Introduction



Coronavirus Disease 2019 (COVID-19) Outbreaks in Correctional and Detention FacilitiesCDNA National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Correctional and Detention Facilities in AustraliaRevision historyVersionDateReason / ChangesEndorsed by1.031/03/20Initial ReleaseCDNA, AHPPC2.010/06/20RevisionUpdate outbreak identification and management guidanceCDNA3.024/07/20RevisionUpdate outbreak identification and management guidanceUpdate infection prevention and control adviceUpdate quarantine arrangements for new admissions to facilities from geographic areas of community transmissionCDNA, AHPPCThe Communicable Diseases Network Australia (CDNA) developed this guideline. The Australian Health Protection Principal Committee (AHPPC) has endorsed it. It is adapted from the CDNA National Guidelines for COVID-19 Outbreaks in Residential Care Facilities in Australia. It includes information from documents and guidelines from various international health authorities. This includes the Public Health Agency of Canada and the Ministry of Justice and Public Health England.This guideline provides best practice information to prevent and manage COVID-19 outbreaks in detention and correctional facilities to assist: public health authoritiesadministrators of correctional facilitiesemployees of correctional facilities health care workers This guideline captures the knowledge of experienced professionals. It provides guidance on good practice based upon the available evidence at the time of completion. Readers should not rely solely on the information contained within this guideline. Guideline information is not a substitute for advice from other relevant sources including advice from a health professional. You may need to use clinical judgement and discretion in the interpretation and application of these guidelines. Correctional and detention facilities are responsible for ensuring they comply with state and territory requirements in relation to outbreak management and the management of possible COVID-19 outbreaks. Membership of CDNA and AHPPC, and the Commonwealth of Australia as represented by the Commonwealth Department of Health (the Department), do not warrant or represent that the information contained in the guideline is accurate, current or complete. CDNA, AHPPC and the department do not accept any legal liability or responsibility for any loss, damages, costs or expenses incurred by the use of, reliance on, or interpretation of, the information contained in the guideline.TaBLE oF CONTENTS TOC \o "1-3" \h \z \u 1.Introduction PAGEREF _Toc44618895 \h 51.1.COVID-19 Outbreaks PAGEREF _Toc44618896 \h 61.2.Roles and Responsibilities PAGEREF _Toc44618897 \h 61.2.1.Correctional and detention facilities PAGEREF _Toc44618898 \h 61.2.2.The State/Territory Department of Health PAGEREF _Toc44618899 \h 72.Understanding COVID-19 PAGEREF _Toc44618900 \h 72.1.Recognising COVID-19 PAGEREF _Toc44618901 \h 72.2.Incubation Period PAGEREF _Toc44618902 \h 82.3.Routes of Transmission PAGEREF _Toc44618903 \h 82.4.People at risk of complications from COVID-19 PAGEREF _Toc44618904 \h 92.plications of COVID-19 PAGEREF _Toc44618905 \h 93.Preparedness and Prevention PAGEREF _Toc44618906 \h 103.1.Preparation PAGEREF _Toc44618907 \h 103.1.1.Prepare an Outbreak Management Plan PAGEREF _Toc44618908 \h 103.1.2.Education PAGEREF _Toc44618909 \h 113.1.3.Workforce Management PAGEREF _Toc44618910 \h 123.1.4.Staff Education and Training PAGEREF _Toc44618911 \h 123.1.5.Consumable Stocks PAGEREF _Toc44618912 \h 133.2.Prevention PAGEREF _Toc44618913 \h 133.2.1.Exposure Pprevention PAGEREF _Toc44618914 \h 143.2.2.Prevention of Introduction into the Facility PAGEREF _Toc44618915 \h 153.2.3.Prevention of Spread Within and Between Facilities PAGEREF _Toc44618916 \h 163.2.4. Prevent spread into surrounding communities PAGEREF _Toc44618917 \h 183.3. Special considerations for prisons with high proportion of Aboriginal or Torres Strait Islanders PAGEREF _Toc44618918 \h 184.Identifying COVID-19 PAGEREF _Toc44618919 \h 184.1.Identification PAGEREF _Toc44618920 \h 184.2.Case Definition PAGEREF _Toc44618921 \h 194.3.Testing for COVID-19 PAGEREF _Toc44618922 \h 194.4.Notification – State/Territory Department of Health PAGEREF _Toc44618923 \h 194.4.1.State/territory Public Health Unit Contact details PAGEREF _Toc44618924 \h 214.5.Notification – Facility General Practitioners (GP) PAGEREF _Toc44618925 \h 215.COVID-19 Case and Outbreak Management PAGEREF _Toc44618926 \h 225.1.Response to symptoms of COVID-19 in a Staff Member PAGEREF _Toc44618927 \h 225.2.Response to an Outbreak of COVID-19 PAGEREF _Toc44618928 \h 235.2.1.Declaring an Outbreak PAGEREF _Toc44618929 \h 235.2.2.Establishing an Outbreak Management Team PAGEREF _Toc44618930 \h 23Testing During an Outbreak PAGEREF _Toc44618931 \h 245.3.Implementing Infection Prevention and Control Measures PAGEREF _Toc44618932 \h 255.3.1.Isolation and Cohorting PAGEREF _Toc44618933 \h 255.3.2.Standard Precautions PAGEREF _Toc44618934 \h 265.3.3.Transmission-based Precautions PAGEREF _Toc44618935 \h 285.3.4.Environmental Cleaning and Disinfection PAGEREF _Toc44618936 \h 285.3.5.Signage PAGEREF _Toc44618937 \h 305.3.6.Visitors and Communal Activities PAGEREF _Toc44618938 \h 305.3.7 Mental health and emotional and social wellbeing PAGEREF _Toc44618939 \h 305.3.8Management of staff PAGEREF _Toc44618940 \h 315.3.9Admissions and Transfers PAGEREF _Toc44618941 \h 315.4Monitoring Outbreak Progress PAGEREF _Toc44618942 \h 335.5Declaring the Outbreak Over PAGEREF _Toc44618943 \h 345.6Reviewing Outbreak Management PAGEREF _Toc44618944 \h 34Appendix 1. Flow Chart for COVID-19 Management in Correctional and Detention Facilities PAGEREF _Toc44618945 \h 36Appendix 2. COVID-19 Outbreak Preparedness Checklist PAGEREF _Toc44618946 \h 38Appendix 3. Letter to Visitors – Preventing Spread of COVID-19 PAGEREF _Toc44618947 \h 39Appendix 4. Swab Collection Procedure PAGEREF _Toc44618948 \h 41Public Health Laboratory Network (PHLN) guidance on the collection of upper respiratory specimens from the is available on the Department of Health website. PAGEREF _Toc44618949 \h 41Detailed PHLNguidance on laboratory testing for SARS-CoV-2 (the virus that causes COVID-19) is available on the Department of Health website. PAGEREF _Toc44618950 \h 411.Before performing swab PAGEREF _Toc44618951 \h 412.Performing the swabs PAGEREF _Toc44618952 \h 413. After performing the swab PAGEREF _Toc44618954 \h 42Appendix 5. Initial facility report to a PHU – COVID-19 Outbreak PAGEREF _Toc44618955 \h 43Appendix 6. Letter to visiting health staff– COVID-19 Outbreak PAGEREF _Toc44618956 \h 44Appendix 7. Transfer Advice Form PAGEREF _Toc44618957 \h 45Appendix 8. COVID-19 Outbreak Management Checklist PAGEREF _Toc44618958 \h 46Appendix 9. Forming a local facility based an Outbreak Management Team (OMT) PAGEREF _Toc44618959 \h 48Appendix 10. Hand Hygiene PAGEREF _Toc44618960 \h 49Appendix 11. Personal Protective Equipment Recommendations PAGEREF _Toc44618961 \h 52Appendix 12. Proper Use of Personal Protective Equipment (PPE) PAGEREF _Toc44618962 \h 53Appendix 13. Respiratory Etiquette PAGEREF _Toc44618963 \h 54Appendix 14. Transmission-Based Precautions PAGEREF _Toc44618964 \h 55IntroductionThese guidelines apply to all detention and correctional facilities in Australia. This includes:prisonsjuvenile detention centres and youth justice centrescommunity correctional centresonshore Australian immigration detention facilities. Inmates of correctional facilities are extremely susceptible to outbreaks of respiratory illness, which commonly occur in winter. Although transmission of COVID-19 in Australia is currently low, respiratory illnesses due to COVID-19 may still occur. More than 65,000 people enter and exit Australian correctional facilities each year.1 People in prison often come from disadvantaged backgrounds and have significant and complex health needs compared to the general population; prisoners are less likely to have seen a doctor recently, five times as likely to be smokers, more likely to have used illicit drugs and more likely to have an infectious disease. Prisoners also have high rates of chronic physical conditions with 30% of prisoners reporting at least one chronic disease.1 Aboriginal and Torres Strait Islander people are significantly over-represented in custodial settings. More than one third of people in Australian prisons are Aboriginal or Torres Strait Islander peoples. This group also has a high prevalence of chronic disease.If cases of COVID-19 are introduced to these facilities, there is increased risk of significant transmission and infection with COVID-19. Preventing the introduction of COVID-19 will assist in minimising potential harm. This includes careful consideration of visitor access and screening. In situations where there is community transmission, it is recommended that quarantining or testing occurs for new admissions to facilities. Facilities should also perform regular surveillance of presentations of acute respiratory infections in the facility. These guidelines are intended to assist detention and correctional facilities to plan, prepare, detect, and respond to COVID-19 outbreaks.Appendix 1 provides a summary of COVID-19 management in detention and correctional facilities in Australia. While this guideline focuses on detention and correctional facilities, the principles apply to many settings including military barracks, boarding schools, hostels and any other setting where residents sleep, eat and live, either temporarily or on an ongoing basis. See additional guidance for investigation and management of COVID-19 outbreaks in high-risk settings in the CDNA COVID-19 National Guidelines for Public Health Units (CDNA National Guideline).COVID-19 OutbreaksIt can be difficult to tell the difference between a respiratory illness such as COVID-19 and a respiratory illness caused by other viruses based on symptoms alone. All individuals with symptoms of COVID-19 should be tested (for example, nose and throat swab collection) until a causative pathogen is identified. People who have clinical signs and symptoms and who also have an epidemiological link (e.g. close contact, travel to a hotspot), are defined as a ‘suspect’ case. For the purpose of this document, individuals tested as part of broader testing (beyond suspect case definition) will be referred to as ‘potential’ cases. If the virus that causes COVID-19 (SARS-CoV-2) is detected in a high-risk setting, this is referred to as a COVID-19 outbreak (refer to 5.2.1 for guidance).While all respiratory viruses can cause outbreaks and significant morbidity and mortality, COVID-19 is acknowledged as a significant health risk particularly for individuals at higher risk of developing severe illness. Correctional and detention facilities are higher risk environments for outbreaks. This is because it is difficult to practice physical distancing in these facilities, where inmates are often located in close proximity and share cells. These guidelines will assist facilities to manage all types of respiratory outbreaks, but the focus is predominantly on COVID-19.Legal FrameworkIt is the responsibility of detention and correctional facilities to identify and comply with relevant legislation and regulations. Facilities must fulfil their legal responsibilities in relation to infection prevention and control, by adopting standard and transmission-based precautions, particularly, in the health facilities within these detention centres. Requirements are outlined in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), and by state/territory public health authorities. COVID -19 is a notifiable condition under the Australian National Notifiable Diseases List (NNDL). This means that in all Australian states and territories, either the medical officer requesting the test and/or the laboratory performing the test, are responsible for notifying the relevant jurisdictional public health authority of the case of COVID-19, as per local legislative requirements.Roles and ResponsibilitiesCorrectional and detention facilitiesThe primary responsibility of managing COVID-19 outbreaks lies with the facility, within their responsibilities for inmate care, and infection prevention and control. All facilities should have in-house (or access to) infection prevention and control expertise, and have outbreak management plans in place. Facilities are required to: detect and notify outbreaks to state health departmentsmanage outbreaks, with advice and support/direction from their state health department/public health unit, in accordance with this guideline, the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), and the Australian Health Sector Emergency Response Plan for Novel Coronavirus (2020)confirm and declare an outbreak in partnership with public health authoritiesprovide advice on infection prevention and control measures and use of personal protective equipment (PPE)confirm and declare when an outbreak is over, in partnership with public health authoritiesThe State/Territory Department of HealthThe relevant state/territory Department of Health (or delegate) will assist facilities to detect, characterise and manage COVID-19 outbreaks, including co-leading the response with the facility where possible. This includes: confirming and declaring the outbreak leading outbreak management undertaking testing of cases and contactsproviding advice on infection prevention and control measures and use of personal protective equipment monitoring for severity of illness informing relevant stakeholders of outbreaksmonitoring the number of COVID-19 cases occurring as the outbreak progressescontributing to national surveillanceconfirming and declaring when an outbreak is over Understanding