Infection control in aged care

In recent times we have increased protections for older Australians in aged care, with the Infection Prevention and Control (IPC) leads in aged-care homes, high-rate vaccinations for residents and mandatory immunisation for staff.

The Australian Institute of Health and Welfare has reported on the direct and indirect health effects of the pandemic across the country, covering the 12 months since April 2020.

People living in residential aged-care facilities made up 75% of Australian deaths from COVID-19, despite only making up 7% of the total cases. Until the beginning of December, there were 671 older people who died from COVID-19 in aged-care homes and they were at least 24% in the 85- to 89-year age group and 34% in those aged 90 and over.

As COVID-19 infections played out across our communities in 2020, we all learnt it was nothing like a gastro or influenza outbreak.

Sadly, there were deaths in Dorothy Henderson Lodge and Newmarch House in Sydney and when COVID-19 appeared in homes in Melbourne, it hit with speed across multiples of homes across a very short period. All at a time when personal protective equipment (PPE) was unavailable or highly priced.

People in general — aged-care teams, governments and sector specialists — were all still learning how this virus was spreading; we were building the plane as it was taking off.

Should we wear masks, should case zero be sent to a hospital or remain in a specific area of a non-purpose built nursing home?

When facilities notified public health authorities of a positive case, some waited four days for testing of staff and residents.

Now we have more understanding of the virus, enhanced Outbreak Management Plans based on lessons learned, trained IPC leads and trained teams of aged-care staff and the use of rapid antigen testing (RAT) in some settings.

We also understand the importance of donning and doffing PPE safely, plus the other controls of new respiratory etiquette, wearing face masks, physical distancing and improving hand hygiene.

Some aged-care providers have sourced their own teams to assist with polymerase chain reaction or RAT testing and now conduct their own contact tracing.

At the end of 2020, the Royal Commission released a special report on COVID-19, calling for an ‘infection control champion’ in every aged-care facility in Australia.

The federal government accepted the recommendation and provided funding of $217.6 million to residential aged-care providers and required all sites to engage an infection prevention control (IPC) lead. Depending on the individual, the focus on online coursework was also challenging. The course was designed to be completed in 80 hours and the targeted IPC training included delivery in a face-to-face format.

Training delivery is sensitive to the aged-care setting, the workforce composition, language proficiency, background education, demographics and flexible to be replicated in rural and regional locations.

The older age groups were among the most vulnerable during the pandemic and that remains the case, although the vaccinations will have given them added protection.

While older Australians remain among those most vulnerable to COVID-19, a number of things are different now, when compared to the first nine months of the pandemic in 2020.

A majority of older Australians in residential aged care are now fully vaccinated and residential aged-care providers have adequate supplies of PPE and hand sanitiser, and have strict hygiene and infection control protocols.

With the Visitor Access Code in place, the providers and federal, state and territory health departments are better prepared.

They have improved communications with the sector, with residents, staff and families and with each other.

These changes mean that our vulnerable older people are better protected, safer and keep infections down in residential care.

In the eight weeks since the Prime Minister announced that vaccination would become mandatory for all residential aged-care workers there has been a concerted effort by providers and workers to respond.

In the aged-care sector we know better than most that COVID-19 can be devastating and have been calling for vaccination of our workforce to be a first priority.

Around 97% of aged care workforce has now received at least a first dose, with providers continuing to update latest numbers into the government’s reporting portal. With vaccines becoming more readily available to frontline residential aged-care workers, this number is expected to reach 100% soon.

However, for a small number of staff there are valid reasons why they can’t be vaccinated — due to medical reasons or because they haven’t been able to gain access to a vaccine in the time available.

In some cases, under the state and territory public health orders temporary exemptions will be in place to ensure there is continuity of care, quality and safety for both the residents and the staff caring from them.

We are actively monitoring progress to achieve vaccination and working in collaboration with government to ensure all the supports that are required to providers are given so that they achieve the vaccination target and maintain the care and safety of those in their care.

At the end of the day protecting older Australians and those who care for them is our number one priority and we are #ProudtoProtect them.

We would expect that with these measures in place and armed with what we have learned from the outbreaks in aged care in Sydney and Melbourne, older Australians in care are better protected in 2021 than in 2020.

It is important to remember that many hundreds of aged-care homes remained — and continue to remain — COVID-free.

The presence of well-rehearsed COVID plans by aged-care providers means that any COVID infections of residents or staff are quickly contained and do not spread through the home.

Image credit: ©stock.adobe.com/au/triocean