Revision History - Department of Health and Human Services



left000Coronavirus (COVID-19) Plan for the Victorian Aged Care SectorVersion 3.0 1 July 2020Revision HistoryVersionSectionDate ModifiedPage #Summary of revisions made3.01.125/61Added legislative obligations to be maintained during pandemic 3.01.122/61Added functional and well-being support services to essential service list3.01.12/62Updated visitor allowances in line with new Directions3.01.122/62Updated symptom examples3.01.122/63Inserted reference to Appendix 10 – Guiding Principles 3.02.3.122/65-6Updated symptoms and testing advice3.02.3.322/66Updated risk for COVID-193.02.422/67Table 2 updated to note fever not always present in older people3.03.2.428/510Staffing model reworded to dedicated staffing model3.03.2.622/611Medication supplies added, and Appendix 11 checklists3.03.2.71/612Communication with residents and families/representatives, including advocacy contact details3.03.3.222/613Updated symptoms and staff policies3.03.3.328/513Added information about screening of all new admissions3.03.3.31/614Admission protocols updated3.04.122/615Department PPE factsheet link added3.04.228/516Outbreak testing and swabbing information updated3.04.422/617Email address added for outbreak case list3.04.622/617Emergency Response Team (ERT) added to Other Support3.04.7.128/518PPE updated and link to department factsheet3.04.7.128/519Added call bells to be regularly cleaned3.04.8.1.128/520-21Care Directions Link included, and Visitors information updated3.04.8.1.322/622Hospital Visitor Directions added National Code for Visiting RACF 3.04.8.1.41/623Added National Code for Visiting RACF 3.04.8.1.41/623Visitor compliance with Code of Conduct3.04.8.1.622/624Flu vax date put into past tense, and examples added3.04.8.1.622/625Add requirements in relation to emergency responders3.04.8.21/625Resident admissions and transfers updated3.05.21/629Checklist: Response to confirmed resident updated3.05.31/630Checklist: response to confirmed staff member updated3.06.222/633Travel quarantine requirements updated3.06.51/634Link to Management of deceased fact sheet included3.06.622/635Reducing stress and anxiety updated3.06.7.222/635Emergency Response Team (ERT) added3.0722/648Appendix 7 updated to include chills3.0722/649Appendix 8 updated to include second test3.0722/656Appendix 11 addedContents TOC \h \z \t "Heading 1,1,Heading 2,2" Revision History PAGEREF _Toc44683340 \h iAcronyms and Abbreviations PAGEREF _Toc44683341 \h i1.Introduction PAGEREF _Toc44683342 \h 11.1.Summary PAGEREF _Toc44683343 \h 11.2.Scope and purpose PAGEREF _Toc44683344 \h 31.2.1.Description of the aged care sector in Victoria PAGEREF _Toc44683345 \h 31.2.2.Sensitive settings PAGEREF _Toc44683346 \h 31.3.Objectives PAGEREF _Toc44683347 \h 41.3.1.Overall PAGEREF _Toc44683348 \h 41.3.2.Residential and aged care sector PAGEREF _Toc44683349 \h 42.Understanding coronavirus (COVID-19) PAGEREF _Toc44683350 \h 52.1Key supports: PAGEREF _Toc44683351 \h 52.2Stages of the public health response PAGEREF _Toc44683352 \h 52.3Identifying coronavirus (COVID-19) PAGEREF _Toc44683353 \h 52.4COVID-19 and other respiratory outbreaks PAGEREF _Toc44683354 \h 73.Preparedness and Prevention PAGEREF _Toc44683355 \h 83.1Key supports: PAGEREF _Toc44683356 \h 83.2Preparedness PAGEREF _Toc44683357 \h 83.3Prevention PAGEREF _Toc44683358 \h 124.Case and Outbreak Management PAGEREF _Toc44683359 \h 154.1Key supports PAGEREF _Toc44683360 \h 154.2Assessment of residents who have fever or influenza-like illness (ILI) PAGEREF _Toc44683361 \h 154.3Case notification PAGEREF _Toc44683362 \h 164.4Outbreak notification PAGEREF _Toc44683363 \h 164.5Establishing an outbreak management team PAGEREF _Toc44683364 \h 174.6Other support PAGEREF _Toc44683365 \h 174.7Infection Prevention and Control Measures PAGEREF _Toc44683366 \h 184.8Visitors, admissions and transfers PAGEREF _Toc44683367 \h 215.Responses for specific scenarios PAGEREF _Toc44683368 \h 275.2Checklist - Response to a suspected case in a resident PAGEREF _Toc44683369 \h 285.3Checklist - Response to a confirmed case in a resident PAGEREF _Toc44683370 \h 295.4Checklist - Response to a confirmed case in a staff member PAGEREF _Toc44683371 \h 305.5Checklist - Response to a confirmed case in a visitor PAGEREF _Toc44683372 \h 315.6Checklist - Response to an outbreak in the facility PAGEREF _Toc44683373 \h 326.Policy guidance on specific topics PAGEREF _Toc44683374 \h 336.1Key supports PAGEREF _Toc44683375 \h 336.2Staff protocols PAGEREF _Toc44683376 \h 336.3End of life care / advance directives PAGEREF _Toc44683377 \h 336.4Grief and bereavement support PAGEREF _Toc44683378 \h 346.5Management of deceased PAGEREF _Toc44683379 \h 346.6Reducing stress and anxiety PAGEREF _Toc44683380 \h 356.7Roles and Responsibilities PAGEREF _Toc44683381 \h 357.Appendices PAGEREF _Toc44683382 \h 37Appendix 1 - Letter to Families – Preventing Spread of COVID-19 PAGEREF _Toc44683383 \h 37Appendix 2 – Checklists for RACF PAGEREF _Toc44683384 \h 39Appendix 3 - Checklist for initial assessment / transfer PAGEREF _Toc44683385 \h 43Appendix 4 – Letter to GPs for COVID-19 outbreak PAGEREF _Toc44683386 \h 44Appendix 5 – COVID-19 sample case list PAGEREF _Toc44683387 \h 45Appendix 6 – Outbreak management checklist PAGEREF _Toc44683388 \h 46Appendix 7 – Screening of visitors for COVID-19 PAGEREF _Toc44683389 \h 48Appendix 8 – Care Plan Confirmed COVID-19 PAGEREF _Toc44683390 \h 49Appendix 9 – Hand Hygiene PAGEREF _Toc44683391 \h 52Appendix 10 – Guiding Principles PAGEREF _Toc44683392 \h 55Appendix 11 – medication preparedness checklists PAGEREF _Toc44683393 \h 568.Additional resources PAGEREF _Toc44683394 \h 58Acronyms and AbbreviationsThe Commission Aged Care Quality and Safety Commission ABHR alcohol-based hand rub ARIacute respiratory infectionCDNA Communicable Disease Network Australia the department Department of Health and Human Services ERT Emergency response team (Commonwealth Department of Health) GP general practitioner HCW health care worker HITHhospital in the homeILI influenza-like-illness OMT Outbreak Management Team PHO public health officer PPE personal protective equipment RACF residential aged care facilities RCF residential care facilities RICPRAC rural infection control practice group the squadInfection Prevention and Control Outreach Nurse SquadIntroductionSummaryCoronavirus (COVID-19) is a respiratory illness caused by a new virus SARS-CoV-2. Symptoms range from a mild cough to pneumonia. Some people recover easily, others may get very sick very quickly. There is evidence that it spreads rapidly from person to person. The World Health Organisation (WHO) has declared COVID-19 to be a Public Health Emergency of International Concern and a pandemic and identified the new virus as SARS-CoV-2. Travel restrictions and rapid public health responses have been put in place.This plan has been developed by the Victorian Department of Health and Human Services (the department) to support residential aged care facilities (RACFs). This document is adapted from the Communicable Diseases Network Australia (CDNA) national guidelines: Coronavirus Disease 2019 (COVID-19) Outbreaks in Residential Care Facilities, and the Commonwealth Infection Control Expert Group: COVID -19 Infection Prevention and Control for Residential Care Facilities. It further adapts existing guidelines on respiratory illness and influenza outbreaks that all RACFs will be familiar with. The Plan also helps deliver the COVID-19 Pandemic Plan for the Victorian Health Sector. This document is aimed at residential and aged care facilities, but the guidelines and principles described here could be adapted and applied to other settings such as the disability sector. The aim of this guideline is to assist RACFs to support their healthcare workers, residents, families and visitors to prepare for, prevent and manage cases and outbreaks of COVID-19. While this Plan focusses on RACF planning and responses that are specific to a coronavirus (COVID-19) pandemic, RACFs need to ensure continuity of care for all residents throughout this time, including during an outbreak. RACFs have an obligation to continue to deliver safe quality care and service to all residents in accordance with their legislative and Aged Care Quality and Safety Standards obligations, at all times.This plan will support RACFs to put into place targeted action to protect residents, staff and visitors as part of Victoria’s pandemic management response. Limitations on visiting from National CabinetOn 18 March 2020, the National Cabinet established to respond to the coronavirus (COVID-19) pandemic (consisting of Prime Minister, premiers and territory leaders) agreed to enhanced arrangements to protect older Australians in RACFs. Restrictions now apply on entry into all aged care facilities. As outlined in the Victorian Directions, only essential, functional and wellbeing support services and visitors providing essential care and support to a resident, including end of life support, will be able to enter, or remain on, the premises of a RACF to prevent the introduction and transmission of coronavirus (COVID-19) in a RACF. Essential services include:Regular staff of the service who provide clinical care, food services, administrative functions and cleaning. Other visiting clinical staff including visiting medical officers such as general practitioners, geriatricians, palliative care physicians and other medical specialists, pharmacy services; specialist nurses; diagnostics services; and allied health services.Other services that are permitted under the Directions include those providing behavioural support services and functional and wellbeing support services, for example: hairdressing, diversional and recreational therapies, music therapies.RACFs should review all visits to reduce movement in and out of the RACF. Clinical visits should be limited to essential assessments and management for resident’s health conditions, including to assess and manage coronavirus (COVID-19) symptoms. Other assessments and clinical activities may be postponed if they do not have adverse impacts on the health of the resident. VisitorsAged care facilities should be implementing the following measures to limit 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 immediate social supports (family members, close friends) or professional service or advocacy at one time, up to two visits per day for a total of no more than two hours a day;Visits should be conducted in a resident’s room, outdoors, or in a specific area designated by the aged care facility, rather than communal areas where the risk of transmission to residents is greater;Visitors should only visit one resident and while visiting should maintain separation of 1.5 metres from residents if possible.Visitors should practice cough etiquette / respiratory hygiene and use alcohol based hand sanitiser before entering and on leaving the resident’s room and the facilityNo large group visits or gatherings, including social activities or entertainment, should be permitted at this timeNo school groups of any size should be allowed to visit aged care facilities.Encourage and facilitate phone or video calls between residents and their friends and family members to maintain social contactChildren aged 16 years or less must be permitted only by exception, as they are generally unable to comply with hygiene measures. Exemptions can be assessed on a case-by-case basis by the RACF, for example, where the resident is in palliative care.Managing illness in visitors and staffAged care facilities should screen all visitors and staff to be vigilant for illness (however mild) and use hygiene measures including physical distancing, and to monitor for symptoms of coronavirus (COVID-19), specifically fever, chills and acute respiratory illness. They should be instructed to stay away when unwell, in order to protect staff health and resident health.Symptomatic staffStaff should be made aware of early signs and symptoms of coronavirus (COVID-19), including atypical symptoms. Any staff with fever, chills or any symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath), however mild, should be excluded from the workplace tested for coronavirus (COVID-19) and remain in isolation until cleared. Staff must report their symptoms to the aged care facility.These guidelines will change as new information about the disease becomes available and as Victoria’s response to coronavirus (COVID-19) progresses. These guidelines will be updated on a regular basis and you should source the most recent updates of the guideline at the department’s COVID-19 website Information about clinical assessment and public health characteristics of coronavirus (COVID-19) is available on the Health services and general practice – coronavirus disease webpage < for the general public is also available on the department’s website < residential aged care facility managers should subscribe to the Chief Health Officer alerts and the Coronavirus update newsletter via the department’s website < Principles Appendix 10 outlines guiding principles for approved providers of Victorian residential aged care facilities in the context of the coronavirus (COVID-19) pandemic, Victorian State Directions and existing RACF obligations.Scope and purposeThis plan provides guidance to inform detailed planning at the individual facility level. All RACF providers should use this plan, and other materials provided by the department to determine how a coronavirus (COVID-19) pandemic may impact their service, their residents, clients and staff, and use those insights to determine further planning and preparedness activities required. Each facility will be different, and this plan will need to be adapted to the individual circumstances of a facility. Certain judgements will need to be made on a case-by-case basis. Description of the aged care sector in VictoriaThere are approximately 50,000 aged care beds in Victoria. There are 5,609 public sector residential aged care beds in Victoria, with the remainder being managed by the private and non-government sector. This plan is not intended as education for the general public. Information for the general public can be found at the department’s COVID-19 website < settingsA residential or aged care facility is considered a sensitive setting in relation to the coronavirus (COVID-19) emergency. Sensitive settings: have populations that are particularly vulnerable to COVID-19may have profound effects on the wider community if an outbreak were to occur within themare a priority setting for any public health response.There is a high risk of an outbreak of coronavirus (COVID-19) in RACFs. Older Victorians, who may also have co-existing illnesses, are at increased risk of serious complications if they contract coronavirus (COVID-19). Infection can spread rapidly through residential and aged care facilities if not managed appropriately. For these reasons, it is important that facilities are prepared and supported to respond to coronavirus (COVID-19). It is the responsibility of RACFs to identify and comply with commonwealth and state legislation and regulations. Specifically, RACFs should fulfil their legal responsibilities in relation to infection control by adopting standard and transmission-based precautions as directed in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) <; and by the Victorian Department of Health and Human Services. RACFs are also required to operate under the Aged Care Act 1997 to be accredited and be eligible for funding. Accreditation requires adherence to infection control standards.COVID-19 is a notifiable condition under Victoria’s Public Health and