irt group covid-19 outbreak management plan · document: 1.48.005 – irt covid omp (acc) page 1 of...

Document: 1.48.005 – IRT COVID OMP (ACC) Page 1 of 36 Version: 2.2

Document is Uncontrolled when Printed Date Reviewed: October 2020

COVID-19 Outbreak Management Plan – Aged Care Centres

IRT COVID- 19 Outbreak Management Plan (OMP)

Aged Care Centres

IRT Group COVID-19 Outbreak Management Plan Aged Care Centres




Table of Contents 1 Quick COVID-19 Checklist Outbreak Management Plan (OMP) ................................................... 4

Refer to – Initial RACF report to a PHU- COVID-19 Outbreak .................................................. 5 Refer to – 1.48.005 (B) IRT COVID OMP- Letter to GPs COVID-19 Outbreak ......................... 5

2 Know the symptoms ....................................................................................................................... 8

3 Incubation period ............................................................................................................................ 9

4 Screening ......................................................................................................................................... 9

5 Identifying an outbreak of COVID-19 ........................................................................................... 10

6 Notification .................................................................................................................................... 10

7 Outbreak Management Team........................................................................................................ 11

8 Public Health Unit (PHU) Line List ............................................................................................... 14 9 Isolation or cohorting ................................................................................................................... 14

10 Infection Prevention Control (IPC) ............................................................................................... 16

10.1.1 Standard precautions ............................................................................................... 17 10.1.2 Contact and droplet precautions .............................................................................. 18 10.1.3 Airborne precautions ................................................................................................ 18

11 Room set up .................................................................................................................................. 19 12 Isolation room/ zone checklist ..................................................................................................... 20 13 Raise awareness/ signage ............................................................................................................ 20 14 Specimen collection in the context of suspected or confirmed COVID-19 ............................... 20 15 Workforce management................................................................................................................ 21




16 Contingency workforce guidance ................................................................................................ 22

17 Key clinical care considerations .................................................................................................. 23 18 Cleaning and environmental hygiene .......................................................................................... 24 19 Laundry and kitchen ..................................................................................................................... 25 20 Waste management ....................................................................................................................... 26

20.1.1 Preparing clinical waste for collection ...................................................................... 26

21 Staff stations/desk areas .............................................................................................................. 27 22 Stock control ................................................................................................................................. 27 23 Visitors and communal activities ................................................................................................. 27 24 Admissions and transfers ............................................................................................................ 28

25 Monitoring outbreak progress ...................................................................................................... 29 26 Declaring the outbreak over ......................................................................................................... 30 27 Review and debrief ........................................................................................................................ 30 28 Key resources ............................................................................................................................... 31 29 Outbreak Management Team (OMT) – roles and responsibilities .............................................. 32 30 Governance ................................................................................................................................... 35

31 Associated documents ................................................................................................................. 36




1 Quick COVID-19 Checklist Outbreak Management Plan (OMP)

Checklist Person Responsible Identify

Identify if your aged care centre has an outbreak (pg. 6-7) Registered Nurse (RN) Team Lead (TL)

Confirm that your aged care centre has an outbreak (pg. 6-7) Care Coordinator (CC)/Care Manager (CM)

Access required resources from Local Outbreak Management Folder- ACT

CM, CC, RN

Follow IRT COVID-19 Outbreak Management Plan (ACC) in con-junction with document: FIRST 24 Hours – Managing COVID-19 in a Residential Aged Care Facility

All employees

Access ACC Outbreak Management Local Contact List RN/CC/CM Implement infection control measures (First 30- 60 minutes) Continue to isolate / cohort ill residents RN/CC/CM

Inform the resident/representatives of their diagnosis RN/CC/CM

Continue to implement contact and droplet precautions RN/CC/CM

Set up PPE stations outside affected residents’ rooms (gloves, sur-gical masks, long-sleeved impermeable gowns, eye/face protec-tion)

RN/TL

Display signage outside room - contact and droplet precaution RN

Display signage - donning and doffing signage CM

Dedicate equipment to affected residents if possible (shared equip-ment must be cleaned)

CM/RN

Provide cleaning solution or detergent/disinfectant wipes for clean-ing of shared equipment

CM

Exclude all unwell staff until symptom-free and negative swab as required Exclude any staff that are close contacts or confirmed case for minimum of 14 days; follow the directives of the PHU

CM/Workforce Coor-dinator

Reinforce standard precautions (hand hygiene, cough etiquette) throughout facility Ensure hand hygiene stations are adequate, stocked and have signage

RN/Site Infection Control Coordinator (ICC)

Display outbreak signage at entrances to the aged care centre and isolation room/zone

RN/CC/CM

Increase frequency of environmental cleaning (see cleaning and disinfecting tasks below)

Hospitality Manager (HM)




Convene your Outbreak Management Team (First 30-60 Minutes) (pg. 9)

Outbreak Coordinator

Notifications (First 30-60 Minutes) (pg. 8) Immediately notify the PHU (State/Territory Health Department) Refer to - Initial RACF report to a PHU- COVID-19 Outbreak

