Public health guidance for acute respiratory illnesses in other disability care settings

Influenza and COVID-19 cases in clients

Support the client to stay at home. Usual care and support that would usually be provided in the home can continue, with appropriate use of PPE and infection prevention and control precautions (see detail below in step 3) taken by staff providing care during the period the client is required to isolate / recommended to stay at home.

• COVID-19 cases should stay at home and minimise their contact with others until their COVID-19 symptoms have gone or they are feeling much better
• Influenza cases should stay at home and minimise their contact with others for:
  • 5 days from symptom onset, or until their symptoms have significantly improved, whichever is longer
  or
  
  • 72 hours after antiviral medication is commenced.
• Clients with other ARIs should stay at home until their symptoms have significantly improved.

Influenza, COVID-19 and ARIs in carers/workers and visitors

Carers/workers and visitors who have new respiratory symptoms should not attend the setting while unwell.

Staff and visitors who test positive for COVID-19 should follow ACT Health advice for people who test positive for COVID-19.

Disability service providers should advise carer/workers and visitors that this result can be registered directly with ACT Health.

Generally, if a person tests positive with a RAT they will be considered a COVID-19 case and do not need to have a PCR test to confirm the result. However, a confirmatory PCR may be recommended in certain situations.

Workers who test positive as part of a workplace RAT screening program should follow the protocols developed by their workplace that support them to isolate and, if indicated, obtain a confirmatory PCR test.

Return to work following a COVID-19 infection

A person with COVID-19 should not enter a high risk setting or provide in-home disability or aged care services for at least 7 days after their positive test, unless attending for urgent medical care, or for an essential reason where prior approval has been granted by the facility or employer. This applies to staff who work in high-risk settings and who provide in-home disability or aged care services.

Contact identification

Following an exposure from someone with an ARI, disability service providers should undertake a risk assessment to determine if any staff or clients have been exposed.

A management plan should then be implemented based on the exposure risk.

This plan should include details of the relevant precautions to minimise risk to the clients, staff and visitors (see Step 3).

Contact management of people exposed to influenza

• clients, staff and visitors who attended at the same time as an influenza case should be aware to monitor closely for ARI symptoms and be tested for COVID-19 and influenza if symptoms develop
• asymptomatic clients, staff and visitors who attended at the same time as an influenza case do not need to undergo influenza or respiratory panel testing

Contact management of people exposed to COVID-19

Where there have been cases of COVID-19 among clients, staff and visitors who have attended during their infectious period, Disability Service Providers should identify those who may have been exposed (contacts):

• determine the infectious period. For COVID-19, the infectious period starts two (2) days before the person with COVID-19 developed COVID-19 symptoms or had their positive COVID-19 test taken, whichever came first
• identify people who have been exposed to the case
• assess the risk to staff and clients using the Risk assessment guidance.

Example risk assessments for staff:

• if the staff member provided close personal care to clients during their infectious period, and wasn’t wearing a mask, and the clients weren't wearing a mask, these clients are higher risk contacts
• if the staff member came to the service to assist for a short period of time, was wearing a mask and eye protection and spent a total of 10 minutes with each client who were not wearing masks, these clients are lower risk contacts

Example risk assessment for a client:

• for clients who attended a day program that involved indoor exercise without masks for less than 30 minutes, at the same time as the infectious person with COVID-19, they would be assessed as a lower risk contact

For contacts, the last date of exposure is considered day zero.

All advice about testing, quarantine and return to work is calculated from this date.

For example: Jane has COVID-19. Her symptoms started in the morning on the 3 January and she got tested later that day. Her infectious period starts on 1 January. She worked while infectious on 1, 2 and 3 January. Bob only worked with Jane on 1 January so that will be his last date of exposure (day zero). Eric worked with Jane on 1 and 2 January, so his last date of exposure will be 2 January. Laura worked with Jane on 30 December. As this is outside Jane’s infectious period, Laura has not been exposed and does not need to be identified as a contact.

