Preparing for and Managing COVID-19 Outbreaks in Long-Term Care and Retirement Homes
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To view an archived recording of this presentation please click the following link: http://pho.adobeconnect.com/pjr7piymt0gy/ Please scroll down this file to view a copy of the slides from the session. Helpful tips when viewing the recording: • The default presentation format includes showing the “event index”. To close the events index, please click on the following icon and hit “close” • If you prefer to view the presentation in full screen mode, please click on the following icon in the top right hand corner of the share screen PublicHealthOntario.ca 2 Preparing for and Managing COVID-19 Outbreaks in Long-Term Care and Retirement Homes Katherine Paphitis Devon Metcalf Content accurate as of September 29, 2020 Terms of use This educational content was developed by Public Health Ontario (PHO). PHO provides scientific and technical advice to Ontario’s government, public health organizations and health care providers. PHO’s work is guided by the current best available evidence. PHO assumes no responsibility for the results of the use of this educational content by anyone. This educational content may be reproduced without permission for non- commercial purposes only and provided that appropriate credit is given to Public Health Ontario. No changes and/or modifications may be made to this educational content without explicit written permission from Public Health Ontario. PublicHealthOntario.ca 2 Outline • What is surveillance? • Outbreak preparedness • What is an outbreak? • Outbreak management considerations: • First steps • Activities and meals • Residents in outbreak area(s) • Infection prevention and control (IPAC) • Staff and approved visitors • Monitoring • Testing • Communications • Transportation of residents • Declaring outbreak over • Available resources PublicHealthOntario.ca 3 What is surveillance? PublicHealthOntario.ca 4 What is surveillance and why do we do it? Surveillance is the ONGOING, SYSTEMATIC collection, analysis and interpretation of information. In a long-term care or retirement home setting, surveillance involves monitoring residents for signs and symptoms of certain illnesses in order to determine what is ‘normal’ (i.e., a baseline) for a facility and to identify any increases in illness. Early identification of illness and potential outbreaks can allow appropriate infection control measures to be implemented to prevent further spread of illness in the facility. Centers for Disease Control and Prevention. Public health 101 series: introduction to public health surveillance [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2020 [cited 2020 Sep 23]. Available from: https://www.cdc.gov/publichealth101/documents/introduction-to-surveillance.pdf PublicHealthOntario.ca 5 How to conduct symptom surveillance • It is usually not practical or feasible to conduct surveillance for all possible symptoms • Consider focusing surveillance on specific symptoms or syndromes (collection of symptoms) of interest (targeted surveillance) including those that may represent diseases of public health significance • Surveillance can be active and passive • Provide results of surveillance to those who need the information to make decisions (e.g., administration, infection control, public health unit) so that appropriate actions can be taken. PublicHealthOntario.ca 6 How to conduct symptom surveillance (cont.) Active Surveillance Passive Surveillance • Designate trained staff who will • Encourage residents to report any be responsible for asking symptoms to staff if they begin to residents about relevant feel ill symptoms daily • Advise staff and visitors who • Review pharmacy, physician, provide care to or interact with clinical nursing notes and residents to report any signs of laboratory information illness observed during resident • Seek out potential cases of illness interactions (e.g., COVID-19) • Advise staff and visitors to report any signs or symptoms of illness PublicHealthOntario.ca 7 Using surveillance data • Track reported symptoms or syndromes over time and act on findings • Compare rates of illness to the same time period in previous years, or from one season to another, e.g. from one respiratory virus season to the next (internal benchmarking) • Compare rates of illness to local homes of similar size/population (external benchmarking) or a known standard • Report any unusual or sudden increases in illness to the local public health unit PublicHealthOntario.ca 8 Outbreak preparedness • Ensure an appropriate supply of Personal Protective Equipment (PPE) • Consider (in discussion with the public health unit) potential cohorting and resident placement options, specific to your facility • Have a