CM

Notify Executive General Manager (EGM) - Aged Care Centres BM

Email ACQSC and notify IRT CIMT EGM – Aged Care Centres

Notify Commonwealth Dept. of Health IRT Quality and Com-pliance Manager

Contact the GPs of ill residents for review CM Provide the outbreak letter to all residents’ GP’s Refer to – 1.48.005 (B) IRT COVID OMP- Letter to GPs COVID-19 Outbreak Local Outbreak Management Folder- PREVENT/ACT

CM

Communication Ensure all IRT business units are informed (this will occur through CIMT)

IRT Quality and Com-pliance Manger

Co-ordinate with EGM - Customer and Marketing to inform families and all staff of outbreak at the aged care centre

EGM – Aged Care Centres

Co-ordinate with EGM - Customer and Marketing to inform all contractors and visitors


Co-ordinate with EGM - People and Culture for implementation of Workforce Plan


Implements COVID Outbreak Stakeholder Communications Plan EGM – Customer and Marketing

Aged Care Centre phone diverted to CCC (134 478) EGM – Customer and Marketing

Direct all media enquiries to IRT Media Advisor (via CCC) 134 478 All employees Aged Care Centres to refer to “Guidance re Media Attention” Information for ACC employees Local Outbreak Management Folder- PREPARE/ACT

All employees

Coordinates with GM - IRT Catering to implement COVID-19 Safe Plan for Food Service to residents at IRT Aged Care Centres and COVID-19 Safe Plan for Food Delivery Drivers

EGM - Aged Care Centres

Restrict Restrict movement of staff between areas of aged care centre (to ensure staff caring for residents who are isolated and patients who are quarantined are kept separate) and between aged care centres

Workforce Plan-ners/Coordinator

Consider isolating/co-horting/ relocation of residents BM/CM Restrict visitors, unless for end-of-life residents or approved by Business Manager

CM

Arrange for CCC to cancel all admission EGM – Customer and Marketing

Cancel all non-essential service providers and group activities during outbreak period

CM/Lifestyle Manager




Collect respiratory specimens Testing of unwell residents or staff, or from asymptomatic residents who are quarantined as directed by PHU

RN

Ensure informed consent is obtained from resident / representative before collection

RN

All site staff may require testing - liaise with PHU CM/Senior Clinical Manager (SCM)

Clinical Management of COVID-19 Clinical review and management of all unwell residents initially and minimum of 4-hourly 1.48.005 (F) Priorities of care during COVID-19 Outbreak Local Outbreak Management Folder- ACT

CM/RN

Ongoing monitoring of all other residents and staff for symptoms CM/RN

Avoid use of nebulisers and use spacers where possible – discuss alternatives with medical practitioners

RN

If a nebuliser is used, staff will require airborne/contact/droplet precautions

RN/ICC

Commence Platinum “Acute Care Plan” for all suspected or positive cases

RN

Consider transfer to hospital in consultation with the resident 1.48.005 (C) IRT Transfer Advice Form COVID-19 Local Outbreak Management Folder- ACT

RN/CC/CM

All residents at the aged care centre are to have an identification armband applied

RN/TL

All unwell residents are to be reviewed by their GP, tele health available

RN

Continue following First 24Hours- Managing COVID-19 (P 6-24) Communicate who is in charge of every shift and ensure understanding of the escalation processes

RN/CM

Review Advanced Care directives RN/CC/CM Environmental cleaning and disinfection Allocate trained staff for cleaning of affected areas - ensure they are trained in routine cleaning, additional and terminal cleaning

Hospitality Manager

Provide cleaning staff with disposable gloves, gowns/aprons and eye/face protection for cleaning tasks

Hospitality Manager

Daily cleaning of all well residents and communal areas using neutral detergent

Hospitality Manager

Schedule at least daily cleaning and disinfecting of symptomatic residents rooms (2-step or 2-in-1 clean) Refer to- COVID-19 Environmental cleaning and disinfecting princi-ples for health and RACF Local Outbreak Management Folder- PREPARE/ACT

Hospitality Manager

Schedule at least twice daily (or more frequent) cleaning and disinfecting of frequently touched surfaces (2-step or 2-in-1 clean) Including taps, handrails, bedside tables, tables, doors, counters, taps, toilets, light switches and shared equipment

Hospitality Manager




Schedule terminal clean of ill residents’ rooms when moved, transferred or discharged

Hospitality Manager

Supply suitable detergent/ disinfectant solution or wipe for disinfecting shared equipment between each resident use

Hospitality Manager

Waste Arrange increase collection of clinical waste BM Identify area specific for excess clinical waste storage until pickup BM Stock control

Attend stocktake Infection Control Co-ordinator & RN

Consider PPE and other essential items – including oxygen and oxygen delivery, emergency and ward stock medication, syringe drivers and batteries, waste disposal bags, cleaning supplies, laundry bags and bed bath requirements etc.