• notify contacts and advise staff on next actions
  • if there is a positive COVID case who has attended the service, you should notify any clients, staff and visitors who have been identified as contacts (those with a potential exposure) and direct them to follow the relevant advice for people exposed to COVID-19 noting that there is specific guidance for staff members who have been identified as higher risk contacts from a workplace exposure in a community healthcare site, available here
  • when notifying clients, staff and visitors of their contact status, you should advise them of their last date of exposure
    • this is the last date that they had contact with the person with COVID-19 during their infectious period
    • be mindful of not compromising the privacy of the person with COVID-19 when providing this information. For contacts, the last date of exposure is considered day zero
    • all advice about testing, risk mitigation measures and return to work is calculated from this date
  • if a person who is identified as a contact has recently recovered from COVID-19, they should follow the advice in their clearance letter / SMS text.
  • guidance is also available on the ACT COVID-19 web information for recovered cases
    • this includes information about whether they are required to quarantine as a contact and whether they should undertake any testing
  • return to work advice for staff, including risk mitigation measures that staff should follow, is available from the Staff return to work guidance. This matrix is updated regularly, so always refer to the online version.

Clients who are household contacts

Clients who live with someone with COVID-19 should follow the advice for household contacts.

Carers, workers and care providers will need to consider PPE and risk mitigation requirements and general advice when providing care to clients who are identified as higher risk contacts.

^*Do not wear a disposable gown while cooking or working near a heater, as gowns are highly flammable. Maintain physical distancing from others when near a heat source and not wearing a gown.

Clients who have influenza, COVID-19 or ARI

^#Do not wear a disposable gown while cooking or working near a heater, as gowns are highly flammable. Maintain physical distancing from others when near a heat source and not wearing a gown.

^Noting carers and workers who have recently recovered from COVID-19 should follow the guidance for recovered cases  about testing.

Precautions required will depend on the number of cases in clients, staff and the number of contacts. Responsibility for these various actions may vary, depending on the setting.

• Disability care service providers should keep a track of the last exposure date within the service to know when you can anticipate lifting these precautions. If there are further cases in a particular household, you should recalculate the anticipated date for lifting precautions.
• Monitor all clients who are contacts for ARI symptoms.
  • If any client develops symptoms, they should be cared for using long-sleeved gown, gloves, P2 / N95 mask and protective eyewear.
  • Clients with ARI symptoms should be supported to seek testing for COVID-19. If they have symptoms and test negative on a RAT, they should have a PCR test or a RAT in 24 hours. They should remain in precautions until their symptoms resolve.
  • If clients have ARI symptoms and test positive on a RAT, they should be managed as having COVID-19 (see above).  They should be supported to see their usual GP or usual care provider regarding eligibility for specific treatments.
• Advise carers and workers who are contacts or who provide care to people with ARI to monitor themselves closely for symptoms, and immediately isolate and get a COVID-19 test if symptoms develop, even if the symptoms are mild.
• Minimise staff who are contacts mixing across shifts by rostering the same staff on together where possible.
• Conduct handovers via the phone instead of in person.
• Where possible, limit social contact between workers on different shifts.
• Hold staff meetings virtually.
• Ensure workers are not using the same shared facilities at shift change over .
• Where possible, carers and workers should not spend time together unmasked indoors – for staff this may require rostering of meal breaks and/or eating outside if weather permits.
• If a client requires transfer to hospital due to illness, please advise the ambulance operator that you are implementing infection control measures due to a COVID-19 exposure and advise them if the client is a contact, and if they currently require risk mitigation measures. Where possible, advise the receiving hospital of this information also.

Workforce

Advice on when a recovered case who is a staff member can return to work is available at Return to work guidance.

If you have a workforce shortage because staff are cases or are contacts, you should:

• follow your staff contingency plan in your Outbreak Management Plan
• consider appropriate risk mitigations for your setting based on the Return to work guidance
• consider altering the roster, with appropriate breaks for staff
• consider calling back staff from leave
• consider moving casual and part-time staff to full-time
• consider sourcing staff from other sites
• consider outsourcing ancillary services such as cleaning and laundry to free up staff for other functions
• consider how staff who are furloughed, from head office or working at other sites can complete tasks that can be done remotely.

Providers can also contact provider.support@ndis.gov.au for further advice on NDIA workforce support arrangements – further information is available here.

If after working through all the above options, you continue to have a critical workforce shortage, please contact ACT Health by emailing outbreak.response@act.gov.au regarding return to work options for furloughed staff. This inbox is monitored 8.30am to 4.30pm (Monday to Friday).