Wellbeing Regulations 2019. Medical practitioners and /or laboratories are legally required to notify all confirmed cases of COVID-19. Notification should take place to the department as soon as practicable by calling 1300 651 160, 24 hours a day, 7 days a week.See the Coronavirus disease 2019: Case and contact management guidelines for health services and general practitioners for updates to case and contact definitions and management guidelines. This is regularly updated and available on the department’s website < overall objectives of this plan are adapted from the objectives of the COVID-19 Pandemic Plan for the Victorian Health Sector <;. The objectives of this plan are to:Protect residents in residential aged care facilities from the spread of coronavirus (COVID-19).Prepare the residential and aged care sector to prevent and manage cases of coronavirus (COVID-19).Prepare the residential and aged care sector to continue to meet the needs of older Victorians.Reduce the morbidity and mortality associated with coronavirus (COVID-19) in aged care residents.Slow the spread of coronavirus (COVID-19) in Victoria through rapid identification and isolation of cases.Empower the aged care sector to ensure a proportionate and equitable response and to facilitate a coordinated response with other health services and sectors.Support containment strategies through accurate, timely and coordinated communication and community support.Mitigate and minimise impacts of the pandemic on the aged care sector, health system and broader community.Residential and aged care sectorIn addition to the objectives of the coronavirus (COVID-19) Pandemic Plan for the Victorian health sector, several key objectives have been identified which are priorities specific to the residential and aged care sector.Optimise hygiene and infection control processes within facilities.Ensure all staff and residents of facilities are vaccinated and protected against influenza.Prepare facilities to reduce their risk from influenza-like illness (ILI), and to detect and manage ILI outbreaks safely and efficiently.Prepare a workforce plan, ensure business continuity and promote self-sufficiency within facilities.Continue to ensure residents, and their families, are involved in decisions, and respect resident preferences and values in order to maximise quality of life and wellbeing. Understanding coronavirus (COVID-19)Key supports:Victorian Department of Health and Human Services COVID-19 website for the most up to date case definition and guidelines: Commonwealth Department of Health COVID-19 website: practitioner notifications: 1300 651 160, 24 hours a day.Stages of the public health responseA State of Emergency was declared in Victoria on 16 March 2020 under the Public Health and Wellbeing Act 2008. Victoria’s response is now focussing on targeted action as community transmission is detected.1Victoria’s response to coronavirus (COVID-19) sets out four stages. The response will work together with all states, territories and the Commonwealth. The four stages may overlap through the course of pandemic response. Responses across all sectors will depend on the stage of response we are in. The table below outlines each of the four stages and these will be expanded on in the remainder of this document.1A Class 2 emergency is a major emergency that is not a Class 1 emergency or a warlike act or act of terrorism. (Class 1 emergencies are either major fires or emergencies with MFB, CFA or SES as control agency). The response in a Class 2 emergency is a collaboration across the health sector, government agencies and the community.Table 1. Stages of pandemic response planStages of response:Stage 1Initial containment stageStage 2Targeted action stageStage 3Peak action stageStage 4Stand-down and recovery stageIdentifying coronavirus (COVID-19)Signs and symptomsThe most common symptoms of coronavirus (COVID-19) infection include (in the absence of an alternative diagnosis that explains the clinical presentation):Fever or chills;acute respiratory infection (shortness of breath, cough, runny nose, anosmia or loss of smell or loss of taste, with or without a fever);tiredness or fatigue;less common symptoms may include headache, myalgia/arthralgia, stuffy nose, nausea and vomiting, diarrhoea.Older people may have non-classic respiratory symptoms, mild or atypical presentations, such as the following symptoms:increased confusion;worsening chronic lung disease; ornasal or conjunctival congestion, haemoptysis, anosmia, sore throat or sputum productionloss of appetite.Note: fever may be absent in older people. Most people will experience a mild illness and will recover, but some people can develop complications which may be life-threatening and result in death. Older people appear to be at greatest risk of these complications. Older residents may experience a worsening of chronic health problems such as congestive heart failure, asthma and diabetes as a complication of coronavirus (COVID-19) infection. Older people at highest risk are likely to be those with other chronic illnesses or with weakened immune systems.Clinicians should test for coronavirus (COVID-19) in any resident of a RACF with any new respiratory symptom, however mild.Please check the department’s coronavirus (COVID-19) website for the most up to date case definition and guidelines < period and infectious periodPeople with coronavirus (COVID-19) generally develop signs and symptoms, including mild respiratory symptoms and fever, on average 5-6 days after exposure (range 1-14 days). People with coronavirus (COVID-19) are thought to be infectious for 48 hours before the onset of symptoms but evidence on the duration of infectivity for coronavirus (COVID-19) infection is evolving. DHHS staff will determine someone with coronavirus (COVID-19) may be released from isolation, based on standardised criteria published in the department’s guidelines for health services and general practices available on the department’s website.Risk for coronavirus (COVID-19)Risk factors include any international travel within the last 14 days, or close contact with a person who is a confirmed case of coronavirus (COVID-19) (without using appropriate personal protective equipment (PPE)) and exposure to a site where there is an active outbreak. It is important that the current case definition for a suspected case of coronavirus (COVID-19) is applied, as described above – see date case definition and guidelines Risk factors for acquiring coronavirus (COVID-19) include any international travel within the last 14 days, close contact with a person who is a confirmed case of coronavirus (COVID-19).TransmissionCoronavirus (COVID-19) is transmitted via droplets or after exposure to contaminated surfaces after close contact with an infected person (without using appropriate PPE). Airborne spread has not been reported but could occur during certain aerosol-generating procedures (medical procedures which are not usually conducted in RACF). Faecal-oral spread does not appear to be a driver of transmission. However, it is an important consideration in a facility, and therefore confirmed cases with ongoing diarrhoea or faecal incontinence who have limited capacity to maintain standards of personal hygiene should continue to be isolated until 48 hours after the resolution of these symptoms. For these reasons, respiratory hygiene and cough etiquette, hand hygiene and regular cleaning of surfaces are paramount to preventing transmission.COVID-19 and other respiratory outbreaksCoronavirus (COVID-19) is a new challenge, but health services and RACF have knowledge and skills to respond to this challenge based on experience with management of respiratory outbreaks, including due to influenza. The first line of defence against coronavirus (COVID-19) is standard infection control measures, especially hand hygiene, which applies for all staff (clinical and non-clinical), residents, and essential visitors of any kind.Annual influenza planning should be integrated into planning for coronavirus (COVID-19), as influenza and coronavirus (COVID-19) might occur together. Influenza immunization for all staff and residents and strict risk reduction measures are essential to protecting residents, workforces and the wider community. As coronavirus (COVID-19) might present in a similar way to how influenza presents, robust systems for preventing, detecting and managing outbreaks of influenza-like-illnesses safely are a key feature of the response in RACF for coronavirus (COVID-19).The management approach to coronavirus (COVID-19) and influenza are similar, however there are key differences, as detailed in the Table 1 below. Influenza and coronavirus (COVID-19) cases should be isolated separately and should not be cohorted together.Table 2: Similarities and differences - coronavirus (COVID-19) and influenzaCOVID-19InfluenzaVaccine availableNoYesFever and acute respiratory symptomsYes*YesNotification processASAP for confirmed cases for RACF, RACF residents and RACF workersApplies when there is an outbreakPrecautionsContact & dropletContact & dropletIsolation of casesYesYes*fever is not always present in the elderly Preparedness and PreventionKey supports:Guidance on forming an outbreak management plan: sample letter to families can be found in Appendix 1. Supporting older people: Seniors On-line and factsheets:Promotional material is available on the department’s website < your hands regularly poster < your cough and sneeze poster < posters and factsheets are also available on the department’s Translated resources page < outlining PPE use: and access to Commonwealth PPE for RACF contact: agedcarecovidppe@.auA sample letter advising of the increased risk of introduction of COVID-19 into the facility due to local transmission can be found in Appendix 1.Precautions posters can be found here: transfers guidelines: other resources and webinars are available on the department’s website at < checklists can be found in Appendix 2.PreparednessAged care facilities must ensure they are prepared for cases of coronavirus (COVID-19). It is a facility’s responsibility to ensure they have an outbreak response plan in place which is updated regularly. Health services will be severely affected by the coronavirus (COVID-19) pandemic. The aged care workforce will likely also be affected. Care protocols may change, and new practices may have to be adapted. For these reasons planning, clear lines of communication and flexibility are critical. There are six key components to preparedness for an RACF:Prepare / update an outbreak management plan.Ensure vaccination against influenza.Support staff, resident and family education during an outbreak.Workforce management.Staff education and training.Consumable munication with residents and their families/representativesPrepare an outbreak management planThe purpose of an outbreak management plan is to help staff prepare for, identify, respond to, and manage a potential outbreak, to protect staff and residents and to reduce the severity and duration of an outbreak should one occur. At a minimum, each RACF should identify a dedicated staff member or outbreak management team to plan for and manage any outbreak within the facility, and to serve as the liaison between the facility and the department. It is recommended the team seek advice from an infection prevention professional in the development of the plan.Each facility should now assess the infrastructure and isolation capabilities and should determine which rooms or units would be used for isolation or cohorting in different scenarios. This will involve a thorough assessment of room plans, environment and infrastructure, entry/exit points, food/cleaning/laundry services and visitor access logistics. This will include consideration such as if kitchens service community clients as well as residential and if it has separate access, is dirty laundry carried past other rooms, are there separate access points for visitors?Ensure vaccination against influenzaThere is no vaccine for coronavirus (COVID-19) at the current time. However, to reduce the impact of concurrent influenza outbreaks on residents, all residents and staff should be vaccinated against influenza. A register of all residents and staff and their vaccination status must be maintained, including the date and type of vaccine given. The immunisation provider must report each administration of seasonal influenza vaccine to the Australian Immunisation Register record for each recipient. As part of their usual practice of accreditation, all RACF are required to offer residents and staff influenza vaccination and record this. In addition, pneumococcal vaccination may be indicated for some residents and should be undertaken as part of the facility’s outbreak response plan.Support staff, resident and family education during an outbreakEducation for staff, residents and families is a major part of outbreak preparation. If an outbreak occurs, information should be distributed to families regarding the outbreak which includes information on hand and respiratory hygiene, enhanced restrictions on visitation, and other steps which families can take to reduce the risk of bringing coronavirus (COVID-19) into the facility. Information will apply to coronavirus (COVID-19) and other influenza-like illness. As part of this approach, signage / posters should be placed at entry points and at reception. The department recommends sending information to families when there is evidence of coronavirus (COVID-19) in the community. A sample letter can be found in Appendix 1. Staff must stay away from work when they have any kind of potentially infectious illness and should notify the facility if they suspect they were working during their infectious period. The principle underlying staff and visitors staying away from the facility if they are unwell applies to all types of infectious illness all year around. Facilities may wish to consider permanent signage reinforcing this message at all entry points to the facility.The provision of appropriate access to family, friends and loved ones will be important in managing residents’ wellbeing during this time. 