COVID-19Recognising COVID-19COVID-19 is a contagious viral infection that generally causes respiratory illness in humans. Presentation can range from no symptoms (asymptomatic) to severe illness with potentially life-threatening complications, including pneumonia. The most common signs and symptoms include: fever dry coughOther symptoms can include: shortness of breathsputum productionfatiguesore throatloss of tasteloss of smelldiarrhoeanausea or vomitingLess common symptoms include: headachemyalgia/arthralgiachillsnasal congestionhaemoptysisconjunctival congestionOlder people may also have the following symptoms: increased confusion worsening chronic conditions of the lungs loss of appetiteFacilities should consider testing any inmate with any new symptom consistent with COVID-19. Potential cases are likely to be identified by:correctional / detention staff (including guards) or dedicated health staffother inmatesself-referralat reception screening or through other meansIncubation PeriodPeople with COVID-19 generally develop signs and symptoms, including mild respiratory symptoms and fever. This usually occurs 5-6 days after infection (mean incubation period 5-6 days, range 1-14 days). In rare cases, the incubation period may exceed 14 days.Routes of TransmissionCOVID-19 is transmitted via droplets and fomites (droplet and contact spread) during close unprotected contact with an infected person or contaminated objects. Airborne spread has not been reported for COVID-19. However, it may occur during certain aerosol-generating procedures conducted in health care settings. Faecal shedding of the virus has been demonstrated in some patients, and viable virus has been identified in some cases. Correctional and detention facilities are considered a higher risk environment for outbreaks. This is because inmates live in close proximity and have shared living arrangements with a large group of people. This makes it difficult to practice physical distancing.People at risk of severe COVID-19Anyone who gets COVID-19 can develop severe disease. However, the likelihood of getting severe COVID-19 illness increases with age. The presence of certain health conditions also increases the likelihood of severe COVID-19. People at high risk of severe COVID-19 illness include those who:are 70 year and olderhave had an organ transplant and on immune suppressive therapy have had a bone marrow transplant in the last 24 months or are on immune suppressive therapy for graft versus host diseasehave a haematologic (blood) cancer e.g. leukaemia, lymphoma or myelodysplastic syndrome (diagnosed within the last 5 years)are having chemotherapy or radiotherapyPeople at moderate risk of severe COVID-19 illness include those who have:chronic kidney (renal) failureheart disease (coronary heart disease or failure)chronic lung disease, excluding mild or moderate asthmahad cancer in the past 12 monthsdiabetessevere obesity with a body mass index of 40 kg/m2 or morechronic liver diseasesome neurological conditions such as stroke or dementiasome chronic inflammatory conditions and treatmentsother primary or acquired immunodeficiencypoorly controlled hypertension (may increase risk)Older inmates or those with chronic conditions are at increased risk of severe COVID-19. The list of people at high or moderate risk of severe COVID-19 is regularly updated based on emerging evidence. Details are available on the Department of Health website. Complications of severe COVID-19Most people with COVID-19 have mild disease and will recover. Some people can develop severe illness with complications which may be life-threatening and can result in plications include:pneumonia (interstitial pneumonitis, secondary bacterial infection)respiratory failureseptic shockmulti-organ dysfunction/failureInmates with COVID-19 who have pre-existing comorbidities may also experience a worsening of these chronic health problems. For example, congestive heart failure, asthma and diabetes.Preparedness and PreventionPreparationFacilities must ensure they are prepared for outbreaks of COVID-19. The basis for an effective infection prevention and control response during the COVID-19 pandemic is a well-functioning infection prevention and control program that works in conjunction with a well-functioning occupational health (OH) program. Facilities must also have strong governance structures to assess risk and implement mitigation strategies.Australian health care facilities are likely to be impacted by the COVID-19 pandemic. It is essential for detention and correctional facilities to work with local and state/territory governments, to ensure that they can manage inmates with COVID-19 while maintaining the level of care required for all other inmates. This might include caring for inmates onsite, if hospital facilities are overwhelmed. However, this will be dependent on the person’s clinical condition, the facility resources and recommended action relating to public health management. The information in this guideline is for facilities and their staff. It provides the information they need to plan for and execute IPC and OH processes intended to prevent exposure to and transmission of COVID-19.Prepare an Outbreak Management PlanPreparing an outbreak management plan will help staff identify, respond and assist in the management of a COVID-19 outbreak. It will protect the health of staff and inmates, and reduce the severity and duration of outbreaks if they occur. At a minimum, facilities must identify a dedicated outbreak leader as well as an outbreak preparedness and response team which includes staff members to plan, co-ordinate and manage logistics in an outbreak setting as well as communicate and liaise with the state/territory health department. The prevention strategies outlined in this guideline should be included in the outbreak management plan. A checklist to assist in outbreak preparedness can be found in Appendix?2. Planning AssumptionsIt is important to note that assumptions about the epidemiology and impact of COVID-19 may change as knowledge emerges. The following public health assumptions are relevant to infection prevention control and outbreak management planning: A resurgence in cases during the COVID-19 pandemic will affect the entire health care system and the community. There may be interruption to usual supply and logistics systems e.g. personal protective equipment (PPE). Hospitals, local public health units and other services may have limited capacity. If there is not a wider outbreak in the general community, the prison may be a source of spread to the wider community and this risk must be managed in consultation with public health authorities. COVID-19 pandemic plans developed by individual facilities are: coordinated with the plans of other organisations in their communities and local/regional pandemic plans; and consistent with the Australian Government Department of Health Australian Health Sector Emergency Response Plan for Novel Coronavirus (2020). A vaccine is unlikely to be available for some time. The efficacy of antivirals against COVID-19 is unknown. However, if antivirals are shown to shorten the length of time people are ill, relieve symptoms and reduce hospitalisations, they may be introduced into standards of care. They will, however, be in short supply and high demand. Organisations will have to rely on traditional infection prevention and control practices (e.g. hand hygiene, appropriate personal protective equipment, and isolating sick individuals) as the main line of defence. Australia may not have a large enough supply of either antivirals or vaccine (when these are first developed) for the entire population. The government will have to set priorities for who receives them. Detention and correctional facilities must follow Commonwealth and State/Territory guidance for priority groups for immunisation, antiviral treatment and prophylaxis, if and when available. During the course of the pandemic, priority groups may change based on the epidemiology of COVID-19 (i.e. the nature of the virus, the people most affected). To meet community needs during a pandemic, resources – including staff, supplies and equipment – may be reassigned or shifted. Care protocols may change and practices may have to be adapted. Facilities will need effective ways to communicate with inmates, staff, and regular visitors including inmates’ families. This is in order to meet their needs for information but reduce demands on staff. A communications plan should be developed.EducationEducation for staff, inmates and visitors is vital to inform their behaviour and help manage the potential occurrence for ongoing transmission in an outbreak setting. Prompt and clear information should be provided to inmates, staff and visitors regarding COVID-19. This includes respiratory hygiene and cough etiquette, hand hygiene and restrictions on visitation. A sample letter outlining the preventative steps visitors can take to reduce the risk of bringing COVID-19 into the facility can be found at Appendix 3. Staff should be informed, and supported, to exclude themselves from work when they have fever and/or an acute respiratory infection, or any other potential COVID-19 symptoms (as per section 2.1, page 6). They must notify the facility if they have been tested for, or confirmed to have, COVID-19. Facilities should reinforce the underlying principle of staff and visitors staying away from the facility if they are unwell. This can be done by placing signage at all entry points to the facility and by encouraging self-screening (refer 3.2.1).Workforce ManagementFacilities should have a staff contingency plan in the event of an outbreak. The plan will outline where unwell staff members need to be excluded from work for a prolonged period or until cleared to return to work. The workforce management plan should be able to cover a 20-30% staff absentee rate. In particular, correctional and detention facilities should consider the potential impact of shortages of healthcare staff working in these facilities. Facilities should consider developing and maintaining a contact list of casual staff. This would include external nursing staff who could be called upon as part of a surge workforce should an outbreak occur. Also consider the current nature of the pandemic and ongoing outbreaks when planning leave.Surge workforce from outside the facility will be required in a significant outbreak. Staff Education and TrainingEach correctional and detention facility is responsible for ensuring their staff are trained and competent in all aspects of outbreak management prior to an outbreak. All staff (including prison officers, healthcare workers, and education staff) should know the signs and symptoms of COVID-19. This will help them to identify and respond quickly to a potential outbreak. Additionally, all staff need to understand the infection prevention and control guidelines and be competent in implementing these measures during an outbreak. Education materials should be provided in relevant languages. Topics for staff education and training should include:Symptoms and signs of COVID-19Exposure risk levels for COVID-19, including travel and contact with confirmed casesVulnerable populations at higher risk of severe illnessPersonal hygiene, particularly hand hygiene, sneeze and cough etiquetteAppropriate use of PPE such as gloves, gowns, eye protection and masks, including how to don and doff PPE correctlyActions on experiencing symptoms of COVID-19 (do not work or visit a correctional or detention facility and seek testing for COVID-19)Handling and disposal of clinical wasteProcessing of reusable equipmentEnvironmental cleaningAdequate cleaning of transport vehiclesSafe laundering of linenFood handling and cleaning of used food utensils.Consumable StocksFacilities should work with health care staff to ensure that they hold adequate stock levels of all consumable materials required during an outbreak, including: personal protective equipment (gloves, gowns, masks, eyewear) hand hygiene products (alcohol based-hand rub, liquid soap, hand towel) diagnostic materials (swabs) cleaning supplies (detergent and effective disinfectant products). Facilities should have an effective policy in place to obtain additional stock from suppliers as needed. In order to effectively monitor stock levels, facilities should: undertake regular stocktake (counting stock) use an outbreak kit / boxPreventionCorrectional and detention facilities should prioritise prevention activities. It is essential that facilities avoid exposure and introduction of cases, which could spread quickly in the high risk environment.There is currently no vaccination to prevent COVID-19. Avoidance of exposure is the single most important measure for preventing COVID-19 in correctional and detention facilities. Facilities must have, and be vigilant in implementing, effective infection prevention and control procedures. Facilities are expected to use risk assessments to ensure the risks of a COVID-19 outbreak are as low as possible. This can involve examining:the layout and environment;equipment; workforce training;systems; andprocesses or practices that affect any aspect of how inmates are managed and how their personal and clinical care is delivered. The general strategies recommended to prevent the spread of COVID-19 in correctional and detention facilities are the same infection prevention and control strategies as part of standard operational activities implemented to detect and prevent the spread of other respiratory viruses such as influenza. During the COVID-19 pandemic, or when local community transmission of the disease is identified, correctional and detention facilities should focus on preventing