Infection prevention strategies to minimise transmission of ARI include vaccination, physical distancing (>1.5 metres), hand hygiene, respiratory etiquette, surface cleaning, ensuring adequate ventilation of rooms, isolating the person who has an ARI, and Personal Protective equipment (PPE).

These measures should all be attended where practical/possible.

Physical Distancing

• Maintain physical distancing of more than 1.5 metres where possible.
• Strategies include moving chairs and tables to encourage clients to sit more than 1.5 metres apart.
• Reduce the length of time people spend together in communal areas.
• Carer/worker breaks:
  • Carers/workers should avoid eating inside with a contact or positive case.
  • If there is a separate staff area within the setting, during breaks only one person should use the staff area while unmasked (e.g. during eating and drinking).
  • This may require rostering of meal breaks.
  • Alternatively, weather permitting, staff can use an outdoor area for breaks.
• If there is a separate staff area, staff should doff and discard PPE prior to eating and drinking. A doffing station should be established at the entry to the staff room. A donning station should be established inside the staff area, and staff should don PPE prior to re-entering the communal areas that require precautions.
• Staff should avoid using the same toilet and bathroom as clients with ARI. If only one bathroom is available, the toilet should be cleaned prior to use, and staff members should doff their gloves and gown prior to using the toilet. A doffing and donning station will be needed near the toilet area.

Hand hygiene

• Encourage frequent hand-hygiene for carers/workers and clients
• Use posters as reminders
• Facilitate good practise by appropriate placement of hand sanitiser
• Use ‘spotters’ or IPC leads to remind staff when to use hand hygiene
• Encourage staff to complete hand-hygiene education. Use ‘5 Moments for Hand Hygiene' posters available here.

Ventilation

Poorly ventilated indoor settings increase the risk of transmission of COVID-19 and other ARIs.

Guidance on ventilation is available here.

Strategies to increase airflow include:

• Improve ventilation in household communal areas in a setting with cases or contacts present:
  • open windows and doors if safe to do so (weather permitting), or optimise ventilation by periodically opening a window
  • if using air-conditioners / heaters, turn off re-circulation feature to prevent air being recycled into the home
  • turn on bathroom exhaust fans and leave the bathroom door open
    • this will help with air removal from the home
• Rooms with cases
  • keep the door closed as much as possible
  • open windows if safe and appropriate to do so (weather permitting), or optimise ventilation by periodically opening a window
  • if a positive COVID-19 case is being cared for in a poorly ventilated area, consider using an air purifier with a high efficiency particulate (HEPA) filter
    • usage and maintenance should be according to manufacturer’s instructions

Cleaning

• avoid touching your face, especially your mouth, nose, eyes and your PPE when cleaning an area occupied by a contact or positive case
• perform hand hygiene before and after removal of PPE
• don recommended PPE prior to cleaning areas occupied by contacts according to the advice provided in Step 3.
  • if cleaning areas occupied by a positive case, PPE worn will include: eye protection such as protective goggles or a face-shield (prescription glasses are not protective); N95 / P2 mask, disposable gloves; plastic apron or a long-sleeved impermeable gown
• clean high touch surfaces with either detergent and disinfectant (a 2-step process) or with a detergent/disinfectant solution or wipe
  • use a TGA approved cleaning and disinfection product for COVID-19
• all surfaces should be cleaned at least daily
• carpeted floors should be vacuumed using a vacuum with HEPA filter
• floors should be cleaned using the standard procedure
  • this includes using an approved floor cleaning solution, mopping from clean areas to dirty areas and discarding the mop-head (if disposable) or sending the re-useable mop-head to the laundry in an alginate bag after use
• always mop the floor in a person with ARI’s room last. If there is more than one of these rooms a separate mop should be used for each room where possible

Laundry

• laundry from the affected case must be collected and laundered separately
• carers / workers collecting laundry from a case should wear PPE (P2 / N95 respirator, eye protection, gown and gloves). Where possible, encourage the client to place their own laundry into the washing machine, and assist with correct machine settings
• follow clothing manufacturer instructions for wash temperature and cycle
  • if possible, water temperature should be set to >60 degrees C, and if this is not possible using a laundry sanitiser is recommended
• if using a commercial laundry service, notify the service
  • contaminated laundry should be placed in alginate bags and managed according to the commercial laundry’s policy for infectious laundry