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. Letter writing, notes and drawings from family and friends are offerings likely to be enjoyed by residents. Some organisations such as Lion’s and Rotary Clubs are creating innovative ways to support older people and Seniors On-line () will be uploading project and ideas as these become known. For example see: managementAs part of business continuity planning, all facilities should review and update their staff contingency / business continuity plan in the event that an outbreak occurs, or a large proportion of the workforce are unable to attend work. Facilities should regularly review the department website for the latest guidelines on requirements for quarantine (staying away when well after potential exposure), isolation and exclusion from work.Facilities should plan, in the event of an outbreak, to implement a dedicated staffing model. This staffing model involves no staff member working across different units or sites. This includes the clinical and nonclinical workforce. Where possible these staffing models should be implemented proactively to reduce the risk of disease transmission.It is possible that up to 40% of staff may be unable to attend work. Staff members who are identified as having been in close contact with the positive resident or staff member will be placed into quarantine for 2 weeks. Facilities should plan now for how they would cope in this situation and where a surge workforce could come from. A list of all staff, casual staff and agency contacts should be formed. Leave planning should take into account the evolving situation. Staff should be supported to exclude themselves from work if they have respiratory symptoms. They should also be advised that they need to notify the facility if they are a suspected or confirmed case of COVID-19 and to notify the department of their occupational history. Other important considerations include night-time staffing and capacity to isolate at night-time (particularly in smaller facilities), managing shared rosters across different RACF sites, and staff who may have other jobs in acute care facilities or other RACF.Staff education and trainingIt is the responsibility of every RACF to ensure their staff are adequately trained and competent in all aspects of outbreak management. This includes being able to recognise deterioration or change of a resident’s health status to enable the service to respond to the deterioration in an appropriate and timely manner. Staff should know the signs and symptoms of COVID-19 and influenza like illness (ILI) in order to identify and respond quickly to suspected cases. Additionally, all staff (including casual, domestic, hospitality and volunteer workers) need to understand the infection control guidelines and be competent in implementing these measures during an outbreak. Specific training should be arranged for staff if needed, including agency staff. This may include online resources. Services will need to discuss with their agency staff providers their responsibilities to ensure all agency staff are competent in infection control measures. Services must ensure agency staff have sufficient time in handover to familiarise themselves with the service’s specific outbreak management and infection control guidelines and rmation sessions should be organised with staff to inform them of these guidelines, other resources, leave policies and to answer any questions.A series of educational webinars will be organised by the department on COVID-19 and infection control practices, to prepare aged care sector workers. These will be available on the department’s website, as will other resources. Facilities should check regularly for added resources. The first webinar held on Thursday 19 March on caring for vulnerable Victorians - COVID-19 and residential aged care focussed on ways to reduce the risk and impact of coronavirus infection for residents and staff. This webinar is available on the department’s website at < Commonwealth also has a number of resources available and has advised that there will be further training for aged care staff. Facilities should continue to regularly check the Department of Health and the Commission’s websites.A list of online resources is available in the additional resources section of this document. following are posters and factsheets you should put up in your aged care service. Promotional material is available on the department’s website your hands regularly poster < your cough and sneeze poster < are also available in languages other than English on the department’s Translated resources page < stocksFacilities must ensure that they have adequate stocks of all personal protective equipment (PPE) and consumables required. These include PPE (gloves, long sleeved gowns, single use facemasks (surgical masks), eye protection), hand hygiene products, testing swabs and cleaning supplies. Facilities should have procedures in place to monitor stock levels, carry out regular stocktakes. The Commonwealth Department of Health has advised in recognition of national supply issues, it will ensure the availability of PPE for aged care services. This is specifically for instances where the RACF cannot access PPE through their usual suppliers, where there is a suspected or confirmed case of COVID requiring urgent access to PPE and where continuity of care is at risk. RACF should contact the Commonwealth regarding PPE supplies. Information and access to Commonwealth PPE for RACF is through: agedcarecovidppe@.au Facilities should educate all staff on appropriate usage of PPE and PPE conservation measures. Conservation of PPE is important due to the increased demand for PPE globally at this time. For example, to conserve PPE, staff should attempt to perform more than one task when they enter a resident’s room where that resident is in isolation. Facilities must not stockpile PPE. Staff should be advised not to take PPE for their own personal use.RACF should ensure that ALL staff are confident in the following procedures:How to put on (donning) your PPEHow to take off (doffing) your PPEHow to put on and fit check a P2 respiratorPosters outlining the above procedures for the above are available on the department’s website < must also ensure medication supplies and stocks are available. RACFs should meet with the local pharmacist to discuss current and future supply planning. A checklist is available on Appendix 11.Residential aged care providers may consider having an imprest system, the medication on site and how long their supplies will last in the event delays are experienced. It is appropriate to review storage and capacity of the stock onsite and consider the implication if larger stock deliveries were to occur, where additional supplies would be secured. A checklist for providers is available in Appendix 11.Facilities should prepare for contingency measures for prescribers. This will ensure the continued supply of medicines during a coronavirus (COVID-19) outbreak. Planning for alternative programs, delivery methods and electronic prescribing should all be considered. Refer to Appendix 11 for resources munication with residents and their families/representativesFacilities should start having conversations about a coronavirus (COVID-19) outbreak and planning with all residents, and their families/representatives. Conversations should include the choice and preferences of each resident/guardian in the event of a positive diagnosis of coronavirus (COVID-19) and should include a confirmation of the currency of the medical treatment decision maker and the advanced care directive. All providers should have readily available current advanced care directives that represent the discussion, the preference and outcome of the conversation. Families / Representative should be aware of the resident’s preferences where appropriate. Refer to Appendix 8. In some instances, families may request resident leave and plan to temporarily relocate the resident to their private homes for the duration of the pandemic and lockdown. These requests should be confirmed after the family are informed of the resident’s care and equipment requirements.The government has adopted new emergency leave legislation amendments which allows for residents to move out of their aged care during this crisis without being penalised. The government will continue to pay the residential care subsidy for the resident on emergency leave.Advocacy information Older people and their families/representatives may wish to seek support from aged care advocates. OPAN (Older Persons Advocacy Network) is a national aged care advocacy organisation that provides free, confidential aged care advocacy services and information. In Victoria, Elder Rights Advocacy represents OPAN: For further information, please contact 1800 700 600 or covid@.au PreventionMeasures to prevent coronavirus (COVID-19) deploy the same infection prevention control strategies used to prevent the spread of other respiratory viruses like influenza. Preventive measures should be undertaken now to minimise risk of exposure. Exposure preventionSupport hand and respiratory hygiene (including cough etiquette) by residents, staff and visitors.In general, for care of undiagnosed respiratory infection, use standard, contact and droplet precautions with eye protection.Make sure soap and paper towels are available at all sinks.Make sure tissues and rubbish bins are available throughout the facility.Place an alcohol-based rub in every room (resident, staff, and communal areas).Ensure staff are informed regarding current guidelines, exclusion recommendations and sick leave policies.Implement screening for staff, volunteers and visitors (including visiting workers).Undertake active screening of new admissions and returning residents.Provide information to visitors / families.Prevention of introduction into the facilityPost signs at the entrance instructing visitors not to visit if they have any symptoms of respiratory infection or have had close contact with a known case of COVID-19.Screen all visitors and workers (for example, volunteers, contractors, casual staff) for fever, chills and other symptoms before allowing them to enter the facility, using the screening checklist at Appendix 7.Ensure staff are aware of sick leave policies, ensure they understand they must not work and must stay home if they have respiratory symptoms, and cannot to return to work until they are well and if they have met case definitions for COVID-19, are cleared by the GP.Screen each new and returning resident entering the facility for respiratory symptoms.Restrict non-essential visitors coming into the facility for example, volunteer groups, school children or group activities and limit the movements of all visitors within the facility, such as restricting access to communal areas. This means limiting visitation to only those who are essential for the resident’s wellbeing and care. Send communications to families / friends / visitors advising them of the increased risk of introduction of COVID-19 into the facility due to local transmission in the community and emphasise the importance of limiting visitation (a sample letters can be found in Appendix 1).Prevention of spread within and between facilitiesAssess all transfers for respiratory symptoms, fever and chills before accepting the transfer and assess again on arrival.Screen all new admissions into the facility. Screening can include asking:have you been overseas in the last 14 days; or have you been in contact with or caring for someone who is a confirmed case of coronavirus (COVID-19) in the last 14 days; or do you currently have or had within the last 7 days a new illness, especially a fever, sore throat, cough, shortness of breath or other respiratory symptoms. Monitoring for atypical symptoms that may include: increased confusion worsening of chronic conditions of the lungs loss of appetite In addition to screening: Confirm if the resident is currently in isolation as a result of a positive coronavirus (COVID-19) test result ensure that essential arrangements and infection prevention practices including hand hygiene, physical distancing, environmental cleaning and use of PPE are implemented. Notify facilities (and transport providers) before transferring a resident with an acute respiratory illness to another RACF or acute care facility.Minimise non-essential transfers in and out of the facility.Keep residents, employees and visitors (friends/ family) informed.Monitor residents and staff for fever or respiratory symptoms.Post clear signs outside each door of any suspected or confirmed case of COVID-19 and describe the type of precautions required. Posters can be found on the Australian Commission on Safety and Quality in Health Care website < criteria for stopping group activities, group dining, closing units or closing the entire facility to new admissions.Consider cohorting residents with symptoms of respiratory infection.Consider dedicating staff to work only on affected units.Monitor residents and staff for symptoms.Restrict all residents to their rooms / units.RACF can accept transfers or readmissions when the case has been cleared by their treating doctor as per the most recent department guidelines < for Aged Care facilitiesThe RACF response will depend on what stage Victoria is at in the epidemic in addition to local factors. For the initial containment stage, all facilities should develop or review their outbreak response plans and supporting organisational policies and procedures. The targeted action stage and the peak action stage will require an escalation in measures. A set of checklists specific to RACF can be found in Appendix 2. These include checklists by stage. Set of checklists in Appendix 2 include the following.Actions for RACF in the initial action stage – what you should do right now.Actions for RACF in the targeted action stage - when there is widespread community transmission.Actions for RACF in the peak action stage.Checklist for managing COVID-19 patients in aged care facilities.All RACF should keep up to date with the latest guidance on the department’s website < and staff should subscribe to the Chief Health Officer alerts and to the coronavirus newsletter which can be done via the department’s website < and Outbreak ManagementKey supportsTesting for COVID-19 in RACF: \Notifications: hotline 1300 651 160. Establishing an outbreak management team: Rural infection control consultants: In-Reach services information: of PPE posters and factsheets: hygiene: ; and and disinfection: Coronavirus disease 2019: Case and contact management guidelines for health services and general practitionersExample signage: Promotional material is available on the department’s website < for residential aged care services, residents and visitors: <; Assessment of residents who have fever or influenza-like illness (ILI)Unwell residents require medical review by their GP regardless of whether an outbreak is present or not. This can be as a face to face or telehealth appointment. Maintaining the health and wellbeing of residents, and ensuring their care needs are met, continues to be the responsibility of the RACF. GPs and other healthcare workers will be under increased pressure and workload in response to COVID-19.Ensure that the GP is informed immediately that a resident has a fever / ILI and may be a suspected case of COVID-19. Inform the GP if there is an outbreak or suspected outbreak within the facility. If it is afterhours, contact the afterhours or locum service as per standard processes. Provide them with a comprehensive clinical history, current clinical observations and facility details. Testing for COVID-19 can be carried out in RACF and involves taking an oropharyngeal / nasopharyngeal swab from the suspected case, according to guidelines provided by the department. These guidelines are available on the department’s website at: \RACF can consider contacting their local Residential-In-Reach service for further support. If urgent medical attention is required call 000 and is in accordance with the residents advance care directives. Advise the operator of the COVID-19 risk.The Commonwealth Department of Health and the Victorian Department of Health and Human Services have prepared a coordinated response to COVID-19 outbreak management within Victoria. The protocol defines the shared responsibilities and testing threshold for COVID-19 positive cases in a residential aged care facility.At the first identification of an outbreak the RACF will be supported by the Public Health Unit of the Department of Health and Human Services to undertake a full round of resident and staff testing.Retesting may be required with timing determined in consultation with the Public Health Unit of the Department of Health and Human Services.It is recommended that the RACF use the same pathology service from the first full round of testing and retesting to enable efficient tracking of sample and results.Case notificationThe responsible health care provider must notify the department as soon as is practicable in the event of a confirmed case of COVID-19. All confirmed cases in an RACF or in a healthcare worker or residential