introduction of the disease into the facility, early detection and prevention of spread within or between facilities if infection has been identified.Exposure Prevention Exposure prevention actions include: Screening for staff and visitors (including visiting workers)Correctional and detention facilities should instruct all staff to self-screen for symptoms. Facilities may also consider implementing screening for staff and visitors entering the facility (e.g. questionnaire). They should observe any exclusion and quarantine requirements related to returning from travel or having close contact with a confirmed case.Staff should be made aware of early signs and symptoms of COVID-19. Staff must not come to work if symptomatic with an illness compatible with COVID-19. Staff with symptoms should seek COVID-19 testing. Sick leave policies must enable employees to stay home if they have symptoms of respiratory infection or other infectious illness. Correctional and detention facilities should use signage at entrances and reception in appropriate languages to inform visitors to self-identify if they have relevant symptoms, travel history or exposure. Visitors must be instructed not to enter the correctional and detention facility until all symptoms have completely resolved. Monitoring inmates and employees for fever acute respiratory symptoms or other symptoms Restrict inmates with fever acute respiratory symptoms or other symptoms to their room. It is strongly recommended that, wherever possible, inmates with symptoms should be allocated to a single room ideally with separate bathroom facilities, and contact with other inmates be avoided. If possible, unwell inmates should be located in single rooms in a dedicated wing or unit, so that specific staff can provide care without moving or being allocated throughout the facility.If unwell inmates must leave their room to attend the infirmary, or facility health unit, they should wear a surgical mask (if tolerated). Staff escorting unwell inmates during transport or movement within the facility should wear a surgical mask, eye protection, gown/apron and gloves, in addition to observing hand hygiene. PPE must be donned and doffed in accordance with recommended practices and disposed of appropriately (see Appendix 12) While separate bathroom facilities are preferred, if communal facilities must be used then facilities must follow infection control and environmental cleaning advice. Individuals should follow the above PPE recommendations when moving to and from communal bathroom facilities. These must be cleaned after each use, advice on environmental cleaning is available here. In general, for care of inmates with an undiagnosed or diagnosed respiratory infection use standard, contact, and droplet precautions with eye protection unless a procedure requires airborne precautions. This includes the use of recommended PPE (including a surgical mask). In less common situations such as if an aerosol generating procedure (AGP) is required, then airborne precautions would be required, including the for use appropriate PPE which would include a fit tested and fit checked P2/N95 respirator.Testing all inmates for COVID-19 if they have any COVID-19 compatible symptomsImplementing other infection prevention and control measures, includes: hand hygiene cough etiquette and respiratory hygieneuse of appropriate PPE based upon assessment of level of precautions requiredavoid using nebulisers wherever possible and use spacers as an alternativeenvironmental cleaning measuresisolation and cohortingphysical distancing.Prevention of Introduction into the FacilityScreen incoming inmates for COVID-19 symptoms in the watch house or at reception, prior to transfer to the facility.New inmates to the facility, who have been in geographic areas with elevated risk of community transmission within the past 14 days, should be quarantined until 14 days from when they were last in the area with community transmission, prior to being allowed to mix with other inmates. Quarantine should be undertaken either in a single cell with access to private toileting facilities, or if unavailable, quarantined inmates may be cohorted in a separate area of the prison (see 5.3.1). Incoming inmates who are unwell should be tested and isolated until a negative test is obtained. Visitors to the facility (including family members, legal support and official prison visitors) can potentially transmit SARS-CoV-2 to inmates and should be limited where possible especially when community transmission is occurring. Alternative means of family/legal contact should be considered such as audio visual links. The following actions should be taken:Facilities should comply with all Commonwealth, and state or territory direction on restrictions relating to visitors. This applies when visitors are unwell or when there is significant community transmission occurring.Facilities should advise all regular and non-regular visitors to be vigilant with hygiene measures including physical distancing. Consideration should be given to the introduction of appropriate barriers such as Perspex screens. They should monitor for symptoms of COVID-19, including fever, acute respiratory illness and other symptoms of COVID-19. Staff and visitors should be instructed to stay away when unwell, for their own protection as well as to protect staff and inmates. All staff and visitors must observe any quarantine requirements and directions. Signage and other forms of communication (i.e. information and fact sheets) in relevant languages must be used to convey key messages. This includes what actions the facility is taking to protect them, and explaining what they can do to protect themselves and inmates. Facilities must ensure that adequate hand washing supplies, alcohol-based hand sanitiser, tissues, and lined disposal receptacles are available for visitors to use. These must be at the entrance of the facility, in the visitor area and in each inmate’s room. Facilities should undertake screening of visitors to facilities. This should include screening for symptoms and a temperature check. Visitors should not be permitted entry if they display symptoms suggestive of COVID-19, have been in contact with a known COVID-19 positive case in the past 14 days, or have been to a high risk area in the past 14 days.NOTE: The safe implementation and use of alcohol-based hand hygiene products should be undertaken in a safe manner within facilities that ensures appropriate access for visitors and inmates, without compromising safety or unauthorised access. Prevention of Spread Within and Between FacilitiesInmates who are being transferred from another facility should be screened for COVID-19 symptoms prior to transfer to and upon arrival at the new facility.Inmates who have been in areas with community transmission in the past 14 days, should be quarantined until 14 days from when they were last in the area with community transmission, prior to being allowed to mix with other inmates. Quarantine should be undertaken either in a single cell with access to private toileting facilities, or if unavailable, quarantined inmates may be cohorted in a separate area of the prison (see 5.3.1). To prevent the spread of COVID-19, the following actions should be taken:Keep inmates and staff informed through regular communication. Support personal protection measures including respiratory hygiene, cough etiquette, and hand hygiene. Provide and facilitate an annual influenza vaccination program for staff and inmates.Ensure signage and other forms of communication (i.e. information and fact sheets) in relevant languages must be used to convey key messages including what actions the facility is taking to protect them, and explaining what they can do to protect themselves. Facilities must ensure adequate hand washing supplies, as well as tissues and lined disposal receptacles are available for inmates to use; in common areas, in the visitor area and in each inmate’s room. Monitor inmates and employees for fever or acute respiratory symptomsRestrict inmates with fever, acute respiratory symptoms or other COVID-19 symptoms to their room. Wherever possible, inmates with symptoms should be allocated to a single room, with access to private toileting facilities, and contact with other inmates should be avoided. Unwell inmates should be located in single rooms in a dedicated wing or unit, so that staff can provide care without moving or being allocated to work in other areas throughout the facility.If unwell inmates must leave their room to attend the infirmary or health centre, they should wear a surgical mask (if tolerated). Staff escorting inmates from one room to another should wear a surgical mask, eye protection, gown or apron and gloves, in addition to observing hand hygiene.In general, for care of inmates with undiagnosed or diagnosed respiratory infection use standard, contact, and droplet precautions with eye protection unless a procedure requires airborne precautions. This includes the use of recommended PPE (including a surgical mask). In less common situations such as if an aerosol generating procedure is required, then airborne precautions would be required, including the for use appropriate PPE which would include a fit tested and fit checked P2/N95 respirator.All inmates and employees with symptoms consistent with COVID-19 should be tested for COVID-19 and other respiratory pathogens such as influenza. Health care personnel should monitor Commonwealth Department of Health and state or territory public health information sources. These sources will help them understand COVID-19 activity in their community and inform their evaluation of individuals with unknown respiratory illness. If there is transmission of COVID-19 in the community, facilities should consult with public health authorities for additional guidance. This is in addition to implementing the precautions described above for inmates with acute respiratory infection or other COVID-19 symptoms. Identify dedicated employees (including health care staff and prison guards) to care for patients with potential or confirmed COVID-19 and provide infection prevention and control training. These dedicated employees should only be caring for COVID-19 patients. Guidance on implementing recommended infection prevention and control practices is available in section 5.4.Identify suitable sites where people with laboratory confirmed COVID-19 and their contacts may be cohorted as follows: isolation for unwell inmates, and quarantine for those exposed. In an outbreak, health care staff should only work within one of the cohorts and not move between those with confirmed COVID-19, those in quarantine, and those unaffected.Provide the correct supplies to ensure easy and correct use of PPE.Make PPE, including surgical masks, eye protection, gowns, and gloves, available immediately outside of the room of an unwell inmate.Place a waste receptacle near the exit of any potential or confirmed (inmate) room, facilitate correct doffing (taking off) and discarding of PPE by staff. Post signs on the door or wall outside of the inmate room clearly describing the type of precautions needed and PPE required.Ensure effective environmental cleaning and increased frequency of cleaning of high touch areas.Ensure safe laundering and waste disposal processes.Notify facilities prior to transferring an inmate with an acute respiratory illness, or other symptoms suggestive of COVID-19, including potential or confirmed COVID-19, or transferring to a higher level of care such as hospital.Usual escorts and healthcare staff may accompany an inmate being transferred provided appropriate PPE is used.If an outbreak occurs in a facility, facility staff should not work at another facility until the outbreak is over. Facility managers and the outbreak management team should risk assess staff areas of work allocations during outbreaks.3.2.4 Prevent spread into surrounding communitiesEnsure arrangements are made for completion of isolation or quarantine for prisoners being released when in isolation or quarantine.3.3 Special considerations for prisons with high proportion of Aboriginal or Torres Strait Islanders of culturally and linguistically diverse inmatesEnsure communication about COVID is available in the primary language of the prisoner using culturally-appropriate messaging.Identifying COVID-19IdentificationCorrectional and detention facilities should establish systems to monitor staff and inmates for COVID-19. These should have a high level of vigilance and have a low threshold for COVID-19 testing. If local transmission of COVID-19 is occurring, effective surveillance will:enable early identification of symptoms in staff and inmates assist to recognise and manage cases early. In the early stages of an outbreak, staff and inmates should be closely monitored for fever or acute respiratory infection (ARI) or other symptoms suggestive of COVID-19. Refer to section 2.1 for a full list of signs and symptoms to look for.If a person with ARI or fever is identified, they should be promptly investigated for a causative agent. While waiting for results, the person should be treated as suspected or possible case. Use appropriate infection prevention and control measures, such as isolation and the use of PPE. This will help to prevent further spread of the disease. The person being tested should be supplied with information and instructions on isolation and other infection prevention and control actions while awaiting results.Facilities should identify, count and gather information on, those with fever, ARI, other respiratory illnesses, or other COVID-19 symptoms each day. These individuals should be promptly tested for COVID-19 to identify a potential COVID-19 