supply of non-expired nasopharyngeal (NPS) and/or nasal swabs readily accessible (on site or available from public health unit) • Have appropriate additional precaution, visitor, outbreak and other signage available • Ensure an appropriate environmental disinfectant is available and in use • Identify staff who work at more than one facility • See COVID-19 Infection Prevention and Control Checklist for Long-Term Care and Retirement Homes Centers for Disease Control and Prevention. Personal protective equipment (PPE) burn rate calculator [Internet]. Atlanta, GA: Centers for Disease Control and Prevention; 2020 [cited 2020 Sep 23]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/burn-calculator.html Ontario Agency for Health Protection and Promotion (Public Health Ontario). Infection prevention and control checklist for long-term care and retirement homes during COVID- 19. [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2020 [cited 2020 Sep 23]. Available from: https://www.publichealthontario.ca/-/media/documents/ncov/ipac/covid-19- ipack-checklist-ltcrh.pdf?la=en PublicHealthOntario.ca 9 What is an outbreak? PublicHealthOntario.ca 10 What is a facility outbreak of COVID-19? Possible: • A cluster of ill residents, staff and/or visitors (but no confirmed cases of COVID-19) Confirmed: • Once COVID-19 is identified to be present or circulating within a facility, in discussion with the local public health unit, a confirmed outbreak may be declared PublicHealthOntario.ca 11 COVID-19 outbreaks by setting: Ontario, January 1 to August 15, 2020 Percentage of total COVID-19 outbreaks by setting type (n=1,163) Total number of COVID-19 outbreaks: 1,163 By setting type: 34.7 12.0 • Long-term care homes: 404 (34.7%) 8.4 • Retirement homes: 175 (15.0%) • Non-congregate settings: 346 (29.8%) • Hospitals: 98 (8.4%) 15.0 29.8 • Congregate settings: 140 (12.0%) Long-term care homes Retirement homes Non-congregate settings Hospitals Congregate settings PublicHealthOntario.ca 12 Outbreak management: first steps PublicHealthOntario.ca 13 First steps: if you have a possible or confirmed outbreak • Contact your local public health unit (PHU) • Be prepared to provide the following: • Total number of residents/staff • A list of ill residents/staff and visitors including rooms, units / floor (i.e., line list – see sample) • A list of possible high risk close contacts • Description of facility layout The Ministry of Health’s Public Health Unit locator: https://www.phdapps.health.gov.on.ca/PHUlocator/ PublicHealthOntario.ca 14 Line lists Line lists provide a summary of the extent and nature of an outbreak Outbreak Line Lists: • Complete separate line lists for staff and residents • Send to public health daily • Information to include: • Demographics: age, sex • Location in facility • Illness details: symptoms, onset date, resolution date • Influenza and pneumococcal vaccine status • Other information: specimens submitted, results, hospitalization etc. PublicHealthOntario.ca 15 First steps: sample line list Source: Ontario. Ministry of Health and Long-Term Care. Control of respiratory infection outbreaks in long-term care homes, 2018. Toronto, ON: Queen’s Printer for Ontario; 2018. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/reference/RESP_Infectn_ctrl_guide_LTC_2018_en.pdf PublicHealthOntario.ca 16 First steps: assemble a team and ensure continuity of services Assemble a team to help manage Ensure access to other key services the outbreak and supports are maintained • Local public health unit staff • Medical care • Facility staff • Routine medications • COVID-19 lead (if identified) • Mental health supports and • Administrators and/or managers counselling • Health care and/or other appropriate • Foot care staff members • Oxygen therapy • Environmental health & infection prevention and control staff • Dietary staff • Communications PublicHealthOntario.ca 17 First steps: defining outbreak and non-outbreak areas • Health unit will work with the facility to determine the outbreak area, and if there is a non-outbreak area • Depending on the size and layout of the facility, one or more units, floors or wings of the facility may be considered a cohort • If ill and well residents are randomly dispersed throughout the facility, an outbreak may be considered facility-wide PublicHealthOntario.ca 18 Outbreak management: cohorting of residents and staff PublicHealthOntario.ca 19 Residents in outbreak area: cohort to prevent mixing Keep all individuals Keep all individuals Individuals can be separate separate together Do not know who is and is not infected * Discuss resident placement options with public health for those who are confirmed to be co-infected with COVID-19 and another pathogen PublicHealthOntario.ca 20 Cohorting scenarios • Cases occur in roommates within