aged care worker must be notified to the department on the hotline 1800 675 398. For the latest recommendations please see the department’s COVID-19 website < public health officer (PHO) at the department will advise and assist with the following:confirming the presence of an outbreakconfirming the control measures that need to be in placetesting of initial respiratory specimensproviding structured advice on whether the case can be managed at the RACF or requires transfer to an alternative facility or acute care based on identified facility capacity to manage a COVID-19 positive resident.The department may contact the RACF for critical information, and may request information from the nominated key contact, the facility manager, and / or other relevant staff members.Outbreak notificationIf an outbreak of COVID-19 is confirmed in a RACF, the department must be informed as soon as is practicable. A confirmed COVID-19 outbreak is defined as one case of COVID-19 confirmed by laboratory testing.These definitions may change. The department’s website <; should be checked for the most recent definition, which will be maintained in the COVID-19 Plan for the Victorian Aged Care Sector (this plan). The department will assist the RACF in determining whether to declare an outbreak. When an outbreak is confirmed, the department may request the following information from the RACF:resident or staff detailsdescription of RACF in terms of size, buildings, layout, infrastructure and staffingtotal number of residents / staff with symptomsdate of onset and details of symptoms of each persontotal number of staff that work in the facility and the affected areatotal number of residents in the facility and in the affected areacapacity to isolate / cohort caseswhether respiratory specimens (nose and throat swabs) have been collectednumber of people admitted to hospital with an ARInumber of people with an ARI who have died.All visiting GPs should be informed at the start of the outbreak. A sample letter for GPs can be found at Appendix 4. If any deaths occur during the outbreak, the department must be notified within 24 hours. A case list should be commenced when an outbreak is suspected. Once the outbreak is confirmed, the list should be updated and emailed to publichealth.operations@dhhs..au or faxed to 1300 651 170 daily, and this needs to detail any hospitalisations and deaths. All GPs and healthcare providers (including transport / ambulance staff) must be informed of the confirmed COVID-19 outbreak before attending the RACF. An example of a COVID-19 case list can be found at Appendix 5.Establishing an outbreak management teamIt is the facility’s responsibility to self-manage the outbreak in accordance with their established outbreak management plan. If possible, an internal outbreak management team (OMT) should be established to direct, monitor and oversee the outbreak, confirm roles and responsibilities and liaise with the department. Instruction for forming an OMT can be found on the department’s respiratory illness management in aged care facilities website < supportThe Commonwealth Department of Health has established an Emergency Response Team (ERT). Where a RACF is significantly and directly impacted by a coronavirus (COVID-19) outbreak, a Commonwealth Department of Health officer will contact the RACF to discuss what support might be needed. They will assess whether an ERT should be deployed for advice on infection prevention and control, workforce requirements, staff movement and staff deployment. This will allow the RACF to continue delivering quality aged care services and to work on establishing longer-term strategies. The Victorian Department of Health and Human Services COVID-19 Infection Prevention and Control Outreach Nurse Squad (the Squad), through the department’s Public Health Unit, may be deployed to a RACF where there is an outbreak. The Squad provides advice, education and support to RACFs on infection prevention and control and testing and other measures as needed. In situations where an ERT or Squad does not visit, facilities may wish to engage an infection control consultant or make contact with the residential in-reach service at their local health service should they require additional support in an outbreak. The rural infection control practice group (RICPRAC) is a collaborative network of rural infection control consultants who may be able to offer advice in relation to infection control issues in an outbreak. Further information and contact details for RICPRAC can be found the department’s website < In-Reach services are run by Victorian public hospitals and provide tertiary care. They may be available to assist residential care services to avoid the transfer of residents to hospital where possible. Details about the services and contact details for Residential In-Reach services in Victoria can be found on the department’s website < Prevention and Control MeasuresSteps, principles and rulesStandard precautionsHand hygiene supplies:Put alcohol-based hand sanitizer with >60% alcohol in every resident room (ideally both inside and outside of the room) and other resident care and common areas (for example, dining area).Make sure that sinks are well-stocked with soap and paper towels for handwashing.Use of PPE:Staff should be trained and deemed proficient in donning and doffing PPE before an outbreak occurs. Posters for how to put on and take off PPE can be found on the department’s website < perform hand hygiene before putting on PPE and immediately after removal of PPE.Staff must wear appropriate PPE when a resident is in isolation and /or it is anticipated that there may be contact with a resident’s blood or body fluids, mucous membranes, non-intact skin or other potentially infectious material or equipment.Gloves, single-use surgical mask, long sleeved fluid repellent gowns and eye protection should be used whenever providing routine care or taking respiratory specimens from residents with respiratory symptoms.PPE should be removed in a manner that prevents contamination of the HCW’s clothing, hands and the environment. PPE should be immediately discarded into clinical waste bins.Whenever there is the risk of splash or splattering of blood or body fluids, secretions or excretions, eye protection should be worn (personal eyeglasses are not adequate eye protection; eye protection includes safety glasses, goggles or face shields).Respiratory hygiene and cough etiquette:Make tissues and single-use surgical masks available for symptomatic residents (should they be required to leave their room) and that there are rubbish bins by every door.Consider designating staff to steward those supplies and encourage appropriate use by residents, visitors, and staff.Consistent application of the precautions noted above will reduce the risk of transmission of respiratory infections.Further information and resources about hand hygiene and PPE can be found at: Hygiene Australia < department’s website < with ARI or suspected cases of COVID-19 should be placed in a single room with their own toilet if possible. The door should be kept closed when possible. Any person entering the room should don droplet and contact precautions personal protective equipment (single-use surgical mask, eye protection, gown and gloves) which should be supplied and available immediately outside the room. Residents should be kept in isolation until a diagnosis of COVID-19 (or influenza) is excluded. Where possible residents should be restricted to their room. If they need to leave the room, they should wear a mask (if tolerated). Thorough infection prevention and control practices should be followed and contact with other residents should be minimised.CohortingResidents with excessive coughing and sputum production should be given the highest priority for a single room. If a single room is not available, several principles can be used to guide the management of residents. Cohorting is when more than one suspected or confirmed case are cared for in the same room or unit. This may be necessary when there are not enough rooms to isolate every suspected or confirmed case. If residents are to be cohorted together, residents with similar signs and symptoms should be placed together. Likewise, residents with the same infective pathogen (if known) (for example, influenza vs COVID-19) should be grouped together. In the event that a single room is not available and cohorting is not possible, a resident with an ARI may need to be kept in the same room as a well resident, but this is the least preferable option. In this scenario residents’ beds should be separated as far as possible (at least 1.5m), the curtain kept drawn between beds and adherence to strict infection control precautions maintained.Where possible, residents with suspected or confirmed COVID-19 should be assigned their own bathroom. If sharing a bathroom, the resident with suspected or confirmed COVID 19 should shower after those residents without suspected or confirmed COVID-19. The bathroom (shower or toilet) and any shared equipment (eg: shower chair) should be thoroughly cleaned and disinfected after each use by the resident with suspected or confirmed COVID 19.Toiletries should not be shared. Bath linen (eg: towels and bathmat) should be separated and laundered after each resident’s use.Consider if the resident with suspected or confirmed COVID-19 could use a commode in their room. Cleaning and disinfectingEnsure appropriate hospital-grade disinfectants are available for frequent cleaning of surfaces which are commonly touched and shared equipment. Ensure all staff and cleaners are aware of disinfectants, cleaning materials, and requirements for cleaning/disinfecting. Schedule regular cleaning of all resident areas when there is an outbreak, and of residents’ rooms when there is a single case. The frequency of environmental cleaning and disinfection during an outbreak should be increased to at least twice daily, particularly of frequently touched surfaces such as bedside rails, over bed tables and door handles and call bells. As per the CDNA guidelines, either a 2-step clean (detergent then disinfectant) or 2-in-1 step clean (detergent and disinfectant combined) is required. The most important areas to clean and disinfect are those in closest proximity to the resident (within 1.5 metres). Frequently touched areas include resident call bells taps, handrails, bedside tables, tables, doors, counters, taps, toilets and shared equipment. Rooms should be terminally cleaned when a case is moved.Further information about cleaning and disinfection can be found in the Coronavirus disease 2019: Case and contact management guidelines for health services and general practitioners <; Handling of LinenSoiled linen should always be treated as potentially infectious.Grossly contaminated laundry should be double bagged using the soluble plastic bag then placed in the linen skip or inserted in the linen skip for soiled linenRoutine procedures for handling resident’s personal laundry remain unchanged in the event of resident with a positive Covid-19.All personal laundry should be laundered on site and not be taken home by family members if that had been their previous practice. Food Services and utensilsThe principles of food hygiene are observed during food preparation and service.Disposable crockery and cutlery is not required.Crockery and cutlery from ill residents does not need to be washed separately as hot water and detergent will inactivate any residual contamination. This applies if using a dishwasher or handwashing the dishes.If handwashing, rinse crockery and cutlery in hot water and leave to dry.Waste Management Usual waste management protocols apply. Clinical waste should be disposed of in the clinical / infectious waste streamsSignageConsider putting up signage now. During an outbreak, signage must be posted at all external entrances to the facility to alert visitors to the outbreak. Signage should also be strategically posted to remind visitors to:not visit if unwell visit only one resident during their visit in their room, and not visit communal areasfollow signs for the use of PPE as indicated perform hand hygiene and respiratory/cough etiquette. Example signage is provided on the department’s Respiratory illness management in aged care facilities website < hygiene for residentsStaff hand and respiratory hygiene is paramount due to the frequent contact a staff member will have with multiple residents. However, hand and respiratory hygiene of residents should not be neglected. Time should be taken to teach residents how to use hand sanitiser and cough etiquette where possible, and to assist them to perform these tasks when needed.Visitors, admissions and transfersVisitors and communal activitiesCare Facilities Directions To prevent introduction of coronavirus into the facility and transmission within the facility, limit the movement of visitors into and within the facility. Facilities must implement strategies as needed during an outbreak as the situation evolves to minimise risk to residents and staff. The position of the National Cabinet regarding visits to aged care facilities has been implemented through directions of Chief Health Officers across the country. The Victorian Directions restrict visitor access across a range of care facilities. The current Victorian Care facilities Directions are located at .This Direction includes all Victorian Commonwealth funded RACFs. Public Residential Aged Care facilities are expected to implement visitor restrictions in line with the current Directions.Facilities must check department websites for up to date information regarding this. During this period only essential services and visitors providing essential care and support to a resident, including end of life support, will be able to enter, or remain on, the premises of a RACF to prevent the introduction and transmission of COVID-19 in a RACF. The restrictions mean:Only essential services will be able to enter a residential aged care facility. An essential service is a person who is providing essential goods and services, and includes the provision of health, medical and pharmaceutical services. Essential services include:Regular staff of the service who provide clinical care, food services, administrative functions and cleaning. Other visiting clinical staff such as visiting medical officers, for example, general practitioners, geriatricians, palliative care physicians and other medical specialists, pharmacy services; specialist nurses; diagnostics services; and allied health services such as physiotherapists.Other services that are permitted under the Directions include those providing behavioural support services and functional and well-being support services, for example: hairdressing, diversional and recreational therapies, music therapies.RACFs should review all visits to minimise movement in and out of the RACF. These decisions should be based on clinical need and consideration of resident choice and lifestyle. Residents will be able to receive 2 care and support visits each day, provided the total duration of such visits is no longer than 2 hours and the total number of visitors is no more than 2. Anyone under the age of 16 will not be able to visit, unless it is for end of life support.Family and loved ones will be able to provide support to a resident who is dying. Restrictions on the number and age of visitors, and the hours of the visit will not apply when support is being provided to a dying resident.No staff or visitor will be able to enter or remain on the premises of a RACF if they met one or more of the following:During the 14 days immediately preceding the