outbreak. Prompt detection of outbreaks allows early implementation of control measures. Refer to facility COVID-19 plans and jurisdictional health units for specific advice, surveillance templates and tools.Health care personnel should monitor Australian Government Department of Health and state/territory public health sources to understand COVID-19 activity in their community. This will help evaluate individuals with undifferentiated respiratory illness or fever. If there is confirmed local transmission of COVID-19 in the community, facilities should:implement the precautions described in this document consult with public health authorities for infection prevention and control guidance.Case DefinitionThe CDNA National Guideline provide the current case definition for COVID-19. This is used to classify an individual as a confirmed, probable or suspect case, or as meeting enhanced testing criteria. COVID-19 should be considered in any inmate or staff member who meets the suspect case definition or fulfils criteria for enhanced testing. These recommendations will change over time based on a variety of factors, including current epidemiology and testing capacity. It is important to check relevant state and territory health department case definitions and criteria for who should be tested, as these vary according to local epidemiology and circumstances. Testing outside of the suspect case definition should be done in some circumstances. Clinical and public health judgement should be used by clinicians and the public health unit to determine who should be tested.Testing for COVID-19If a case is identified, arrange testing for COVID-19 for all staff or inmates. If available, consider additional serological tests. Test all staff and inmates in the facility who are symptomatic, for COVID-19 and other respiratory pathogens including influenza.The recommended test and methods of sampling for COVID-19 are outlined in the CDNA National Guideline. If a medical officer requests a test, an appropriately trained health professional should collect the appropriate respiratory samples with the proper use of PPE. Inmates do not need to be transferred to hospital for the purpose of testing for COVID-19. Testing must occur in an appropriate location (i.e. a single room with the door shut). Guided by the clinical picture, the responsible medical officer should consider requesting testing for additional respiratory pathogens.Procedures for obtaining nose and throat swabs are at Appendix 4. Notification – State/Territory Department of HealthLaboratory confirmed COVID-19 is a notifiable disease in all Australian states and territories. The requesting medical officer and/or the testing laboratory is obligated to notify the infection to the jurisdictional communicable disease authority, depending on local legislative requirements. This notification is confidential. If a case is suspected, the local state/territory Department of Health must be notified immediately. A Public Health Unit (PHU) will assist with advice and guidance on appropriate follow on actions. See sample reporting template available at Appendix 5. An outbreak response team should be set up which includes the PHU. Correctional and detention facilities must be prepared to provide this information to the PHU:the setup of the facilitytotal number of inmates and/or staff with fever or ARI or other COVID-19 symptomsdate of onset of symptoms/ illness of each person type of symptoms of each person number of people admitted to hospital with fever, ARI, or other COVID-19 symptomsnumber of people with relevant symptoms who have died total number of staff that work in the facility and in the affected area total number of inmates in the facility and in the affected area if appropriate respiratory specimens have been collectedresults of any respiratory specimens already testedarrangements for cleaning, handling of laundry and waste in the facility.The PHU should advise assist and provide direction to the facility to:define the outbreak settingconfirm and declare a COVID-19 outbreakcontact tracing identify those most at risk of severe diseasearrange diagnostic testing for COVID-19 for all staff and inmates in the outbreak settingutilise records to notify all visitors of the outbreakensure that the facility managers notify other staff, inmates and visitors and family members where relevant, that cases of COVID-19 have occurredadvise staff about enhanced implementation of infection prevention and control measuresensure that staff who have worked at any other facility in the last 14 days are identified by the facility and this information is provided to the outbreak team collate information onto a line list and keeping this up to date ensure staff form an outbreak management team (see below)identify and inform relevant internal and external stakeholdersisolate and treat people who test positive. Quarantine people who test negative and monitor for illnesswhere feasible, commencing a program of repeat tests for those who may be susceptible or incubating who are in quarantineidentifying suitable sites where individuals may be cohorted together into either: isolation of the sick OR quarantine of the exposed or vulnerable not exposed.More information for PHUs managing outbreaks in correctional and detention facilities and other high-risk settings is available in the CDNA National Guideline. The PHU will provide the facility with a preferred case list (also called a ‘line list’) template to use when an outbreak is notified. The facility must advise the local PHU and Commonwealth Department of Health within 24 hours of any deaths that occur during an outbreak. A record of any inmates who are admitted to hospital should be made on the case list and sent to the department daily (see section 5.5.1).State/Territory Public Health Unit Contact detailsStateContact DetailsQueensland13 432 584 (13 HEALTH)New South Wales1300 066 055Australian Capital TerritoryBusiness Hours: 02 5124 9213After Hours: 02 9962 4155Victoria1800 675 398Tasmania1800 671 738South Australia1300 232 272Western Australia08 9222 4222WA HealthNorthern Territory08 8922 8044Up to date local State and Territory health department contact details are available on the Australian Government Department of Health website. Notification – Facility General Practitioners (GP)A GP or medical officer should review any unwell inmates, whether an outbreak is present or not. If a regular visiting GP or other health care professional assesses the inmate, inform them a COVID-19 outbreak is present at the facility. See a sample letter for GPs at Appendix 6. This will facilitate:appropriate testing samples to be takenearly implementation of infection prevention and control procedures– treatment for symptomatic patients. It is important to speak with the PHU to confirm the presence of an outbreak before issuing the outbreak letter to visiting GPs.COVID-19 Case and Outbreak ManagementInmates with potential or confirmed COVID-19 require immediate and appropriate management. Special considerations in the management of inmates with potential or confirmed COVID-19 in a correctional and detention facility include:Immediately isolate ill inmates (or cohort) and minimise interaction with other inmates. Confirmed cases should not be cohorted with potential cases. Ensure that effective communication on the state of the outbreak is available to prisoners and their families.If an inmate has symptoms consistent with COVID-19, use a low threshold to request medical review and testing.Wherever possible, transfer inmates to hospital if their condition warrants. Patients with severe symptoms or complications of COVID-19 may warrant transfer to hospital (refer 2.5). If transfer is required, advise the hospital in advance that the inmate is being transferred from a correctional or detention facility where there is potential or confirmed COVID-19. A sample transfer advice form is provided at Appendix 7.Usual escorts and healthcare staff may accompany unwell inmates provided appropriate PPE is usedVehicles used for transport must be appropriately cleaned after transfer of the sick prisoner. Notify the appropriate authorities as outlined in section 4.4 and 4.5.The PHU may advise the facility to implement additional actions while waiting for the test results in order to minimise transmission. Health care staff and the infirmary should prioritise assessment of patients to prevent acute care hospitalisation (for COVID-19 or other infections), if possible. For example, to prevent patients with medical conditions from deteriorating and requiring hospitalisation in an acute care facility. If one or more cases of COVID-19 are confirmed in the facility, health care staff should monitor patients as frequently as clinically required or at a minimum once per shift and have a mechanism for alerting the health care staff if there is any deterioration in the prisoner’s state. Correctional staff supervising unwell inmates should be trained in recognising the deteriorating patient. Where clinical deterioration is identified, monitoring frequency should increase. Response to symptoms of COVID-19 in a staff memberHealth care workers and other staff members who develop fever, respiratory illness or other COVID-19 symptoms should:be immediately excluded from the facility not attend work until a diagnosis is sought. If the staff member tests negative for COVID-19, the staff member may be able to return to work once cleared and asymptomatic. However, the staff member must complete any quarantine periods (e.g. if they are a close contact).If a diagnosis of COVID-19 is confirmed, the staff member must be excluded from work (refer to guidance here) until they meet the criteria for release from isolation outlined in the CDNA National Guideline. The correctional or detention facility must notify the relevant authorities as outlined in section 4.4 and 4.5. Early action is critical to minimise transmission in detention and correctional facilities. The PHU may advise the facility to implement additional actions while awaiting test results.Response to a COVID-19 outbreakThis section provides detailed information on the required actions once an outbreak has been identified. An outbreak management checklist is provided at Appendix 8. Additional information for PHUs responding to an outbreak in a high-risk setting is available in the CDNA National Guideline.Correctional and detention facilities should engage an infection prevention and control consultant or discuss additional support requirements with their PHU. Surge staffing from local hospitals or other agencies may be available to assist correctional and detention facility staff and avoid transfer of inmates to hospital. Declaring an outbreak A COVID-19 outbreak is defined as a single confirmed case of COVID-19 in an inmate or staff member of a correctional or detention facility.This definition does not include a single case of an infrequent visitor to the facility. To determine whether someone is a frequent or infrequent visitor consider the: frequency of visitstime spent in the setting number of contacts within the setting. These definitions offer guidance. The State/Territory PHU will assist the correctional or detention facility to decide whether to declare an outbreak. If an outbreak is suspected, the PHU may advise the facility to take specific actions, while waiting for test results. Establishing an Outbreak Management TeamThe correctional or detention facility is responsible for managing the outbreak and should take a strong leadership role with support/ directed by the PHU staff. An internal outbreak management team (OMT) should be established to:direct, monitor and oversee the outbreakconfirm roles and responsibilities liaise with the state/territory Department of Health and PHU. The team should:not be part of day-to-day facility management meet within hours of the identification of a case consider the progress of the responseundertake ongoing monitoringdeal with unexpected issues, and initiates changes, as required. When an OMT is formed, it is important to:meet regularly, usually daily, at the height of the outbreak to monitor the outbreakinitiate changes to response measures discuss outbreak management roles and responsibilities. In reality, a small number of staff will perform multiple roles in an OMT.A number of roles in an OMT will be filled by health care staff. However, additional prison staff particularly management should actively manage the response.For detailed information on forming and implementing an OMT, see Appendix 9.5.2.3. Testing during an outbreakOnce an outbreak is declared, the PHU will assist to coordinate testing in the facility. If an index case of COVID-19 acquired their infection in the facility, there are likely to be other cases in the facility.The PHU will assist the facility OMT to:test all members of the facility (including staff), as required isolate positive cases, which may involve cohortingquarantine close contacts, which may involve cohorting and ensure a system for symptom monitoring isolate unwell contacts, which may involve cohortingquarantine all other inmates and staff who test negative and are asymptomatic to prevent transmission in a separate area from close contactsscreen individuals who test negative for symptoms and, where feasible, implement a program of repeat tests (e.g. 72 hourly)repeat testing will identify those who are pre-symptomatic. This will enable rapid removal from the environmentundertake contact tracingregularly screen staff for symptoms. The PHU will help identify when cases can be released from isolation, according to the requirements in the CDNA National Guideline.Implementing Infection Prevention and Control MeasuresCorrectional and detention