaches to things that will help you achieve the highest possible care and support to older people in their homes and in residential settings. 

So the IPC Guidelines is a comprehensive resource – you’ve heard that from Professor Collignon – offering practical information and developing knowledge around both residential and home care settings. This Guide should be your primary reference particularly in areas such as developing policies and procedures, including education, training, audits and surveillance. These are the things that should help you too in planning and preparing should and when you have an infectious diseases outbreak of whatever course, flu, RSV or COVID, and help you by updating your emergency and outbreak management plans.

Many of you who may well have been on these webinars before would have heard me talk about clinical governance and the continuous need for quality improvement. Again this Guide will help you with that, reducing the overall infection risk. And can’t emphasise enough again encouraging vaccination for both residents and aged care workers is such an important part of our approach to preventing infectious diseases.

So the IPC Guide also talks about having an antimicrobial stewardship or AMS program. Now I know you will all understand that we now realise that we need to use antibiotics only when they’re indicated because we will see and continue to see antimicrobial resistance grow. The AMS program should be tailored to the situation which we are describing and the Guide will help you to think about that. The CDNA ARI Guidelines should be a resource to go to when you’re dealing with an outbreak. Now we all know and I’m sure you all know the first time you open these Guidelines shouldn’t be the first time when you have an outbreak. You need to be using these guidelines again in your preparation and how you’re going to respond to a new respiratory outbreak with residents, how then during an outbreak you can implement the measures that are scribed for you in the IPC Guidelines, how you can manage case contacts, how you can look at the treatment protocols and interventions you can do. And of course we learnt so well the importance of effective communication with staff, residents and their families during an outbreak. So again these work together to help guide you through how you would manage an outbreak.

During the pandemic definitely we all know it became exceedingly clear that IPC protocols and practices in aged care settings can save lives over the duration of [0:44:05]. This time when many of us have worked together through some of these challenges we have seen enormous improvements and significant development in the ability for the prevention, response and recovery from outbreaks and to that I congratulate many of you on the amazing work that’s been done to address these. And now we see these new IPC Guidelines, as Professor Collignon suggested perhaps the first in the world with a really key focus on aged care, it will help further develop. But we can’t take our eye off the ball at any point in time because as we know any infection will exploit any chink in our armour.

I think both previous speakers have talked about the experience we now realise and the impact of restrictive measures on our residents and therefore any approach we make needs to be balanced and risk based and needs to include residents and their families in decision making. So the CDNA ARI Guidelines do go to the importance of taking what’s called obviously in public health a proportionate approach in managing risk but also considering residents’ wellbeing. We don’t want to further be detrimental to residents’ wellbeing through our approaches. And as I say it's important to include where you can residents or their family and work through issues around visitation and minimising risk.

I’ve already mentioned and I know the previous two speakers have done this but it is without doubt one of the most important things we need to do is to keep those vaccination rates up. I know for many of us who’ve been around since the beginning of the pandemic this can feel like it’s just a continuous circle that we’re never going to get out of and it really is and we need to accept that. Spring weather is here and it’s getting warmer. That leads towards the festive period and we know that that will see an increase in the circulation of viruses because we just all get out and about more. So continuing to promote, advocate, educate, help people make informed decisions around vaccinations is a very important part of your role and everyone’s role.

So current recommendations are all people over 75 years should receive two doses of the vaccine each year. Two doses each year. Currently only 53% of aged care residents over 75 years are up to date with their COVID vaccines and that’s not high enough. And we know we’ll see increased numbers of outbreaks as we go towards Christmas and we would really, really love to see more vaccinations being delivered before that time.

So if your resident client has not already had a vaccination this year or six months since their last vaccination they’re eligible. We’ve tried to make this now as simple as we can. Aged care homes can arrange COVID vaccination clinics ahead of Christmas so we can ensure residents have full protection. And also a reminder that we no longer need to wait six months after a COVID infection to get a vaccine. Vaccines are free for people over 65. So again reiterate important role in informing discussion with residents and their families around the importance of vaccination.

Thank you again for all you do in supporting our most vulnerable in our community. We’ve talked a lot about IPC and each of its parts that we’re seeing, these new IPC Guidelines, the new Quality Standards are coming in association with the Act and of course some of the existing documentation that comes, for instance the Communicable Disease Network of Australia. So thank you and I’ll hand back to Rhiannon.

Rhiannon Box:
Thank you so much Alison. So we will now use the last ten minutes of this webinar to move to the question and answer section and we will attempt to get through as many questions as we can. We will be starting with some of the pre-submitted questions that we’ve received in the lead up to this webinar and the first question I have is for Loren. And the question is:
Q:    Is there an environmental risk assessment tool already established that community care providers can use?
Thanks Loren.

Loren deVries:
Thank you. So there is no environmental risk assessment tool that’s currently established or recommended but what the Commission or what the legislation talks about is each individual provider should develop their own tool that they can develop, implement and review, dependent on the service that they offer and the environment that they are visiting. The environmental risk assessment is not something that’s unique I guess just to highlight to infection prevention. Rather this needs to be part of the provider’s systems and processes and an environmental risk assessment should be undertaken prior to commencement of any engagement with a consumer just to manage and support the potential risks in the environment.

Rhiannon Box:
Thanks very much Loren. The next question I have is for Alison and that question is:
Q:    What does this look like in home care particularly in regards to competency assessment?
Thanks Alison.

Professor Alison McMillan:
Thanks Loren and thanks to whomever provided us this question. So advice given by the Department in the context of aged care does and can include home care, CHSP and recognises the particular vulnerability of older people in the older age groups. IPC practices are extremely important in residential care settings but they’re equally important in home settings where home care providers often are delivering very close personal care due to the risk of transmission. Now Professor Collignon talked about some of those principles in his presentation and those principles exist in any care setting, acute, residential or home care. There are these principles that one should follow. However we understand and realise that the complexity of this when delivering these in someone’s home is just an added challenge where clinical procedures may be done in an environment.