entry, the person arrived in Australia from a place outside Australia;Those who have been in contact with a confirmed case of COVID-19 in the last 14 days; orThose with fever or symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath, temperature higher than 37.5 degrees); orThe person does not have an up to date vaccination against influenza, if such a vaccination is available to the person.The person has been diagnosed with coronavirus (COVID-19) and has not yet been given clearance from self-isolation under the current Diagnosed Persons and Close Contacts Directions.Implementing the Care Facilities Directions Proactively locking down services and not allowing visitors to prevent risks to residents’ health and wellbeing goes beyond the Deputy Chief Health Officer’s Directions. In considering the safety of their residents, RACFs responses should be balanced with appropriate compassionate visits from family and loved ones. Residential aged care services are faced with a number of competing legal rights and obligations in the current emergency and providers must balance those obligations to provide an outcome that is reasonable and proportionate to the risk in the circumstances. This balancing exercise must be undertaken on a case-by case basis and must be continually re-evaluated.What is required of providers is a weighing up of the restrictions contained in the Directions against the existing obligations owed by aged care operators under the relevant Commonwealth legislation. These obligations include: having regard to dignity of risk, the right to exercise choice and control in decision making about care, personal and social experiences and to exercise independence. The overarching principle for operators of services in responding to the COVID-19 pandemic must be the health, welfare and safety of their residents, staff and the broader community. Operators must comply with the restrictions contained in the Directions and their approach to minimising the transmission risk must be continuously reviewed to ensure it keeps pace with contemporary practice. In undertaking this task, operators should be considering the following competing but important matters:The legal restrictions contained in the Directions;The obligations owed by aged care operators as contained in the Aged Care Act 1997 (Cth), the Aged Care Quality Standards and the Charter of Aged Care Rights, particularly the requirements to:treat residents with dignity and respect, support residents to exercise choice and independence and take risks (Standard 1); engage care recipients in care assessment and planning in a way that needs and reflects their preferences (Standard 2); implement infection control measures to minimise infection-related risks through standard and transmission-based precautions (Standard 3); andprovide services and supports for daily living, including assisting residents to participate in their community both within and outside the service environment (Standard 4).The obligation owed by operators to provide and maintain a workplace that is safe and without risk to health and safety, as far as reasonably practical, for both employees and other persons coming on site.The duty of approved providers not to deprive residents of their liberty and free movementFurthermore, in the case of PSRACS, the human rights of residents under the Charter of Human Rights and Responsibilities Act 2006 (Vic), particularly the rights relating to freedom of movement, liberty and security of person and protection of families and children.A service should be continually reviewing their response to this emergency in the light of these competing obligations. Solutions should be determined on a case-by-case basis and operators must be flexible and responsive to the care needs of their residents and the circumstances within the broader community. It is not possible to adopt a 'set and forget' or ‘one size fits all’ approach. For example, it may be appropriate to allow a particular resident to go for a walk if you are confident that the resident understands the need to maintain a physical distance from others and will not touch surfaces on their walk and will also undertake handwashing on their return. With other residents, a walk outside the facility may only be possible if they are accompanied by a staff member to ensure that they observe these practical restrictions. Hospital Visitors DirectionsNOTE: The Hospital Visitor Directions are relevant to some Public Sector Residential Aged Care as they apply to all large health services/hospitals, rural public hospitals and multi-purpose services.The Hospital Visitor Directions also apply to denominational hospitals and private hospitals that provide Commonwealth funded residential aged care beds.Visits by otherwise excluded persons in exceptional circumstances To comply with the Charter of Rights and Responsibilities Act, the Hospital Visitor Directions allow the director of a facility to approve a visit for a small class of visitor who would otherwise be excluded because they:have returned from overseas within the preceding 14 daysare a close contact of someone who tested positive in the last 14 days orhave a temperature over 37.5 symptoms of respiratory illnessbut who:has returned a negative test result andwishes to visit a resident for the purpose of providing end of life support, or in the case of a child, where the visitor is a parent or guardian (very small numbers expected in the latter category)The same exception and conditions apply in relation to a visitor in the above categories who has NOT received a negative test result but with additional approval required from the CHO or Deputy CHO (i.e. as well as approval and any conditions of director of facility).Each visit in relation to the above criteria will be determined on a case by case basis.Facilitating visits – the National Code for Visiting Residential Aged Care Homes During COVID-19Major providers have signed up to the National Code for Visiting Residential Aged Care Homes During COVID-19 which sets out principles, rights and responsibilities, and a complaints process. It also provides links to practical resources about innovative ways to facilitate compassionate visits while adopting a risk-based approach to restricting visits in line with the Directions. The Code proposes some practical solutions such as:using a visitor's register or booking system to control the amount of visitors to the facilityonly permitting visits which are pre-organised and at a mutually convenient time for the facility and the visitor having a visitors' room or other controlled space for visits in the facility, to permit visitors to be monitored regular communication with the family contact of residents to assist with increased anxiety over reduced visiting andfacilitating communication with residents through electronic means, in lieu of regular in person visits. How to facilitate visitor compliance with DirectionsServices can develop a Visitors Code of Conduct for all visitors to RACF, modelled on the Code, which:is clearly communicated with visitors and incorporated into any visitor booking system displayed at the entrance to the RACF to ensure that visitors are aware of what is expected of them while they are visitingexplains consequences for non-compliance, including an express statement that any non-compliance places the health and safety of residents, staff and the community at riskexplains that in the event of non-compliance, staff may ask visitors to leave.Advice produced by the Aged Care Quality and Safety Commission on 22 April to support providers and care residents during visitor restrictions due to the COVID-19 pandemic can be found at . Existing guidelines continue to recommend asking essential visitors who do visit a resident to:only visit the resident and practice physical distancing during that visit.wear PPE only if directed to by staffperform hand hygiene before entering and after leaving the resident’s roomenter and leave the facility directly without spending time in communal areas.If there is an outbreak within the RACF, visitation should be limited further to only those who are essential for the resident’s emotional well-being and care. The facility should send communications to families advising that COVID-19 has been identified in the RACF and re-emphasise the importance of postponing visitation. Ideally, visits should be scheduled in advance during a limited number of hours. Any visitors (that are permitted after screening) should wear a facemask while in the facilities.A RACF screening tool is available at Appendix 7.Influenza vaccination requirements Residential aged care facilities have been required to take all reasonable steps from 1 May 2020 to ensure all staff and visitors to the site are vaccinated with the 2020 seasonal influenza vaccine. Staff unable to have an influenza vaccine are required to provide evidence from a medical practitioner as to the reason they are unable to have the vaccine. Once provided, they are permitted to work in a residential care services but, services may consider redeployment options if available.RACFs must implement a robust process and undertake screening of all staff, contractors and visitors.Aged care providers are required to take all reasonable steps to ensure that these Directions are being followed and a person does not enter or remain on the premises if they do not meet the influenza vaccination requirements. There are penalties that apply for the individual and for businesses that do not comply. While this is a decision for each RACF, it is recommended that written evidence be provided to the RACF.Example: notice of vaccination from the dispensing pharmacist/health practitioner; letter from general practitioner advising of medical contraindication and therefore exemption from influenza vaccinations requirement.This information should be collected as part of the RACFs routine immunisation record keeping so that written evidence only needs to be provided once and staff can look up records or provide a local pass to allow for speed of access for those for whom immunisation status has already been confirmed.A factsheet about Influenza vaccination advice for residential aged care staff and visitors is available at Commonwealth has advised that residential aged care services should document that evidence of influenza immunisation status was requested and provided from all staff and visitors and gives examples of appropriate evidence as:‘a statement or record from a health practitioner; or an immunisation history statement available from Medicare online or the Express Plus Medicare mobile app. Approved providers may also consider maintaining records to support effective administration and to substantiate their compliance with this requirement.’A statutory declaration is a legally binding document and would also be acceptable evidence that the person is making a truthful statement that they have an up to date influenza vaccination. Requirements in relation to essential services, emergency responders and law enforcement officers during an emergencyAll essential services (for example, health service employees and nursing agency staff), emergency responders and law enforcement officers, including ambulance officers, must have had the 2020 influenza vaccination to enter the facility if the vaccination is available to them. Ambulance Victoria, for example, has strict vaccination policies in place, therefore Ambulance Victoria Officers are not required to produce evidence of vaccination. Similarly, services may wish to consult the agreement(s) they have with nursing agencies to ensure this requirement is met.Where emergency responders attend a residential care service for an emergency, and are unable to provide evidence or confirmation of vaccination, they must only remain on the premise for no longer than is necessary to manage the initial emergency response.Admissions and transfersNew resident admissions and readmissions should be as per usual administrative processes if there is no confirmed COVID-19 outbreak in the RACF. New or returning residents should be screened for evidence of fever or ARI, and anyone with a positive screen result should be tested and placed in self isolation until test results are received. If there is a confirmed outbreak within the facility, the ability to admit is dependent on:the physical layout of the facility,the ability of the RACF to implement effective isolation and outbreak management containment measures.Where new admissions are unavoidable, new residents and their families must be informed about the current outbreak. Isolation and adequate outbreak control measures must be in place for these new residents, as they would be for the facility.Residents should avoid returning from social or hospital leave that is not COVID-19 related, to a RACF with a confirmed COVID-19 outbreak if it can be avoided. This should be discussed with the department’s Public Health Unit. In some circumstances, it may be feasible for residents to access other options, such as family care for the duration of the outbreak. For residents who were confirmed COVID-19 cases that were transferred to hospital and have been assessed as clinically ready for discharge back to the RACF, the RACF must ensure they provide infection control and isolation measures as required. Risk assessment for new suspected or confirmed cases of COVID-19 in residentsRACFs can contact the department for advice and guidance regarding support for the management of residents with COVID-19. The purpose of this guideline is to assist the RACF to decide on the best approach to manage the case.A risk assessment should be performed for each confirmed case within an RACF in consultation with the treating physician. The decision to transfer should be based on:Clinical need (e.g. active management / requirement for respiratory support); andInfection control need.Risk assessment for management of new cases should consider the following:the clinical needs of the residentadvance care plans and what the resident would want (see COVID-19 Factsheet on advance care planning)suitability of the RACF for isolation and maintaining infection control capacity of the workforce at the RACF to manage the residentrisk to the other residents (and staff)what additional resources are required to manage the resident at the RACFcapacity of the hospital to manage the personany alternative options (e.g. access to GPs and residential in-reach services, including after hours)Criteria for admission to hospital as part of the initial assessment when considering transfer of newly diagnosed case is below. All efforts should be made to facilitate infection control practices and obviate the need for transfer, as minimising unnecessary transfers to acute care will be an integral part of Victoria’s public health response. PrinciplesCases should not be transferred unless clinically requiredThe main reason for transfer on clinical grounds is for respiratory supportAdvance care plans should be respectedMost cases can be managed within the RACF, and all efforts should be made to facilitate this wherever possibleDecisions will be made on a case-by-case basis and will depend on the situationThe advice given may depend on the stage of the responseIf transfer is required, the receiving facility and transport staff should be informed that the resident is a suspected or confirmed case of COVID-19.Criteria for admission to hospital Resident’s wishes have requested active treatment (as detailed in an advance care directive) Clinical status would benefit from hospital admission as discussed with medical team- i.e. respiratory supportDiscussion with admitting hospital; capacity