facilities should consider early consultation and engagement with infection control practitioners to assist outbreak management. Isolation and cohortingAn inmate with an ARI, fever or other COVID-19 symptoms should be in a single room with their own ensuite/bathroom facilities, if possible, while waiting for a diagnosis. Inmates requiring droplet precautions should be restricted to their room. If possible, it is preferable for unwell inmates to be located in single rooms in a dedicated wing or unit, so that staff can provide care without moving throughout facility or being allocated to work in different areas. If possible, medical consultations should be provided in the inmate’s room. Inmates may attend urgent medical or procedural appointments but should wear a surgical mask when outside of their room, moving to the infirmary or during transport. Escort staff accompanying inmates to another room for appointments should wear a surgical mask, eye protection, gown or apron and gloves, in addition to observing hand hygiene.If the inmate requires transfer to another facility, including hospital, advise the hospital and transport provider in advance that the transfer is from a facility where there is potential or confirmed COVID-19. Inmates may be transferred with usual escorts and health care staff provided appropriate PPE is used (follow the advice of health care staff). If the numbers of cases in a facility increase in an outbreak situation, isolation resources may come under pressure. If a single room is not available, follow these principles to guide inmate placement:solitary confinement rooms may be appropriate if alternative single room accommodation is not available.inmates with excessive cough and sputum production or other risk factors for transmission should have highest priority to a single room. inmates who are confirmed cases can be placed together in the same room (cohort), if feasible.Staff must ensure they change their PPE and perform good hand hygiene when moving between inmates cohorted in the same room.A minimum of 1.5 m spacing between beds must be observed If these options are not available and an inmate needs to be isolated, staff should contact the local PHU to seek advice on the best alternative. Once isolation or cohorting measures are in place, to further reduce the risk of transmission, allocate specific correctional and detention facility staff (including specific healthcare staff and specific guards) to the care of inmates in isolation. A register of staff members caring for patients with COVID-19 should be maintained.The facility must ensure that staff members: do not move between their allocated room/ section and other areas of the facility, or care for other inmates. monitor themselves for signs and symptoms of acute respiratory illness and do not attend work if unwell.do not work in other facilities even if asymptomatic, until the outbreak is declared over.Unaffected vulnerable inmates who are at risk of severe COVID-19 disease should be separated from those who may have been exposed. Consider other measures to protect vulnerable inmates including early release or alternative accommodation. This particularly applies to inmates considered suitable for early release and youth.Standard PrecautionsStandard precautions are a group of infection prevention and control practices always used for the care of and contact with all persons and all times regardless of a known or perceived infectious disease risk. The principles of standard precautions should be practiced in correctional and detention facilities and must be implemented for interactions with a potential or confirmed COVID-19 case. Health care staff and general correctional and detention staff must abide by the recommended precautions to protect themselves and others if an inmate is unwell or suspected to have an infectious illness including COVID-19. Standard precautions include:performing hand hygiene before and after every episode of inmate contact (5 moments)the use of PPE (including gloves, gown/apron, appropriate mask and eye protection) depending on the anticipated exposuregood respiratory hygiene/cough etiquetteregular cleaning of the environment and equipment, management of sharps and linen and waste management.Hand hygieneCOVID-19 can be spread by contaminated hands. It is important to use frequent hand hygiene. Hand hygiene refers to any action of hand cleansing, such as:hand washing with soap and water or hand rubbing with an alcohol-based hand sanitiser (gels or rubs). Washing with soap and water is preferred but alcohol-based hand gels and rubs are suitable when hands are not visibly soiled. If hands are visibly soiled or have had direct contact with body fluids they should be:washed with soap and running water then dried thoroughly with disposable paper towel. See Appendix 10 for detailed information on hand hygiene. Online hand hygiene courses are available at National Hand Hygiene Initiative. Encourage staff, in particular healthcare staff to complete refresher training. Staff, inmates and visitors must have ready access to hand hygiene stations. These might be alcohol-based hand rub/gel or hand basins with liquid soap, water and paper towel. Make sure you adequately stock and maintain these. Where possible, have hand basins that are hands-free (for example, elbow operated). This facilitates hand hygiene practices and prevents re-contaminating hands when turning taps off. However, where hands free taps are not available, people can turn the taps of using paper towel used to dry hands. Ensure staff and inmates are aware of the proper hand hygiene technique and why it’s important. Encourage inmates and visitors to use good hand hygiene. This is very important to prevent transmission of infectious organisms. Inmates should receive instruction in hand hygiene and wash their hands:after toiletingcoughing, sneezing blowing their nosebefore and after eating when leaving their room. Remind visitors to perform hand hygiene when they enter and leave the facility.The use of gloves should never be considered an alternative to hand hygiene. Hand hygiene is required before putting on gloves and immediately after removing them.Personal protective equipment (PPE)Staff must wear appropriate PPE when caring for infected inmates requiring contact and droplet or airborne precautions. A gown, eye protection, mask and gloves may be required depending on the level of precautions required. PPE requirements for caring for patients with suspected or confirmed COVID-19 are outlined in Appendix 11 and in ICEG guidelines and are on the Department of Health website. Train correctional and detention facility health staff and ensure they are competent in the proper use of PPE. This includes donning and doffing procedures. New staff must complete training and all existing health staff, including non-clinical support staff should complete refresher training. Staff must remove PPE in a way that prevents contamination of the HCW’s clothing, hands and the environment. Staff should:immediately discard PPE into appropriate waste binsalways perform hand hygiene before putting on PPE and immediately after removing PPE. See Appendix 12 for useful educational and promotional material for the proper use of PPEFacility health staff must change their PPE and perform hand hygiene after every contact with a suspected or confirmed case of COVID-19 or when in contact with an ill inmate. PPE should not be worn when moving from one room to another.Respiratory etiquetteRespiratory etiquette aims to reduce the spread of virus via droplets produced during coughing and sneezing. Encourage inmates, staff and visitors to practice good respiratory etiquette. This includes:coughing or sneezing into the elbow or a tissue disposing of the tissue performing good hand hygiene. See Appendix 13 for useful educational and promotional material. Give specific advice to any inmate with ARI as a reminder.Transmission-based precautionsTransmission based precautions are infection prevention and control precautions used in addition to standard precautions to prevent the spread of conditions or infectious diseases that cannot be controlled by the use of standard precautions alone. These precautions target the mode of transmission including contact, droplets or airborne spread. COVID-19 is most commonly thought to be spread by contact (direct with a case or indirectly via contaminated surfaced) and infected droplets (e.g. those produced via coughs, sneezes etc). Airborne spread is less common but may occur e.g. during aerosol generating procedures or care of severely ill patients. Contact and Droplet precautions are the transmission based prevention precautions required when caring for inmates with potential or confirmed COVID-19. Contact and Airborne precautions, including the use of a P2/N95 mask which has been fit-checked, are required when conducting aerosol generating procedures. Transmission based precautions usually involve the use of items of PPE, additional cleaning recommendations and isolation of suspected or confirmed cases.See Appendix 14 for more information on transmission-based precautions when caring for inmates with suspected or confirmed COVID-19, the ICEG guidelines are available on the Department of Health website.Environmental cleaning and disinfectionRegular, scheduled cleaning of all inmate and staff areas is essential during any disease outbreak. Clean frequently touched surfaces those closest to the inmate, and those regularly touched by the hands of staff or inmates more often. Cleaning AND disinfection is recommended during COVID-19 outbreaks. Use either a 2-step clean (use detergent first, then an effective disinfectant) or 2-in-1 step clean (use a combined detergent/disinfectant product). Follow these principles: Clean inmate room/zone/bathroom/toilet every day Clean and disinfect frequently touched surfaces more often. These include:bedrailsbedside tableslight switchesremote controls, commodesdoorknobssinkssurfaces equipment close to inmates or staffwalking aideshandrails and table tops in facility communal areas guard station counter tops.Cleaners should: wear appropriate PPE, including impermeable disposable gloves and a surgical mask, gown or apron, eye protection or a face shield while cleaning. observe contact and droplet precautions.adhere to the cleaning product manufacturer’s recommended dilution instructions and contact time.use a Therapeutic Goods Administration (TGA) listed disinfectant with virucidal claims (kills viruses). A chlorine-based product such as sodium hypochlorite is suitable for disinfection. The manufacturer’s instructions for dilution should be followed.terminally clean the room when the ill inmate moves or is discharged.Minimise equipment and items in patient areas. Any reusable inmate care equipment should only be used for the individual inmate. If it must be shared, clean and disinfect between each inmate use.Wash and sanitise linen using hot water (>65 degrees Celsius for 10 minutes). Use a standard laundry detergent. Dry linen in a dryer on a hot setting. Standard operational procedures should be implemented for the safe laundering of used linen within the facility, which should then support that there is no need to separate the linen for use by ill inmates from the linen used by other inmates. Use appropriate safe work practices including the use PPE when handling soiled linen. Standard safe operating procedures including the use of PPE where applicable, applies for the use, cleaning and sanitising of crockery and cutlery in a hot dishwasher. If a dishwasher is not available, wash by hand using hot water and detergent. Rinse in hot water and dry. There is no need to separate the crockery and cutlery for use by ill inmates from that of other inmates.See the Australian Government Department of Health website for more information on environmental cleaning and disinfection. This is available in ICEG guidance. SignagePlace signs at the entrances and other strategic locations within the facility to inform visitors of the infection prevention control requirements. Ensure a droplet and contact precautions sign/s in appropriate language/s is placed outside symptomatic inmates’ rooms to alert staff to follow transmission-based precautions.Standardised signs are available to all facilities so health care workers, staff and patients are aware of the precautions to apply for:all patients (Standard Precautions) for those patients who require Transmission-based Precautions, due to COVID-19. You can find these resources are available at the Australian Commission for Safety and Quality in Health Care website: Visitors and communal activitiesDuring a COVID-19 outbreak, visitor access into and within the facility should be restricted.Facilities should:suspend all group unnecessary activities, particularly those that involve visitors.postpone visits from non-essential external providers (e.g. hairdressers and allied health professionals).ensure facility managers have notified all staff, inmates and visitors as relevant, that cases of COVID-19 have occurred in the setting.suspend visits when there is high community transmission of COVID-19ask regular visitors and families of inmates to only visit for essential reasons during the COVID-19 outbreak. Strongly discourage visits by young children as they are less able to comply with standard precautions and PPE requirements.limit visitors to one at a time.check all visitors for symptoms and record this and visitor details on a register. Instruct visitors to:wear PPE as directed by staffenter and leave the facility directly without spending time in communal areasperform good hand hygiene before entering and after visiting the inmate.consider installation of protective