So again it’s contextual with home care but those essential principles in my mind remain the same. And they will be about then working in a home care setting with the recipient or the client of care around their role, your role and the environment in which you’re operating. So your staff and support workers and health professionals need to understand these principles. And so in the context of competency assessment the competency assessment is an element of this but it is so important and we heard that in one of the previous presentations. This is a continuous process. Educating staff, reminding staff. We know that knowledge drops off quite quickly. We know that we have high turnover of staff in some situations. So it is about making sure that staff have completed training and that they can provide evidence through their feedback or through a competency test if you choose to, to make sure that they’re familiar with their responsibilities in preventing the transmission of infection to those most vulnerable. So yes these principles can exist in home situations as well and that’s part of the risk assessment. And applying those principles that are so clearly explained in the IPC Guidelines. Thanks Rhiannon. 

Rhiannon Box:
Thanks Alison. The next question I have is for Professor Collignon and that question is:
Q:    Will there be a complementary consumer guide produced to assist consumers with understanding the provider’s obligations?
Thanks Professor Collignon.

Professor Peter Collignon:
Well there is already some information there. There is at least one page that says how to stay safe and prevent infections with an info graph. And that’s designed for everybody but residents and their families should be able to understand that as well. As time goes on I hope individual organisations but other people expand that to make it more applicable because this won’t work unless we have the residents and their families as part of this as well.

Rhiannon Box:
Fantastic. Thank you. The next question I have is for you again Professor Collignon and that question is:
Q:    Why has the Guide focused on respiratory precautions rather than current droplet and airborne precautions?

Professor Peter Collignon:
Well I hope I touched on this in my talk. Basically there’s a continuum between aerosols and droplets. So we took the view that basically you’ve got to make a risk assessment and in high risk situations from aerosols that’s where you need respirators and N95 masks. And an example of that is using nebulisers. But equally you’ve got to look at decreasing the risk and one of the ways you can decrease that risk is to use spacers instead of a nebuliser for instance. Get rid of the risk. Now for other things, CPAP machines, again that’s where we regard it as higher risk. WHO and others have got a list of what they regard as producing large numbers of aerosols and we’re recommending N95 respirators for that. But for the rest we think on the available evidence you get very good protection by wearing a surgical mask and eye protection and that is much more comfortable and it’s much more likely you’ll get compliance with that than if you go for an N95 mask all the time at all times.

Rhiannon Box:
Fantastic. Thank you. The next question I have is for you again Professor Collignon and that is:
Q:    Do IPC leads know what to factor into their risk assessment when determining if PFRs should be used?

Professor Peter Collignon:
Well again as part of our document we’re saying the individual IPCs have got to make a risk assessment. We give some of the criteria like I’ve given there – nebulisers, how much aerosols are produced – but it’s also have you got wandering people with dementia who may have an infection. So there is no one black and white answer. The IPC on the ground along with others involved in these decisions need to look at all these factors. There’s minimum standards we have. If they want to apply more that’s part of the risk assessment and information they’ve got to collect on the ground and make a decision at that time.

Rhiannon Box:
Thank you. And the next question I have is for you once again Professor Collignon and that is:
Q:    Were infection prevention and control experts who work in the area of aged care consulted about the changes to transmission based precautions combining droplet and airborne precautions and the use of N95 masks at the discretion of leads who may be inexperienced in this area?

Professor Peter Collignon:
Well the short answer is yes, yes and yes. I mean most of the panel consisted of people with infection control expertise or at least a lot of experience in aged care. And I can tell you there was a lot of discussion about this and there was consensus. We didn’t even have to take a vote. We were trying to come up with something that protected patients and staff but was practicable and would go into the medium to long term. And that’s where we’ve arrived at. We also sent this out for public consultation again to the aged care sector and others, and the overwhelming, I would think 95% plus, approved what we put out. So we don’t actually say we’re absolute and we know the answers but we’ve taken lots of things into consideration. And as far as we can see the overwhelming majority of the people who work in the sector agree with this approach that we’ve taken.

Rhiannon Box:
Fantastic. Thank you. And the very last question I have is for Alison and that is:
Q:    How are we supporting healthcare staff, cleaners, nursing and support staff to be updated on cleaning infection control? Where can we access online training for our aged care workers with the new Infection Prevention and Control Guide applied?
Thanks Alison.

Professor Alison McMillan:
Given the time constraints we’ve got I’ll go absolute to the point. Home care providers and aged care providers should be implementing effective systems and processes for IPC and this includes training for all workers including health professionals and support workers. Chapter 6 of the new Aged Care Infection Prevention Guide addresses cleaning, safe and hygienic environments, and there’s also more information on environmental cleaning and IPC that can be obtained from the Australian Commission on Safety and Quality in Health Care’s website. And finally ACIPC, the Australasian College of Infection Prevention and control have resources specific to environment, cleaning, including ACIPC are holding a webinar as part of their aged care IPC community of practice on the 16th of October which will help people. And so go to the ACIPC website. They’re delivering aged care specific training. That’s where you’ll get the very best expert advice on how to manage this from the expert group. Thanks Rhiannon.

Rhiannon Box:
Thanks so much Alison. And that concludes today’s webinar. All the questions that we didn’t have a chance to answer we will be publishing answers on our website. We would appreciate it if you could please stay online and complete a short survey to help us improve our webinars. Please scan the QR code or follow the link that we have posted in the Q&A. The survey will take about one minute to answer three short questions. Thank you to everyone who was able to join us today and thank you to our panel presenters. We hope everyone has found this session useful. Thank you.

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