to accept has been confirmed and they are aware resident is a suspected or confirmed COVID-19 caseDiscussion with ambulance to confirm they are aware resident is a suspected or confirmed COVID-19 case.Responses for specific scenariosThe following are specific scenarios which an RACF could face during the pandemic and for which the facility should be fully prepared to deal with. Checklists for actions required for each scenario are outlined below. A suspected case in a resident A confirmed case in a residentA confirmed case in a staff memberA confirmed case in a visitorAn outbreak in residents or staff Checklist - Response to a suspected case in a resident Immediately implement droplet and contact infection control protocols as per outbreak management plan. Where possible isolate the resident in a single room with the door closed. Avoid unnecessary interactions on behalf of staff with resident. If the resident cannot be isolated, avoid interactions with other residents and place a face mask, if tolerated, on the suspected case. If isolation not possible, consider cohorting.Continue to maintain routine care provision for resident. Consider how to support residents with complex behaviours including dementia and mental health diagnosis, with proactive approaches. Increase frequency of clinical observations and monitoring of resident as per Care Plan for Suspected / Confirmed COVID-19 in aged care resident Identify if the resident has an advance care plan and ensure staff and family are familiar with the resident’s preferences and values. Any person entering the room should don droplet and contact precautions PPE (single-use surgical mask, eye protection, gown and gloves).Ensure the doctor or staff interacting with the resident have PPE on, and that there are adequate PPE, waste disposal and hand sanitiser / hand washing facilities available at the room.Contact healthcare provider (if not already involved) to arrange for clinical assessment and testing. Unwell residents must be reviewed by their GP regardless of whether an outbreak is present or not. Inform them that this is a suspected case of COVID-19.As this is a sensitive setting, testing and transport of the test to the laboratory should be prioritised as per DHHS directives.Arrange for transfer of the resident to hospital only if clinically indicated, in consultation with the healthcare provider and the department. If transfer is required, inform the hospital and transport staff that the resident has a suspected case of COVID-19. Assist the department in collecting critical information about the case and contacts / exposures.Consider enhanced infection and control measures and enhanced surveillance for further cases. Review outbreak plans and prepare for further cases.Checklist - Response to a confirmed case in a residentImmediately implement droplet and contact infection control protocols as per outbreak management plan. Where possible isolate the resident in a single room with the door closed. Avoid unnecessary interactions on behalf of staff with resident. If the resident cannot be isolated, avoid interactions with other residents and place a face mask, if tolerated, on the confirmed case. If isolation is not possible, consider cohorting.Ensure the doctor or staff interacting with the resident have PPE on, and that there are adequate PPE, waste disposal and hand sanitiser / hand washing facilities available at the room.Notify Department of Health and Human Services of confirmed case in resident.Upon notification by the department, a facility risk / situation assessment will be performed in conjunction with the department, to determine what further measures need to be taken. Assist the department with collection of critical information and contact tracing (all staff at RACFs, this includes visiting health staff, and visitors)Declare and commence outbreak management plan with nominated outbreak management teamAll staff and residents swabbed for coronavirus (COVID-19).Display outbreak notification posters at entrance of facility and resident’s roomsContinue to maintain routine care provision for positive resident as per Care Plan for Suspected / Confirmed COVID-19 in aged care resident, and for all other residents.Consider how to support residents with complex behaviours including dementia and mental health diagnosis, with proactive approaches. Increase frequency of clinical observations and monitoring of resident as per Care Plan for Suspected / Confirmed COVID-19 in aged care resident.Identify if the resident has an advance care directive and ensure staff and family are familiar with the resident’s preferences and values. Implement enhanced surveillance to detect further cases early (daily symptom screening and observations).Agree method for daily status, including clinical status, to update the department. Inform department promptly if case deteriorates / if transfer is required.The resident should remain in isolation until advised by the department and treating general practitioner. Roster staff to dedicated working groups within the facility. Advise staff not to work at other workplaces.Limit non-essential access to facility as per guidelines and Chief Health Officer directives.Perform risk assessment to identify any environmental / infection control shortcomings. Identify and implement enhanced infection control measures.Prepare regular daily communication to inform staff, residents and families / visitors.Checklist - Response to a confirmed case in a staff memberAny member of staff (healthcare or non-healthcare) who develops symptoms compatible with coronavirus should immediately be excluded from the facility and should remain away whilst a diagnosis is determined.If COVID-19 is ruled out, the staff member can return to work once they are well depending on their condition and guidance from their GP. If a diagnosis of COVID-19 is confirmed, the staff member must not return to work and must remain in isolation until they meet the criteria for discharge from isolation as per the department’s most recent guidelines Roster staff to dedicated working groups within the facility. Advise staff not to work at other workplaces.The RACF must notify the department as soon as practicable.Work with the Emergency Response Team (ERT) and/or Infection Prevention and Control Outreach Nurse Squad to determine what further measures need to be taken. All staff and residents tested for coronavirus (COVID-19).Assist the department with collecting critical information (contact tracing).Perform environmental risk assessment to identify any breaches to infection control policies, identify and implement enhanced infection control measures and cleaning / disinfection procedures.Implement enhanced surveillance for further cases within the facility and amongst staff.Review outbreak plans and requirements for implementation.Assess staffing issues. Inform staff, residents and families / visitors.Roster staff to dedicated working groups within the facility. Advise staff not to work at other workplaces.Display outbreak notification posters at entrance of facility and resident’s roomsChecklist - Response to a confirmed case in a visitorNotify the department. Assist department in collecting critical information – determining if there are any close and casual contacts of the case and the timeframe of exposure.Determine whether isolation of individual residents or staff, cohorting or quarantine of a section of the facility is required, in consultation with the department. Consider restricting visitors and movement in and out (and within) the facility. Inform staff, residents, and families / visitors.Implement increased infection and control policies, and cleaning / disinfection procedures.Limit non-essential access to facility as per guidelines and Chief Health Officer directives.Checklist - Response to an outbreak in the facilityAn outbreak in this scenario refers to one confirmed case in a resident or staff member Continue to maintain routine care provision for residents. Consider how to support residents with complex behaviours including dementia and mental health diagnosis, with proactive approaches. Implement enhanced surveillance to detect further cases early (daily symptom screening)Increase frequency of clinical observations and monitoring of affected residents as per Care Plan for Suspected / Confirmed COVID-19 in aged care resident.Establish an Outbreak Management Team (OMT) and activate the outbreak response plan. It is the facility’s responsibility to manage the outbreak. This will include limiting movement of staff across facilities or to other workplaces if possible.Arrange for isolation or cohorting of residents in rooms or units as necessary. Arrange for dedicated staff to look after isolated or cohorted patients to reduce the risk of transmission to other residents. The outbreak lead should keep a log of the entire outbreak, meet daily with the OMT, and liaise with the department. Agree method for daily status updates with the department and provide a clinical daily status update to the department. Inform the department promptly if case deteriorates / if transfer is required. The facility should engage an infection control consultant or make contact with the residential in-reach service at their local health service if they require additional support in an outbreak. Avoid all unnecessary transfers of residents to hospital, new admissions or readmissions unless absolutely necessary. Restrict visitors. Inform staff, residents and families / visitors.Telehealth appointments should be facilitated where possible to avoid unnecessary movements.Residents should not be removed from isolation until agreement by the department and treating general practitioner. Policy guidance on specific topicsKey supportsFact sheet for recognising end of life symptoms can be found here Flinders University palliative care practice tip sheets for care workers, personal care attendants and nurses can be found here: <; Facts sheet on advance care planning can be found here: advance care plan FAQsAdvance care planning resources can be found here: and bereavement resources: protocolsStaff members returning from overseas All international passengers, including healthcare workers arriving into Victorian airports or disembarking at maritime ports must go into mandatory quarantine for 14 days from the day of their arrival at a state designated facility in Melbourne.Any staff member who meets one or more of the travel criteria () will not be able to enter or remain on the premises of a RACF. If any healthcare worker with direct patient contact, residential care worker, or aged care resident has a fever (≥ 37.5) AND an acute respiratory infection (e.g. shortness of breath, cough, sore throat), they are classified as a suspect case. They should isolate, seek appropriate medical attention and must be tested for COVID-19. It is recommended that medical practitioners do not test or treat themselves and seek medical care from another medical practitioner.Note that guidelines are rapidly changing and the department website should be checked regularly. Staff members returning from sick leaveStaff members who are sick should not return to work until they are well (depending on the condition). If they have suspected COVID-19 they should not return until testing has excluded the infection or until they have been advised they can return by the department. If they have confirmed COVID-19 they should not return to work until they have been cleared by their healthcare provider and the department. End of life care / advance directivesExisting advanced care plans should continue to be respected and used to guide care/treatment, with the resident’s wishes in mind. Advance care directives should be updated as part of preparedness activities. Goals of care should be clarified for all residents who are unwell, and a medical treatment decision maker identified if the resident does not have decision making capacity.As there is no specific treatment or cure for COVID-19, medical care is supportive in nature. A main reason for transfer to acute care would be for respiratory support such as ventilation, which may not be appropriate for many residents. Plans should be made now for a situation in which end of life care may need to be given at the RACF for a resident who is in isolation (e.g. consider how the family would be accommodated and infection control maintained). RACF should be able to manage residents requiring respiratory support for palliation, with options for assistance through their usual supports and referral processes to In-Reach or HITH services. Treatments and investigations that cause suffering to the person should be avoided when there is clearly no benefit to be gained. Decisions about transfer to acute care, or medical interventions need to take into account the person’s condition, their preferences for care and in discussion with family members. Ensuring that the resident’s advance care plan has been reviewed and is understood by the care team and the family is important in making decisions about care. For residents with severe COVID-19 and/or complications, end of life and comfort care may be required. Resources for recognising end of life symptoms and how to support a person who is dying and their family can be found at: and bereavement supportEach person’s grief trajectory will be unique. For the majority, grief will involve intense yearning, intrusive thoughts and images and emotional responses such as anxiety, unhappiness or uneasiness. These symptoms will not persist longer than a few months and eventually they will be able to integrate the loss into their lives and regain their interest and engagement with life.In most cases, responding to families and staff during times of grief and bereavement requires empathetic support and acknowledgement that grief is a normal emotion.Providing good end of life care, providing structured information and support at various points and providing information on support strategies will assist people during bereavement.In addition to providing care for bereaved family members and carers, good bereavement support will involve caring for staff through processes such as death reviews, professional development and professional supervision. The Australian Centre for Grief and Bereavement provide resources for supporting people experiencing grief and bereavement that can be found here: of deceasedContact and standard precautions should be used by all staff when the deceased has known or suspected COVID-19 infection. The same precautions should be followed when handling the body as when caring for the resident during life. Deceased bodies should be placed in a leak-proof bag. Staff handling deceased bodies should wear PPE: gown, gloves, mask, eye protection. If relatives wish to view the body, the face can be uncovered but they should refrain from touching the body.The case list is updated with the date of the death and the information is forwarded to the department. Reducing stress and anxietyOutbreaks can be very stressful for staff, residents and families alike. Preparing now and keeping up to date with the latest information and guidelines will help reduce uncertainly. Employee assistance programmes are available for staff who need additional support.Resident stress and anxiety can be reduced through modified lifestyle and wellbeing programs. These should be run consistent with physical distancing and infection control protocols.Roles and ResponsibilitiesResidential and Aged Care FacilityIt is the primary responsibility of the RACF to manage cases of COVID-19, within their responsibilities for infection control and resident care. All RACFs are expected