screens to reduce contact or ensure all visitors wear masks.5.3.7. Mental health and emotional and social wellbeingExtended periods of isolation can result in distress and deteriorating mental health. Facilities should ensure inmates continue to have access to their families and support networks through telephone and video contact. Facilities should ensure mental health and social support services are able to access and support inmates while in isolation or quarantine. Cultural support should be available for Aboriginal and Torres Strait Islander inmates.Management of staffOnly designated staff should care for patients with potential or confirmed COVID-19. During an outbreak of COVID-19, wherever possible, ensure health care workers and corrections staff do not move between wings or units of the facility to provide care for other inmates. This is particularly important if not all wings/units are affected by the outbreak. It is preferable to cohort staff to areas (in isolation or not in isolation) during the outbreak.During a confirmed COVID-19 outbreak staff should attend work only if they are asymptomatic and have not been identified as a contact or directed not to attend work. All staff members should self-monitor for signs and symptoms of COVID-19. If they are unwell, staff should not attend work, and should self-exclude, even if they have used appropriate PPE. See section 5.2 for further guidance about managing staff members who have suspected or confirmed COVID-19. Facility staff should not work at another facility until the outbreak is declared over. All staff working on site should participate in any whole-of-facility testing. Staff should be regularly screened for symptoms (and tested, if necessary) during an outbreak. Check staff for symptoms (including fever) at the beginning of every shift. Record staff testing details in a register. During an outbreak, facility managers must notify all relevant internal and external stakeholders that a case of COVID-19 has occurred in the facility. This includes staff, inmates (where applicable) and visitors (if relevant). Admissions and transfersNew admissionsCorrectional and detention facilities should take care when considering processes for new admissions during an outbreak. New inmates should be screened for recent travel and contact history. It may be appropriate for new inmates to undergo screening, including temperature and wellness checks. Facilities should consider past medical history and ask targeted questions to determine vulnerability to severe illness, should they develop COVID-19. An ongoing outbreak does not mean the facility has to go into complete “lock down”. It is preferable that new inmates are not admitted to an affected unit during an outbreak. If new admissions cannot be avoided, inform of the current outbreak. Adequate outbreak control measures must be in place for these new inmates. Re-admissions of confirmed casesThe re-admission of inmates who meet the definition of a potential or confirmed case and who have been hospitalised for their illness is permitted, provided appropriate accommodation and infection prevention and control requirements can be met. Inmates who have been transferred to hospital for any reason should be readmitted to the facility as soon as they are well enough to be discharged from hospital.Re-admission of non-casesInmates who have been in hospital who are not suspected or confirmed cases of COVID-19, should re-admitted to the facility, as soon as they are well-enough for discharge. This does require:adequate outbreak control measures to be in placesafe accommodation for inmates who are not?affected. If non-cases are re-admitted, the inmate must be informed about the current outbreak and adequate outbreak control measures must be in place.TransfersIf transfer to hospital is required, the ambulance service and receiving hospital must be notified of the outbreak/suspected outbreak verbally. You will also need to complete a transfer advice form (see Appendix 4).Inmates may be transferred with usual escorts and accompanying health care staff. All escorts should adhere to appropriate PPE requirements (on the advice of health care staff) during transfer. If transfer to another custodial facility is required, inmates should undergo COVID-19 screening including temperature and wellness checks prior to transfer. Any inmates pending transfer with ARI should be promptly investigated for a causative agent. While awaiting results the patient should be treated as a possible case and appropriate infection prevention and control measures including isolation and the use of PPE should be used, to prevent further spread of the disease within and across facilities.Unaffected inmatesIn exceptional circumstances, it may be feasible to transfer inmates who are not symptomatic to other correctional and detention facilities for the duration of the outbreak. You should advise the receiving facility that the inmate may have been exposed and is at risk of developing disease. Provide them with information on the symptoms of COVID-19 and how to use appropriate personal protective measures. If the inmates have had close contact with an unwell inmate, quarantine to a single room wherever possible as a precaution. Release from detentionRelease from detentionIf an inmate is released from detention the PHU should be notified and the following measures implemented/considered as required:If the inmate is a confirmed case, ensure they are transported safely to accommodation suitable for isolation and that ongoing care and monitoring are maintained.If the inmate is a close contact, ensure they are transported to accommodation suitable for quarantine for the length of time required. Ensure ongoing support and advice, including access to testing, if required.If the inmate is not a close contact, ensure they are advised to self-monitor for any symptoms and seek testing urgently if they occur. If a prisoner who is known to be COVID-19 positive is due for release, the relevant PHU should make an assessment on the adequacy of the likely place of isolation and the willingness and ability of the inmate to comply with isolation. Accommodation needs to be provided for inmates who are homeless for at least the duration of the isolation period. Aboriginal and Torres Strait Islander inmates in particular need to be sure that overcrowding and other factors will not compromise their ability to remain isolated. Monitoring Outbreak ProgressIncreased and active observation of all inmates for the signs and symptoms of COVID-19 is essential in outbreak management. This will enable identification of ongoing transmission and potential gaps in infection prevention and control measures. Facilities should have the capacity to monitor or count inmates and staff displaying signs and symptoms of COVID-19 every day. This will ensure swift infection prevention and control measures are implemented or strengthened. This is important to reduce transmission and the duration of the outbreak.Testing (including repeat testing) and ongoing actions for individuals in the defined setting should be undertaken in line with the CDNA National Guideline. This includes:isolating and treating individuals who test positive.quarantining, as best as possible, and monitoring for symptoms, those individuals who test negative.where feasible, commencing a program of repeat testing for those in quarantine.Update the information in the line list through daily meetings of the OMT, or more frequently if major changes occur. Provide the line list to the PHU each day (or as arranged) until the outbreak is declared over. The PHU will review updated information for:evidence of ongoing transmission effectiveness of control measures and prophylaxis. The PHU will discuss this with the correctional or detention facility OMT and advise of any required changes to current outbreak control measures. The OMT should also continue to engage with infection prevention and control practitioners. The OMT should review all control measures and consider seeking further advice from PHU if:the outbreak comprises more cases than can be managed by the facility.the rate of new cases is not decreasing.three (3) or more inmates are hospitalised related to COVID-19, ORCOVID-19-related death has occurred. Telephone to notify the PHU of this.Specialised advice is available from:local state, territory or regional PHU.infection prevention and control practitioners in local hospitals, state and territory health departments, or private consultants.infectious disease physicians, who may be approached for specialist management of complex infections.Declaring the Outbreak OverThe time from the onset of symptoms of the last case until the outbreak is declared over can vary. Repeat PCR testing of the quarantined cohort allows for close observation of the outbreak. It will also help to determine when it can be declared over. In most circumstances a COVID-19 outbreak can be declared over if no new cases occur within 14 days (maximum incubation period) following the date of isolation of the last case. A decision to declare the outbreak over should be made by the OMT, in consultation with the PHU. The PHU may recommend a longer period before declaring the outbreak over. Once the outbreak is over, provide cluster reports to relevant stakeholders and ensure that data are appropriately summarised. The OMT may make decisions about ongoing facility surveillance after declaring the outbreak over, considering the following needs:Maintain general infection prevention and control measures.Monitor the status of ill inmates and communicate with the public health authority if their status changes.Notify any late, COVID-19-related deaths to the PHU.Alert the PHU to any new cases, signalling either re-introduction of infection or previously undetected ongoing transmission.Advise relevant state/territory/national agencies of the outbreak in a correctional or detention facility, if applicable.Reviewing Outbreak ManagementAfter a declaration that an outbreak is over, it is important that all parties reflect on: what worked well during the outbreak which policies, practices or procedures need to be modified to improve responses for future outbreaks. The OMT should consult with the local PHU to consider a debrief for any outbreak. A debrief provides the opportunity to: identify strengths and weaknesses in outbreak response and investigation processesprovide information to help improve the management of future outbreaks involve all members of the OMT and any others who participated in the response to the outbreak.Audits are commonly used in clinical practice as part of continuous quality improvement. They can be useful for healthcare workers to review how the outbreak was managed. Australian public health practitioners and researchers have developed an outbreak audit process, with: a framework for deciding which outbreak investigations to audit, an approach for conducting a successful audit, a template for trigger questions. This tool enables agencies like health care centres within correctional and detention facilities to assess their outbreak response against best practice. You can find the tool at for COVID-19 Management in Correctional and Detention Facilities in Australia00Flowchart for COVID-19 Management in Correctional and Detention Facilities in Australialeft5530190Appendix 1. Flow Chart for COVID-19 Management in Correctional and Detention Facilities center160866This guideline is for correctional and detention facilities in Australia to use. It has been adapted from Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units. : the case definition may change over time PREPARE FOR COVID-19 Plan for casesDevelop a facility management planEnsure all staff are aware of this plan. Ensure a functioning ILI Surveillance system. ILI surveillance ACTION / INFORMATIONTASKVaccinate all inmates and staff against influenza Ensure all staff and inmates are aware of the importance of annual influenza vaccination.Provide free influenza vaccination for all staff on site.Encourage healthcare staff to vaccinate inmates against influenza.Create a list of staff and inmates by influenza vaccination status; ensure it is kept updated and accessible.Infection prevention and control preparednessProvide annual infection prevention and control training to all healthcare staff and key correctional staff that includes information about COVID-19Ensure personal protective equipment (PPE), hand washing facilities and alcohol based hand rubs are available near point of care.Ensure educational materials are available for inmates.Ensure adequate environmental cleaning, laundering and waste disposal processed are in place.Encourage frequent and appropriate hand hygiene at all times (5 Moments).Ensure infection prevention and control signage is available for use.Consider how case isolation will be managed.Develop contingency staffing plans in event of staff illness and isolation.Ensure stocked hygiene stations are at each visitor entranceAssess inmates for signs & symptoms of COVID-19Risk Assessment for COVID-19:Healthcare staff and facility management should keep up to date with the latest guidelines on who should be tested for COVID-19: Correctional and detention staff should be aware that they are working in a high risk environment. They should not attend work if they feel unwell. This will protect themselves and others.Healthcare staff should be vigilant in monitoring for COVID-19. They should strongly encourage good hygiene for both inmates and staff.Identify signs/symptoms of COVID-19:CLINICAL CRITERIA Fever (≥37.5°C) or history of fever OR acute respiratory infection (e.g. shortness of breath or cough) OR loss of smell or loss of taste. The treating clinician