Waste management

• waste generated from a client with ARI’s room should be discarded into  a rubbish bag within the client’s room, and this can be double bagged and placed in the household waste. PPE guidelines should be followed when handling waste.
• clinical waste should be discarded into yellow clinical waste bags. Disability service providers are required to have a clinical waste management procedure in place when providing services to clients. Clinical waste includes waste contaminated by blood or body fluids. Clinical waste should not be placed into the general waste system.
• all other waste can be discarded into the general waste and placed into the normal waste collection system.

Use standard and transmission-based precautions

• standard precautions are the primary strategy to minimise transmission of healthcare associated infections
  • use standard precautions at all times
• to reduce transmission of ARIs when providing care to clients who are contacts, use PPE according to guidelines in Step 3
• when caring for a positive case Standard + Contact + Airborne precautions are recommended
  • this includes the use of full PPE (eye protection, N95/P2 masks, long-sleeved impermeable gown and gloves)

Reducing risk of transmission of ARI using PPE

• Disability care services should provide ongoing PPE education programs in your service. IPC leads can use resources to assist with PPE education
  • NSW Clinical Excellence Commission has resources available.
• Encourage all staff to complete online COVID-19 Infection Control Training available from Australian Government Department of Health and Aged Care.
• Donning/doffing posters in English, Nepali, Malayalam, Hindi and Filipino are available from the advice for staff and operators of aged care facilities webpage.
  • Coronavirus (COVID-19) - donning and doffing personal protective equipment

Personal Protective Equipment

• When implementing your plan, consider your immediate and ongoing PPE requirements. If there are additional cases, you may need additional PPE for a longer period.
• It is the responsibility of the disability service provider to have enough PPE on-hand to manage an influenza, COVID-19 or ARI exposure or infection. PPE can be ordered from your supplier or small amounts purchased through pharmacies or other stores.
• The disability service providers is responsible for costs generated from additional PPE and they should be aware of funding available to support PPE supply .

If you have a critical shortage of PPE and do not have enough PPE for the next 24 hours, contact ACT Health by emailing outbreak.response@act.gov.au and flag the email as urgent. This inbox is monitored 8.30am to 4.30pm Monday to Friday.

Where you have not already done so, communicate regarding the COVID-19 exposure to:

• The NDIS Quality and Safeguards Commission: notification of event form COVID-19 (registered providers)
• Staff
• Clients and families where relevant
• The client’s local GP to arrange for access to anti-viral therapy if the client has tested positive for COVID-19 or Influenza.
• Health care providers and other services where relevant

• If a client has tested positive for COVID-19, assist the client to follow up with their usual GP or health provider, or consider registering with ACT's COVID Care@Home program if careful monitoring is needed. Guidance is available in the information for people who test positive for COVID-19.
• Remind clients, carers, and workers of the importance of informing the Disability Service Provider if they have symptoms of an ARI, or have received a positive COVID-19 PCR test or RAT and were infectious while at work/while receiving care.
• Continue to implement entry screening for staff and visitors if relevant (for example, day programs/excursions)
• Keep a record of which clients and carers / workers are contacts and their last exposure date. Be aware of test results of client contacts and any staff contacts who are returning to work early due to workforce shortages.
• Keep a record of your risk assessment and plan following each ARI exposure, including details of when it was last updated and which cases the risk assessment and plan has accounted for.

This information does not need to be reported to ACT Health.

If your service needs additional support, this information may be requested by ACT Health.

You should have this information ready to provide if needed.

Please note that ACT Health won’t review this information routinely unless you contact ACT Health and advise that there are issues requiring the attention of ACT Health.

If there are any further cases in the service, repeat the above steps, update your plan, notify contacts, undertake relevant actions, communicate again, and continue to monitor.

Any clients or staff who are re-exposed should have their testing and quarantine requirements reset to reflect the updated date of last exposure if relevant.

ARI precautions can cease when each carer/worker or client has completed recommended testing, risk mitigation time or isolation.