to:detect and notify outbreaks to the Victorian Department of Health and Human Services (DHHS) as soon as is practicable.self-manage outbreaks in accordance with state and Commonwealth guidelines. The Victorian Department of Health and Human Services (the department)The department provides advice to RACFs to prevent, detect and manage cases of COVID-19. The department may direct a RACF to take action to manage public health risk, including any action to manage an outbreak of COVID-19, under the Public Health and Wellbeing Act 2008.The responsibilities of the department include:assisting facilities to confirm and identify outbreaks by applying the case definition correctly and providing advice on testing of residents and/or staff;providing guidance and direction on actions to prevent cases in RACFs and in management of any outbreak;assisting facilities to monitor for severity of illness, including recording deaths and hospitalisations;sending an Infection Prevention and Control Outreach Nurse Squad to visit the site, if deemed appropriate; informing relevant stakeholders of outbreaks;monitoring the extent of COVID-19 outbreaks in Victoria;contributing to national surveillance as part of the COVID-19 response;coordinating the Victorian response to the public health emergency.The CommonwealthCommonwealth funded RACFs operate under the Aged Care Act 1997. In order to be eligible for funding they are required to meet accreditation standards, including adherence to infection control standards. Aged Care Quality and Safety Commission The Aged Care Quality and Safety Commission (the Commission) is the national regulator of aged care services. It takes a proportionate risk-based approach in responding to the COVID-19 situation. The role of the Commission is to:independently accredit, assess and monitor aged care services against the Aged Care Quality Standards, including the requirement to minimise infection-related risks through implementing standard and transmission-based precautions to prevent and control infection;resolve complaints about the delivery aged care services;provide education to providers, including with respect to best-practice infection prevention and control.AppendicesAppendix 1 - Letter to Families – Preventing Spread of COVID-19 FILLIN \* MERGEFORMAT [Facility Letterhead]……/……/……Dear family memberThere is local transmission of coronavirus (COVID-19) in the community. While all types of respiratory viruses can cause sickness in the elderly, COVID-19 is a particularly contagious infection that can cause severe illness and death for vulnerable people.COVID-19 PandemicCOVID-19 has caused outbreaks of illness in the Australian community, and local transmission has occurred in some communities. Residential care facilities are particularly susceptible to COVID-19 outbreaks. Even when facilities actively try to prevent outbreaks occurring, illness in the wider community may lead to residents or staff contracting the COVID-19 and outbreaks in residential care facilities. Families play an important role in protecting their relatives from community viruses. Practical steps you can take to prevent COVID-19 from entering residential care facilities are outlined below. Avoid spreading illnessesWashing your hands well with liquid soap and water or alcohol-based hand rub before and after visiting and after coughing or sneezing will help reduce the spread of disease. Cover your mouth with a tissue or your elbow (not your bare hand) when coughing or sneezing and dispose of used tissues immediately and wash your hands. Follow any restrictions the residential care facility has put in place Facilities will post signs at entrances and within their units to inform you if an outbreak is occurring so look out for these warning signs when entering the facility. It is important to follow the infection control guidelines as directed by the facility staff. This may include wearing a disposable face mask and/or other protective equipment (gloves, gowns) as instructed. Certain group activities may be postponed during an outbreak.Stay away if you’re unwellIf you have recently been unwell, been in contact with someone who is unwell or you have symptoms of respiratory illness (e.g. fever, cough, shortness of breath, sore throat, muscle and joint pain, or tiredness/exhaustion) please do not visit the facility until your symptoms have resolved. If you have been in contact with a confirmed case of COVID-19 you must stay away until you are released from self-isolation.Limit your visitIf there is an outbreak in the residential care facility, we ask that you only visit the person you have come to see and keep children away if they or your resident family member is unwell. Avoid spending time in communal areas of the facility if possible to reduce the risk of spreading infection. Thank you for your assistance in adhering to these steps. These measures will greatly assist residential care facilities and protect the health of your relatives in the event of a COVID-19 outbreak. Should you require further information regarding COVID-19, please refer to the Victorian Department of Health and Human Services website: sincerely FILLIN \* MERGEFORMAT [Name] FILLIN \* MERGEFORMAT [Position] FILLIN \* MERGEFORMAT [Facility/Organisation]Appendix 2 – Checklists for RACFChecklist 1 - COVID-19 Actions for RACF in the Initial Action StageCOVID-19 ChecklistActions for RACF in the Initial Action StageMAP – Assess current facilities / resources / weaknesses, food support service implications of isolation etc., overnight staffing Prepare or update facility respiratory outbreak management plan Identify a dedicated staff member/ team who will plan and coordinate the outbreak response, and update the outbreak management plan as neededEnsure all staff (and the relevant healthcare providers in the community who may be involved) are aware of the plan and their roles and responsibilities within itSend out preparatory letter to families of residents with information regarding COVID-19 and prevention of transmissionConvene one or more staff education and information sessions and provide educational materials to staff. Ensure all staff (clinical and non-clinical) have undergone education and training in all aspects of outbreak identification and management, particularly competency in infection controlInfluenza - Vaccinate all residents and staff against influenza (and recommend vaccination for all volunteers / visitors) Ensure the list of staff and residents by influenza vaccination status updated and accessiblePut signage up to discourage sick persons from visitingDevelop a staffing contingency plan in case up to 40% staff absence from any causeDevelop and maintain a contact list for casual staff members or external agency staff for workforce surge capacityUpdate a contact list of all staff, record details of other sites they may workDevelop a plan for cohorting residents and staff in an outbreakEnsure adequate stocks of PPE, hand hygiene products, nose and throat swabs and cleaning supplies. Arrange for regular stocktake.Update advance care plans for all residents if appropriateEnsure all staff consult with manager before booking leave or returning from leave (leave planning should consider the nature of the current situation)Subscribe to CHO alerts and check department website regularlyPrepare residents now, if their bloods are due organise for them to be done now rather than later and ensure all relevant medications are well stockedEnsure all staff are aware of the notification process for suspected and confirmed casesEnsure staff are confident at assessing residents for respiratory illness, particularly for fever or cough (with or without fever). Encourage reporting of COVID-19 symptoms by staff and residents. Update list of important contacts (DHHS Victoria, facility GPs, infection control consultants).Develop a staged visitor restriction plan: for restricting unwell visitors from entering the facility as well as limitation of well visitors during an outbreak to reduce risk of transmission both within the facility and externally (e.g. security, signage, restricted access).Make a plan for plan for communicating with staff, residents, volunteers, family members and other service providers (e.g. cleaners) during an outbreak.Identify who is responsible for overseeing increased frequency of cleaning, liaison with contractors or hiring extra cleaners as necessary.Checklist 2 – COVID-19 Actions for RACF in the Targeted Action Stage (when there is widespread community transmission)COVID-19 ChecklistActions for RACF in the Targeted Action Stage (when there is widespread community transmission)Consider deferring routine appointments / investigations or non-essential movement of residents in and out of the RACF and consider alternatives such as telehealth consultations.Consider limiting non-essential staff meetings and consider alternatives such as teleconferencing. Postpone routine educational meetings or conduct via other methods.Limit non-essential visitors and volunteers.Consider asking staff who are not required on site to work from home when they are not required in person.Review and enhance cleaning procedures for all areas.Review and consider limiting leave to allow for surge capacity.Reduce or stop visitors, minimise non-essential transfers, consider discharge to home where appropriate / safe.Implement daily cleaning procedures.Implement daily screening of residents for symptoms of COVID-19, including taking daily observations (esp. temperature).Checklist 3 - COVID-19 Actions for RACF in the Peak Action StageCOVID-19 ChecklistActions for RACF in the Peak Action Stage (Confirmed Case and Outbreak)Defer all non-essential appointments / investigations / transfers / movements.Restrict ALL visitors to the facility except in exceptional circumstances (e.g. end of life situations – in which case the visitor should wear a facemask and restrict their visit to the resident’s room)Encourage residents to remain in their room. If there are cases in the facility, restrict residents as much as is possible to their roomsIf residents need to leave their room (e.g. for medically necessary purposes), they should wear a facemask, perform hand hygiene, limit their movement in the facility and minimize interactions with other staff and residents (physical distancing, stay at least 1.5m away from others).Stop all communal dining.Cancel all outings and activities.Implement cohorting of ill residents and units, with dedicated staff to work on those units.Appendix 3 - Checklist for initial assessment / transferClinical questionsIs the resident acutely unwell and do they require care which cannot be provided on site i.e. respiratory support?Has the case been assessed by a medical professional and do they agree that the resident should be transferred to acute care?If this occurs after hours, has the out of hours GP or other covering service been contacted for advice, and do they agree that the resident should be transferred to acute care? Does the resident have an advance care plan? Is transfer to acute care consistent with the plan?Has the potential transfer been discussed with the receiving hospital to confirm with their capacity to accept the resident, and that they are aware the resident is a suspected or confirmed COVID-19 case?Has the ambulance been advised the resident is a suspected or confirmed COVID-19 case?Logistics questionsDoes the facility have capacity to isolate the case?Is a single room available?Are there other cases within the facility?If a single room is not available, is cohorting a possibility?If cohorting is not a possibility, can the case be managed in a shared room but at a sufficient distance from the other resident(s) with special curtains?Will the resident comply with isolation? (e.g. do they have dementia, delirium or behavioural issues)Are there other structural issues within the facility which may pose a major barrier to infection control and isolation?Is there a major risk to other residents and staff of keeping the case at the RACF? Does the facility have sufficient staff to allow for isolation of the patient?Can the facility manage the case 24 hours a day? (specifically enquire about night-time staffing issues)Does the facility have adequate PPE, disinfectant etc. to ensure isolation/infection control?Appendix 4 – Letter to GPs for COVID-19 outbreak[Facility Letterhead]……/……/……Respiratory outbreak at FILLIN \* MERGEFORMAT [Facility Name]Dear DoctorThere is an outbreak of acute respiratory illness affecting residents at the facility named above. The outbreak may involve some of your patients who may require review. It is important to establish if the outbreak is caused by coronavirus disease 2019 (COVID-19). This is a notifiable condition. We recommend that you:Establish if any of your patients are affectedHelp determine if the outbreak is caused by SARS-CoV-2: Obtain/order appropriate respiratory samples from residents who meet the case definition, for respiratory PCR testing. Ensure that your patients are vaccinated against influenza, if there are no contraindicationsEnsure that you observe hand hygiene procedures and use appropriate PPE when visiting your patients. Limit the use of antibiotics to patients with evidence of bacterial superinfection, which is uncommon. There is significant evidence that antibiotics are over-prescribed during the during institutional respiratory illness outbreaks. Control measures that the facility has been directed to implement include: Isolation of symptomatic residents Use of appropriate PPE when providing care to ill residentsExclusion of symptomatic staff from the facilityRestriction/limitation of visitors to the facility until the outbreak has resolvedPromotion of thorough hand washing and cough and sneeze etiquette.Should you require further information regarding COVID-19, please refer to the Victorian Department of Health and Human Services website: you require any further information or advice please contact [insert details].Yours sincerely, FILLIN \* MERGEFORMAT [Name][Position][Facility/Organisation]Appendix 5 – COVID-19 sample case list Appendix 6 – Outbreak management checklistAdapted from the RACF checklist for respiratory illness outbreak management.Outbreak management checklistIdentifyIdentify if your facility has an outbreak using the current definition Implement infection control measures Isolate / cohort ill residents and implement Care Plan for Suspected / Confirmed COVID-19 in aged care resident Implement droplet and contact precautions Provide PPE outside rooms Display sign outside roomsExclude ill staff until symptom free (or if confirmed cased of COVID-19, until they meet the release from isolation criteria)Reinforce standard precautions (hand hygiene, cough etiquette) throughout facility Display outbreak signage at entrances to facility Increase frequency of environmental cleaning (minimum twice daily) Notify The Victorian Department of Health and Human Services on ph. 1300 651 160Fax initial case list to 1300 651 170Contact the GPs of ill residents for reviewProvide the department outbreak letter to all residents’ GPs Inform families and all staff of outbreakRestrict Restrict movement of staff between areas of facility Aim for dedicated staff to care for ill residentsAvoid resident transfers if possible Restrict ill visitors where practical Cancel non-essential group activities during the outbreak period Influenza vaccination Offer influenza vaccination for all unvaccinated staff and residents MonitorMonitor outbreak progress through increased observation of residents for fever and acute respiratory symptomsUpdate the case list daily at the facility and fax to the department