may consider investigating inmates or staff with atypical signs and symptoms of COVID-19.RISK ASSESSMENT FOR COVID-1900This guideline is for correctional and detention facilities in Australia to use. It has been adapted from Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units. : the case definition may change over time PREPARE FOR COVID-19 Plan for casesDevelop a facility management planEnsure all staff are aware of this plan. Ensure a functioning ILI Surveillance system. ILI surveillance ACTION / INFORMATIONTASKVaccinate all inmates and staff against influenza Ensure all staff and inmates are aware of the importance of annual influenza vaccination.Provide free influenza vaccination for all staff on site.Encourage healthcare staff to vaccinate inmates against influenza.Create a list of staff and inmates by influenza vaccination status; ensure it is kept updated and accessible.Infection prevention and control preparednessProvide annual infection prevention and control training to all healthcare staff and key correctional staff that includes information about COVID-19Ensure personal protective equipment (PPE), hand washing facilities and alcohol based hand rubs are available near point of care.Ensure educational materials are available for inmates.Ensure adequate environmental cleaning, laundering and waste disposal processed are in place.Encourage frequent and appropriate hand hygiene at all times (5 Moments).Ensure infection prevention and control signage is available for use.Consider how case isolation will be managed.Develop contingency staffing plans in event of staff illness and isolation.Ensure stocked hygiene stations are at each visitor entranceAssess inmates for signs & symptoms of COVID-19Risk Assessment for COVID-19:Healthcare staff and facility management should keep up to date with the latest guidelines on who should be tested for COVID-19: Correctional and detention staff should be aware that they are working in a high risk environment. They should not attend work if they feel unwell. This will protect themselves and others.Healthcare staff should be vigilant in monitoring for COVID-19. They should strongly encourage good hygiene for both inmates and staff.Identify signs/symptoms of COVID-19:CLINICAL CRITERIA Fever (≥37.5°C) or history of fever OR acute respiratory infection (e.g. shortness of breath or cough) OR loss of smell or loss of taste. The treating clinician may consider investigating inmates or staff with atypical signs and symptoms of COVID-19.RISK ASSESSMENT FOR COVID-19Implement additional infection prevention and control measures immediatelyThe treating doctor should review each inmate with suspected COVID-19 Obtain laboratory request forms for respiratory viral testing INCLUDING CORONAVIRUS.Collect the appropriate respiratory sample. Use a single viral transport collection swab for each person.Observe droplet precautions when collecting specimens i.e. gown, gloves, fluid resistant surgical mask and eye protection (goggles). Wash hands before and after collection.MANAGE A POTETIAL OR CONFIRMED CASE OF COVID-19Collect specimensWhen caring for inmates with a COVID-19-like illness, follow droplet precautions including gown, gloves, eye protection (goggles) and a fluid resistant surgical mask. Maintain a 1.5 metre distance between an infected person and others.Isolate inmates with COVID-like illness, if feasible. (Single room with bathroom facilities)Staff and visitors with a COVID-like illness must stay away from the facility until well. They should seek medical rm all visitors of cough etiquette and hand hygiene.Immunise inmates and staff who have not been immunised with the current influenza vaccine as soon as possible.Ensure appropriate management of casesSymptomatic and supportive treatment under the guidance of the GPUse of antiviral medication is a clinical decision made by the GPTransfer to hospital as indicated. Confirm outbreakA single confirmed or probable case of COVID-19 in an inmate or staff member of a correctional or detention facility.MANAGE A SUSPECTED OUTBREAK OF COVID-19Document and monitor outbreak dailyInform the PHU and set up an outbreak response team with the PHUNominate an outbreak coordinator and management team at the facility.Create a detailed list of inmates and staff with COVID-like illness including location, influenza vaccination status, onset date, symptoms, specimens taken and results, treatment and outcome. Update the list and forward to PHU rmInform the relevant state or territory Public Health Unit. Contact again if death or hospitalisation of inmate or staff rm GPs, facility staff, inmates and regular visitors.End outbreakNo new cases for 14 days from isolation of the last case.Send final detailed list to the relevant state or territory Public Health Unit Review and evaluate outbreak management.Implement additional infection prevention and control measures immediatelyThe treating doctor should review each inmate with suspected COVID-19 Obtain laboratory request forms for respiratory viral testing INCLUDING CORONAVIRUS.Collect the appropriate respiratory sample. Use a single viral transport collection swab for each person.Observe droplet precautions when collecting specimens i.e. gown, gloves, fluid resistant surgical mask and eye protection (goggles). Wash hands before and after collection.MANAGE A POTETIAL OR CONFIRMED CASE OF COVID-19Collect specimensWhen caring for inmates with a COVID-19-like illness, follow droplet precautions including gown, gloves, eye protection (goggles) and a fluid resistant surgical mask. Maintain a 1.5 metre distance between an infected person and others.Isolate inmates with COVID-like illness, if feasible. (Single room with bathroom facilities)Staff and visitors with a COVID-like illness must stay away from the facility until well. They should seek medical rm all visitors of cough etiquette and hand hygiene.Immunise inmates and staff who have not been immunised with the current influenza vaccine as soon as possible.Ensure appropriate management of casesSymptomatic and supportive treatment under the guidance of the GPUse of antiviral medication is a clinical decision made by the GPTransfer to hospital as indicated. Confirm outbreakA single confirmed or probable case of COVID-19 in an inmate or staff member of a correctional or detention facility.MANAGE A SUSPECTED OUTBREAK OF COVID-19Document and monitor outbreak dailyInform the PHU and set up an outbreak response team with the PHUNominate an outbreak coordinator and management team at the facility.Create a detailed list of inmates and staff with COVID-like illness including location, influenza vaccination status, onset date, symptoms, specimens taken and results, treatment and outcome. Update the list and forward to PHU rmInform the relevant state or territory Public Health Unit. Contact again if death or hospitalisation of inmate or staff rm GPs, facility staff, inmates and regular visitors.End outbreakNo new cases for 14 days from isolation of the last case.Send final detailed list to the relevant state or territory Public Health Unit Review and evaluate outbreak management.Appendix 2. COVID-19 Outbreak Preparedness ChecklistPlanning actionsDoes your facility have a respiratory outbreak plan that covers all the areas identified below? Has your facility updated its respiratory outbreak plan this year?Were relevant health care providers/organisations in the community (e.g. associated GPs, visiting consultants) involved in the planning process?Are all facility staff aware of the plan and their roles and responsibilities?Staff, inmate and family educationHave your facility staff completed education and training in all aspects of outbreak identification and management, in particular competency in infection prevention control?Has your facility run one or more staff education sessions?Has your facility provided inmates with information about preventing of transmission?Staffing actionsDoes your facility have a staffing contingency plan in case 20% to 30% of staff fall ill and are excluded for 14 days?Has your facility developed a plan for cohorting staff in an outbreak?Stock levelsDoes your facility have an adequate stock of PPE, hand hygiene products, nose and throat swabs and cleaning supplies?Outbreak recognition actionsDoes your facility routinely assess inmates and staff for respiratory illness, in particular for fever or cough (with or without fever)?Does your facility encourage staff to report COVID-19 symptoms during the pandemic?Does your facility have a process to notify the facility manager and the state/territory Department of Health and Human Services as soon as practicable (and within 24 hours) of a suspected COVID-19 case?Communication actionsDoes your facility have a contact list for the state/territory health department and other relevant stake holders (e.g. facility doctors and infection prevention and control consultants)?Does your facility have a plan for communicating with staff, inmates, and family members during an outbreak?Does your facility have a plan to restrict unwell visitors entering the facility and limiting well visitors during an outbreak? This is important to reduce risk of transmission within the facility and externally (This should include. security, signage and, restricted processes)?CleaningDoes the plan identify who is responsible for overseeing increased frequency of cleaning, liaison with contractors or hiring extra cleaners as necessary?Appendix 3. Letter to Visitors – Preventing Spread of COVID-19 FILLIN \* MERGEFORMAT [Facility Letterhead]……/……/……Dear visitorThere is local transmission of Coronavirus Disease 2019 (COVID-19) in the community. COVID-19 causes respiratory illness ranging from cold-like symptoms to severe pneumonia. Correctional and detention facilities are particularly susceptible to COVID-19 outbreaks. This is because of the close living space where it can be difficult to practise physical distancing.COVID-19 PandemicCOVID-19 has caused outbreaks of illness in the Australian community, and local transmission has occurred in some communities. Even when facilities actively try to prevent outbreaks occurring, many external visitors may lead to inmates or staff contracting COVID-19, which can result in outbreaks.Families play an important role in protecting their relatives from community viruses. Practical steps you can take to prevent COVID-19 from entering correctional and detention facilities, as outlined below. Avoid spreading illnessesWashi your hands well with liquid soap and water or alcohol-based hand rub before and after visiting and after coughing or sneezing. This helps to reduce the spread of disease. Cover your mouth with a tissue or your elbow (not your bare hand) when coughing or sneezing. Dispose of used tissues immediately and then wash your hands again. Follow any restrictions the correctional or detention facility has put in place Facilities will put up signs at entrances to inform you if an outbreak is occurring. Look out for these warning signs when entering the facility. It is important to follow the infection prevention and 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. 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 correctional or detention facility, you may be asked to reduce your visit time and keep vulnerable visitors away from the facility. In particular, it is recommended that young children not visit during this time as they are typically unable to comply with appropriate hygiene requirements. Thank you for your assistance in adhering to these steps. These measures will greatly assist our facility and protect the health of your family member/s in the event of a COVID-19 outbreak. Should you require further information regarding COVID-19, please refer to the Commonwealth Department of Health website: Yours sincerely, FILLIN \* MERGEFORMAT [Name] FILLIN \* MERGEFORMAT [Position] FILLIN \* MERGEFORMAT [Facility/Organisation]Appendix 4. Swab Collection ProcedureSwab Collection ProceduresPublic Health Laboratory Network (PHLN) guidance on the collection of upper respiratory specimens is available on the Department of Health website.Detailed PHLN guidance on laboratory testing for SARS-CoV-2 (the virus that causes COVID-19) is available on the Department of Health website. Before performing swabIMPORTANT NOTES:Contact your laboratory provider for current local advice about swabs.Do not use bacterial swabs for specimen collection. If in doubt, check!To conserve swabs, the same swab that has been used to sample the oropharynx should be utilised for nasopharynx/deep nasal sampling.Obtain required materials:Personal protective equipment (PPE) for the health care worker taking the swab. This should include gloves, eye protection (goggles or face shield), surgical mask, and gown, if necessary.One dry, sterile, flocked swab.One viral culture swab with viral culture medium.Tongue depressor.Performing the swabsFor information about performing swabs, see the Department of Health website.IMPORTANT NOTES: Choose an area for the procedure where the patient can rest their head against a wall or use a high-backed chair with room for you to stand beside (not in front of) the patient.Ensure the area is lit well, with hand washing and infectious waste disposal facilities.Remember to WASH AND DRY HANDS before and after the procedure!You MUST wear gloves, surgical mask, gown and eye protection when collecting nose and throat swabs. Do a risk assessment to see if you need to wear a gown or apron. Do NOT touch a mask while you’re wearing it. Do NOT wear a mask around your neck at any time. When removed, handle the mask only by the ties. The person donning and doffing PPE must be trained and competent in the use of PPE.Preparation:Perform hand hygiene.Don PPE in