daily Add positive and negative test results to case listDeclare Declare the outbreak over when there are no new cases 14 days from the date of isolation of the most recent case (in consultation with the department if needed)Review Review and evaluate outbreak management – amend outbreak management plan if needed Appendix 7 – Screening of visitors for COVID-19Limitation of visitation to sensitive settingsThe Department of Health and Human Services is recommending that visits to some settings be limited, in order to protect Victorians in those settings from COVID-19. Screening of all visitors and attendees at a sensitive setting aims to identify people who should not be permitted entry. More information on COVID-19 is available at the bottom of this Advice.Please note it is now recommended that residential aged care facilities undertake temperature checking of visitors and attendees at this time.This is in keeping with a Direction issued by the Deputy Chief Health Officer that bans entry of any person listed in the Direction with a temperature of 37.5 degrees from entering a residential aged care facility.ChecklistAssess if the individual attending the sensitive setting is at risk of COVID-19. Ask the following questions of all attendees entering the sensitive setting:Have you been overseas in the last 14 days?Have you been in contact with a confirmed case of COVID-19 in the last 14 days?Do you have a new illness, especially a fever, sore throat, cough, shortness of breath or other respiratory symptoms?Do you have an up to date vaccination against influenza? (If such a vaccination is available to the person. Please note after 1 May 2020 all visitors will need to be vaccinated against influenza).If the person answers YES to questions 1 or question 2 the person should be in quarantine (self-isolation) and must not enter the sensitive setting under any circumstances.If a person answers YES to question 3 they should be advised they cannot enter the sensitive setting and should seek medical assessment if they have not already done rmation on COVID-19What is coronavirus disease (COVID-19) and how is it spread? COVID-19 is a new viral disease that has resulted in a pandemic. Cases have been reported in many countries including Australia. The virus can be spread from person to person from infected people through coughing, sneezing or by germs on hands. What are the symptoms and who is at risk? Most patients have had fever, chills, cough, and shortness of breath. Patients with more severe disease have had evidence of pneumonia (chest infection). This is changing rapidly and readers are referred to the department’s website. The elderly and people with underlying illnesses (such as diabetes, lung disease, kidney disease or supressed immunity) are at risk of severe illness or death if they get COVID-19.More informationFor the latest advice, information and resources, go to Call the Coronavirus Hotline on 1800 675 398. It operates 24 hours a day, seven days a week. Appendix 8 – Care Plan Confirmed COVID-19 Does person have a history of contact with a confirmed caseof Coronavirus (COVID-19)? Yes FORMCHECKBOX No FORMCHECKBOX First test Date swab sent ____/_____/_______Date result received _____/_____/_____COVID-19 Test Result: positive / negative (circle one) Other Infection Detected: ________________Second test Date swab sent ____/_____/_______Date result received _____/_____/_____COVID-19 Test Result: positive / negative (circle one) Other Infection Detected: ________________DATE:ADMISSION & ONGOING ASSESSMENT CARE PLAN Reporting case of confirmed case of COVID- 19 infectious illness Department of Health and Human Services notified on phone number 1800 675 398 Date: Advance care planning / Advance Care DirectivesStaff are clear about each about the resident’s values and preferences for their future care. Staff have identified medical treatment decision maker advanced care planning, directives and goals of care are current Yes FORMCHECKBOX ?No FORMCHECKBOX Medical treatment decision maker contact details confirmed and available.Yes FORMCHECKBOX ?No FORMCHECKBOX Advance care plans, goals of care and directives: Must be discussed with the resident and family /representative communicated to staff.Consultation GP FORMCHECKBOX ?RESIDENTIAL IN REACH FORMCHECKBOX ?LOCUM FORMCHECKBOX Tick who has been contactedInfection prevention precautions in place Refer to this guidelineRoom isolation with own ensuite Yes FORMCHECKBOX ?No FORMCHECKBOX Cohorted in wing apart from other non-infected residents Yes FORMCHECKBOX ?No FORMCHECKBOX Infection control precautions are in place Yes FORMCHECKBOX ?No FORMCHECKBOX Single use PPE in placeMaskGlovesLong sleeved gowns: Yes FORMCHECKBOX ?No FORMCHECKBOX AssessmentsConsider both measurement of resident observations and, timely reporting and review of results by clinical staffBaseline typical results for this resident include: 4/24 or QID obs or more frequent as per clinical status T,P,R,BP & Oxygen saturations in Room air / on Oxygen (humidified and warmed if possible) Reportable levels as per GP order, or may include: T ? 38.5 °C, notify GP possible blood cultures requiredPersistent tachycardiaRespiratory rate >30 breathes per minuteBP < 90 mmHg systolic, < 60 diastolicO? Sat < 92% O2 via nasal prongs as prescribed by GP (recommended at 4L/min)If any changes in clinical status report and escalate as soon as possible to the Registered Nurse in charge of the ShiftIs the person symptomatic? Risk of clinical deterioration Sore Throat Yes FORMCHECKBOX No FORMCHECKBOX High temperature Yes ? FORMCHECKBOX No FORMCHECKBOX Cough present Yes FORMCHECKBOX No FORMCHECKBOX Increased effort to breathe /shortness of breath Yes FORMCHECKBOX ?No FORMCHECKBOX Changed conscious state Yes FORMCHECKBOX ?No FORMCHECKBOX Acute onset confusion change in behaviours Yes FORMCHECKBOX ?No FORMCHECKBOX Evidence of Cyanosis (blue lips or fingers) Yes FORMCHECKBOX No FORMCHECKBOX Secretions / Crepitations present Yes FORMCHECKBOX ?No FORMCHECKBOX Audible wheeze present Yes FORMCHECKBOX ?No FORMCHECKBOX Little or no urine outputYes FORMCHECKBOX ?No FORMCHECKBOX If any changes in clinical status report and escalate as soon as possible to the Registered Nurse in charge of the ShiftMedicationsRisk of acute pain and discomfortAdministered as per medication chart Consider anticipatory medications as per goals of care Consider increased assessment for pain and other signs and symptoms of distressNutrition and Hydration Risks of dehydration and monitor appropriately. Ensure timely referral to dietician and /or speech therapistConsider resident’s current nutrition care plan including allergies, modified diets etc, in light of current illness Commence fluid balance chart monitoring.Mobility Risk of decreased mobility and functionality due to illness Ensure timely referral to physiotherapist and /or occupational therapistConsider resident’s current mobility care plan including mobility, transfers, etc, in light of current illness and possible functional declinePsychosocial Risk of impact to health and wellbeing including risk of increased levels of anxiety and exacerbation of pre-existing mental health conditions.Consider residents current psychosocial needs, in light of current illness and care management strategies.Other /Allied health Risk of DVTRisk of development of secondary complicationsConsider implementation of measures to reduce complications of immobility and functional decline: eg hourly deep breathing and coughing, regular bed mobilityProgress notes documentation Documentation should be regular to indicate clear monitoring and evaluation of resident’s progress and overall health status. A second COVID-19 test should be undertaken at the request of the patient’s GP or the Public Health Unit in DHHS, in order to confirm the patient has recovered and/or is no longer infectious. Name:…………………………………………………..Designation:………………………………….Signature:………………………………………………..Appendix 9 – Hand HygieneSource: Hand Hygiene Australia, adapted from ‘5 Moments for Hand Hygiene’, 'How to Handwash', and 'How to Handrub' ? World Health Organization 2009. All rights reserved.Appendix 10 – Guiding PrinciplesThese principles are intended to guide decisions made by approved providers of Victorian residential aged care facilities in the context of the coronavirus (COVID-19) pandemic, the Directions and existing obligations.The health, welfare and safety of residents and staff and the broader community is the overarching principle in decision making.As the situation is evolving, so too must the operator’s response. There should be awareness that Directions are being updated regularly and that other jurisdictions are working to different parameters (at different times).A careful examination of each iteration of all the relevant Directions should be undertaken to assess precisely what is required by approved providers in operationalising the relevant Directions. An assessment should be undertaken as to how operationalising the Directions may conflict with any existing obligations owed to residents and staff starting with the Aged Care Act 1997 (Cth). Planning for, operationalising and implementing the Directions should include mitigation strategies for minimising any risk of conflicting obligations. Practical and innovative solutions should be considered and resourced where reasonable. A 'one size fits all' approach is not appropriate. Approved providers must ensure the actions they take are fit for purpose. They must collaborate with residents, families and staff and involve them in decision making to ensure a balanced approach. A risk-based approach to decision making must be utilised. For any operational decisions required, the decision-making process should involve consultation with key stakeholders, the process and reasons for the decision must be clearly documented and the decision communicated clearly to those involved. Consider whether support is required to facilitate communication (e.g. an interpreter).All decisions made must be proportionate to risks to the resident, staff and the broader community, and must be reasonable in the circumstances of the COVID-19 pandemic. This will involve a weighing exercise and consideration of external factors, such as local transmission or community outbreak.Operators must ensure that resident care planning is continuously updated to reflect the changes resulting from the Directions and that residents are provided with their care plan (as requested). In relation to PSRACS, consider the impact to the human rights of residents – consider whether there a less restrictive way for the desired outcome to be achieved. Consider all practical solutions in order to adhere, as is reasonable in the circumstances, to existing obligations. For example, creating new ways of exercising for residents which ensure physical distancing. Ensure that there is a heightened sense of communication and two-way planning with residents. It is a crucial time for care to be tailored and workarounds put in place. Ongoing communication with staff is critical to ensure they understand and endorse the organisations response and measures implemented. Having staff 'on board' goes a long way to effectively operationalising reasonable measures. Governance framework and activities, committees and the Board must endorse the approach taken at RACF level. This will ensure that decisions are being appropriately considered and a consistent organisational approach taken. Appendix 11 – medication preparedness checklistsMedication access and management Meet with the pharmacy and discuss:How many months of resident medication supplies do they have in stock?How robust is the pharmacist’s supply chain? What are the pharmacy’s workforce contingencies? Can they assist you other ways? i.e. getting supplies for you that you can’t access elsewhere? What type of prescriptions will they accept (paper, digital image etc)? Will the pharmacy deliver to the facility if in lockdown? Other considerations to support medication access and management What process is in place if the pharmacy can’t deliver? What do you do if your pharmacy closes? Who can support you? What contingencies are in place?End of life medication supply – what drugs do you need? How much? Equipment – what do we need – syringe drivers, IV pumps, IV polesOther key stakeholders to consider in medication access and managementDiscussions with GP’s – prescriptions, alternative medications etc. Discussions with Residential In Reach – how can they assist? Expand your network – do you know what other facilities in your area are doing? Do you have an imprest of medications? Can you get one?Imprest systemsWhat is an imprest medication system?An imprest system allows registered health practitioners to access imprest medications – these are medications are supplied to a facility as ward stock and that have not been prescribed for specific patients.What medications are kept on imprest?Antibiotics, pain relief medications and other medications for urgent use, such as salbutamol inhalers and adrenaline. Schedule 4 and Schedule 8 medications that are often used for end of life care can also be kept on imprest.Why should my facility set up a medication imprest system?An imprest system can help mitigate a shortage of essential medications in the event that prescribed medications are not accessible.What does my facility need to set up an imprest system?A facility needs a Health Services Permit (HSP) in order to hold imprest stock. Application for an HSP is via an online form. Your facility will require separate lockable storage to secure Schedule 2,3 and 4 imprest medication. Schedule 8 substances ideally need to be stored in their own compliant safe and separate controlled drug register for recording transactions. Your facility requires appropriately trained, authorised registered health practitioners to access and administer imprest medications. This includes nurses – RN Division 1 and EN Division 2 (endorsed) but not personal care assistants.Preparedness for prescribers Public Health Emergency Orders on prescribingTo facilitate the supply of medicines during the COVID-19 pandemic and to reduce regulatory burden on prescribers and pharmacists, public health emergency orders (PHEO) have come into effect – they are listed and updated on the following website: Factsheet: Advice for prescribers – COVID-19Digital image prescriptionsPrescribers in Victoria can now transmit a digital image of a prescription for a Schedule 4 medicine (excluding drugs of dependence) to pharmacists. Prescriptions can be transmitted (via fax, email or text message) directly from the prescriber to pharmacist. Flyer for prescribers: Digital Images of PrescriptionsFast track Electronic Prescribing (ePrescribing)The Australian Government will fast track the implementation of electronic prescribing (ePrescribing). This measure will allow a doctor to prepare an electronic prescription that the patient will then be able to electronically share with their pharmacy, where the pharmacy is able to support the home delivery of medicines. Factsheet: Primary Care – Fast Track Electronic PrescribingAdditional resourcesVictorian Department of Health and Human Services website for aged care sector Victorian Department of Health and Human Services website for health services and general practitioners: Department of Health and Human Services website for the general public: interim additional guidance for infection prevention and control for patients with suspected or confirmed COVID-19 in nursing homes: COVID-19 guidelines for outbreaks in residential care facilities: learning online resources ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download