the order of gown, surgical mask, eye protection, and gloves.Explain the procedure to the patient and obtain consent.Place patient standing or sitting with head tilted at 700, supported against a bed, chair or wall.3. After performing the swabLabelling and storage of specimen:Label the tube or bottle containing the swabs with the patient’s full name, date of birth, specimen type and date of collection. The accompanying request form should include the facility name.Safely remove PPE (remove gloves, perform hand hygiene, remove gown, perform hand hygiene, remove eyewear/goggles, perform hand hygiene, remove mask, perform hand hygiene).Send specimens on the day of collection. Refrigerate the specimen until it is sent to the laboratory (do NOT freeze the specimen). Package specimens in a small insulated bag/box (with ice bricks) for transport to the pathology laboratory.IMPORTANT NOTE: Dispose of gloves, gowns and masks in an infectious (biohazard) waste bag.Appendix 5. Initial facility report to a PHU – COVID-19 OutbreakDate/time: ___________________ Public Health Officer:_____________________ Contact details: Person notifying outbreak: _______________ Position: ______________________ Telephone number: ____________________ Email: _________________________ Facility details: Name of Facility_______________________________________________________Address: _____________________________________________________________ Facility Manager / Director: ______________________________________________ Telephone number: _____________________ Fax number: ____________________ Email address: _________________________ Description of facility: __________________________________________________ Total number of inmates: _______________ Total number of staff: ____________ Total number of inmates who identify as Aboriginal and Torres Strait Islander: ___________Age range of inmates: ___________________ Number of units / wings / areas in facility: __________________________________ Floorplan provided: Yes / No Inmates: Unit nameInmate no.Additional detailsStaff:Staff typeNo. of staffNo. casual staffManagementAdministratorGuardHealthcare staffOther (specify)Appendix 6. Letter to visiting health staff– COVID-19 Outbreak FILLIN \* MERGEFORMAT [Facility Letterhead]……/……/……Respiratory outbreak at FILLIN \* MERGEFORMAT [Facility Name]Dear Doctor,There is an outbreak of acute respiratory illness affecting inmates at the facility named above. The outbreak may involve some of the patients your regularly see, who may require review. It is important to establish if the outbreak is caused by SARS-CoV-2. Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, is a notifiable condition. We recommend that you:review regular patients for symptomshelp determine if the outbreak is caused by SARS-CoV-2: obtain/order appropriate respiratory samples from inmates 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 institutional respiratory illness outbreaks. Control measures that the facility has been directed to implement include: isolate symptomatic inmatesuse appropriate PPE when providing care to ill inmatesexclude symptomatic staff from the facilityrestrict/limit visitors to the facility until the outbreak has resolvedpromote good hand hygiene and cough and sneeze etiquette.More information regarding COVID-19, is available on the Commonwealth Department of Health website: you require any further information or advice please contact [insert details].. Yours sincerely, FILLIN \* MERGEFORMAT [Name] FILLIN \* MERGEFORMAT [Position] FILLIN \* MERGEFORMAT [Facility/Organisation]Appendix 7. Transfer Advice Form FILLIN \* MERGEFORMAT [Facility Letterhead]Date:……/……/……To: FILLIN "[Admitting Officer, Facility Name]" \* MERGEFORMAT FILLIN "[Admitting Officer, Facility Name]" \* MERGEFORMAT [Admitting Officer, Facility Name]Please be advised that: FILLIN \* MERGEFORMAT [Inmate Name] is being transferred from a facility where there is a cluster/outbreak of COVID-19. At this stage the outbreak is: suspected confirmed Please ensure that appropriate infection prevention and control precautions are followed with this inmate.At the time of transfer: does not have an acute respiratory illness has an acute respiratory illness is a suspected case of COVID-19 is confirmed case of COVID-19 is believed to have had close contact with a confirmed case of COVID-19Inmate details: ______________________________________________ Given name SurnameDate of birth:Name of originating facility:Name of contact person:Phone number:Appendix 8. COVID-19 Outbreak Management ChecklistIdentifyUse the guideline to identify if your facility has an outbreak Screen staff for symptoms at the start of each shiftImplement infection prevention and control measures Isolate / cohort ill inmatesImplement contact and droplet precautions Provide PPE outside room Display sign outside room Exclude 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) Collect respiratory specimens Collect appropriate respiratory specimens from ill inmates or staff, or from asymptomatic inmates who are quarantined if undertaking repeat testing If it is likely that the case acquired infection in the facility, test all members of the facility Notify The state/territory Department of Health and Human Services Contact the GPs/treating doctors of ill inmates for reviewProvide the outbreak letter to all inmates’ healthcare staffInform staff and regular visitors/families of outbreakRestrict Restrict staff from moving between different areas of the facility (e.g. to ensure staff caring for patients who are isolated are kept separate from patients who are quarantined)Avoid inmate transfers if possible Restrict ill visitors where practicalCancel non-essential group activities during the outbreak period MonitorMonitor outbreak progress through increased observation of inmates for fever and/or acute respiratory illness. Conduct repeat testing, where feasibleUpdate the facility case list daily and provide to the public health unit dailyAdd positive and negative test results to case listDeclare If a repeat testing strategy has been employed, in most circumstances the outbreak can be declared over when there are no new cases 14 days from the date of isolation of the most recent case. Review Review and evaluate outbreak management – amend outbreak management plan if needed Appendix 9. Forming a local facility based an Outbreak Management Team (OMT) The outbreak management team (OMT covers) several critical functions. Some people may perform more than one role. The OMT should initially meet within hours of a case being identified and then daily to:direct and oversee management of the outbreakmonitor the outbreak progress and initiate changes in response, as requiredliaise with GPs and the state/territory Department of Health, as arranged.The OMT should include the following roles and functions: RoleFunctionChairperson (facility Director, Manager or Senior Medical OfficerThe chairperson is responsible for co-ordinating outbreak control meetings, setting meeting times, agenda and delegating tasks.SecretaryThe secretary organises OMT meetings, notifies team members of any changes, and records and distributes minutes of meetings.Outbreak Coordinator (Nurse, Infection Prevention and Control Practitioner or Doctor)The coordinator ensures that all infection prevention and control decisions of the OMT are carried out, and coordinates activities required to contain and investigate the outbreak. This role is often given to an Infection Prevention and Control Practitioner (ICP) or delegate.Media Spokesperson (facility Director, Manager, Nursing Manager or Senior Medical Officer)Significant media interest in outbreaks in correctional and detention facilities is common, especially if there are adverse outcomes. The department can assist facilities to manage media interest arise. It is recommended that facilities liaise with the department prior to making media statements.Visiting General PractitionersSome GPs may be available to participate in the OMT. Their role should be identified during the planning process. It is valuable to identify a clinical lead amongst those GPs who attend a facility. In an outbreak, this person is important to facilitate assessment and management of ill inmates, and to work with the correctional and detention facilities and the department to implement control strategies.Public Health OfficersAn understanding of what assistance can be provided by PHUs and their role/responsibility should be confirmed at the initial OMT meeting. It is usually not necessary for PHUs to be part of the OMT.Appendix 10. 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 11. Personal Protective Equipment Recommendations Standard precautions apply to the care of all patients at all timesTransmission base precautions are required in addition to standard precautions when standard precautions alone are insufficient. Personal Protective Equipment Requirements by level of precautionPersonal Protective EquipmentPrecautionContactDropletAirborneGloves YesYesYesGown/Apron (impermeable)Yes Yes Yes Surgical MaskWhen in close contact (less than 1.5m)YesNo – see below P2/N95 RespiratorNo No YesEye protection Protective eye wear/ Goggles/face shieldYes Yes Yes See Australian Commission on Safety and Quality in Health Care (ACSQHC) Personal Protective Equipment (PPE) advice available at 12. Proper Use of Personal Protective Equipment (PPE)Source: Special precautions for COVID-19 designated zones, Australian Commission on Safety and Quality in Health Care.Appendix 13. Respiratory EtiquetteCough and Sneeze EtiquetteWhen coughing or sneezing, use a tissue to cover your nose and mouthDispose of the tissue afterwardsIf you don’t have a tissue,cough or sneeze into your elbowAfter coughing, sneezing or blowing your nose, wash your hands with soap and waterUse an alcohol-based hand cleanser if you do not have access to soap and waterRemember: Hand hygiene is the single most effective way to reduce the spread of germs that cause respiratory disease!Anyone with signs and symptoms of respiratory infection:should be instructed to cover their nose/mouth when coughing or sneezing;use tissues to contain respiratory secretions;dispose of tissues in the nearest waste receptacle after use; andwash or cleanse their hands afterwards.When coughing or sneezing, use a tissue to cover your nose and mouthDispose of the tissue afterwardsIf you don’t have a tissue,cough or sneeze into your elbowAfter coughing, sneezing or blowing your nose, wash your hands with soap and waterUse an alcohol-based hand cleanser if you do not have access to soap and waterRemember: Hand hygiene is the single most effective way to reduce the spread of germs that cause respiratory disease!Anyone with signs and symptoms of respiratory infection:should be instructed to cover their nose/mouth when coughing or sneezing;use tissues to contain respiratory secretions;dispose of tissues in the nearest waste receptacle after use; andwash or cleanse their hands afterwards.Appendix 14. Transmission-Based PrecautionsTransmission-Based PrecautionsInfection Prevention and Control MeasureRoute of transmissionContactDropletAirborneGloves Yes YesYes As per Standard precautionsGownYes contact with the person/patient or their environment eg when clothing is in substantial contact with the inmate, items in contact with the inmate, and their immediate environmentYes As per Standard precautionsYes As per Standard precautionsSurgical MaskYes As per Standard precautionsYesNo P2/N95 RespiratorNot requiredNot requiredYesGoggles/face shieldYesYes Yes YesSingle room with own ensuite/bathroom facilitiesNOTE: Door should be closedYesOR Cohort based on laboratory confirmation of COVID-19 YesOR Cohort based on laboratory confirmation of COVID-19 No single room with negative pressureSpecial handling of equipmentSingle use or if reusable, reprocess according to IFU before reuse.Avoid contaminating environmental surfaces and equipment with used gloves.Standard Precautions Avoid contaminating environmental surfaces and equipment with used gloves.Standard Precautions Avoid contaminating environmental surfaces and equipment with used gloves.Transport of inmatesSurgical mask if coughing/sneezing and other signs and symptoms COVID-19.Notify the facility receiving inmates.Advise transport staff of level of precautions to be maintained. Surgical mask if coughing/sneezing and other signs and symptoms COVID-19.Notify the facility receiving inmate.Advise transport staff of level of precautions to be maintained. Patients on oxygen therapy must be changed to nasal prongs and have a surgical mask over the top of the nasal prongs for transport (if medical condition allows).Surgical mask if coughing/sneezing and other signs and symptoms COVID-19.Notify the facility receiving inmate.Advise transport staff of level of precautions to be maintained. Patients on oxygen therapy must be changed to nasal prongs and have a surgical mask over the top of the nasal prongs for transport (if medical condition allows).AlertsRemove gloves and gown/apron and perform hand hygiene on leaving the room.Patient Medical Records must not be taken into the room.Signage of room.Visitors to patient room must also wear surgical mask and perform hand hygiene.Patient Medical Records must not be taken into the room. Signage of room.Visitors to patient room must also wear P2/N95 mask and perform hand hygiene.Patient Medical Records must not be taken into the room. Signage of room.Room cleaningStandard cleaning protocol.Cleaning and Disinfection - Consult with infection prevention and control professional.Cleaning and Disinfection - Consult with infection prevention and control professional. ................
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