Infection Control Co-ordinator & RN

Monitor Maintain daily line list CC/CM

OMT to meet minimum daily (everyday Monday-Sunday) Outbreak Manage-ment Team (OMT)

Communication updates continue minimum daily to residents/ representatives of the aged care centre Refer to- COVID Outbreak Stakeholder Communication Plan Local Outbreak Management Folder- ACT

Resident NOK Com-munication Repre-sentative (Outbreak Management Team)

Monitor outbreak progress through increased observation of residents for fever and/or acute respiratory illness and undertake repeat testing, where feasible

RN

Update the case list daily at the aged care centre and provide to the public health unit daily

RN/CC/CM

Add positive and negative test results to case list RN/ CM Declare 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.

PHU

Review Review and evaluate outbreak management – amend outbreak management plan if needed

OMT




2 Know the symptoms Refer to- COVID-19 Identifying the Symptoms

Local Outbreak Management Folder- PREVENT

Identifying COVID-19 The most common signs and symptoms include: • fever (note: fever may be absent in the elderly)

• dry cough Other symptoms can include:

• shortness of breath

• sputum production

• fatigue

• sore throat

• loss of taste

• loss of smell

• diarrhoea

• nausea or vomiting Less common symptoms include: • headache

• myalgia/arthralgia

• chills

• nasal congestion

• haemoptysis

• conjunctival congestion Older people may also have the following symptoms: • confusion or behavioural change

• worsening chronic conditions of the lungs

• loss of appetite Staff should be aware of these symptoms and note that the majority of cases experience mild symptoms. If staff develop any symptoms, they must isolate and get tested to prevent trans-mitting the virus to other staff members or residents.




Elderly residents often have non-classic respiratory symptoms including behaviour change, and may not develop a fever. Ideally, staff should know residents well so that they can detect changes in behaviour. Aged care centre staff should consider testing any resident with any new respiratory symptom, even if they are not typical of COVID-19. Asymptomatic COVID-19 infections are relatively common and may occur in residents in residential aged care centres. In residential aged care centres, public health units may consider testing asymptomatic con-tacts to inform management of the outbreak.

3 Incubation period People with COVID-19 generally develop signs and symptoms, including mild respiratory symptoms and fever, on an average of 5-6 days after exposure to the virus (mean incubation period 5-6 days, range 1-14 days). In rare cases the incubation period may exceed 14 days.

Contact tracing On identification of a confirmed, suspected or close contact case of COVID-19 the PHU will undertake contact tracing as required. IRT will assist to expedite this process and identify immediate risks by requesting/collating a list of potential people and places that the case has been in contact with in the past 14 days. This includes residents, employees, visitors, volunteers or contractors. This will trigger immediate consideration of precautions required and additional areas or sites that may be affected. Where it is identified that additional sites may be at risk, Outbreak Management Teams should be placed on notice at these sites also with increased monitoring implemented until further advice from the PHU is received.

4 Screening Wellness screening - employees, contractors and approved visitors

• Before entering our aged care centres all employees, contracts and approved visitors must read and confirm wellness screening questions. This information is updated to reflect the state/territory COVID-19 status.

• IRT regularly updates Local Leadership Teams via email “Wellness Screening Ques-tions” communication.

• Wellness screening questions are available on the IRT intranet.

Wellness screening - residents The 1.48.003 IRT Resident Screening Checklist – Outbreak Prevention Tool has been developed to assist in the early detection of unwell residents and infectious illnesses and is to be implemented at every hand-over. This checklist serves as a prompt to consider and communicate the overall wellness of our residents each shift. Any residents that are found to have symptoms of illnesses outlined in the screening check-list must be handed over to the employees on the next shift and also escalated to the Regis-tered Nurse/Care Manager for review and action.




COVID-19 location and hotspot information This information is communicated via email to Local Leadership Teams and to employees via the ESS notice board. COVID-19 location and hotspot information is changing rapidly. COVID-19 location and hotspot information is available on the IRT intranet Register of secondary employment is checked against the most up-to-date information at all times by IRT workforce Business Partners.

Increased PPE requirements where there is significant community transmission In areas determined to have significant community transmission, additional precautions may be required. Liaison will take place with the Public Health Unit in these circumstance and the following document is available for reference: Recommended minimum requirements for the use of masks or respirators by health and resi-dential care workers in areas with significant community transmission of COVID-19

Local Outbreak Management Folder- PREPARE/ACT

5 Identifying an outbreak of COVID-19 Confirmed outbreak

A COVID-19 outbreak is defined as a single confirmed case of COVID-19 in a resident, staff member or frequent attendee of a residential aged care centre. This definition does not include a single case in an infrequent visitor of the aged care centre. A determination of whether someone is a frequent or infrequent visitor may be based on fre-quency of visits, time spent in the setting, and number of contacts within the setting. While the definitions above provide guidance, the state/territory PHU will assist the aged care centre in deciding whether to declare an outbreak. Public health units may advise that the aged care centre should take some actions where an outbreak is suspected, whilst awaiting laboratory confirmation.

Suspected case Resident are screened for symptoms of COVID-19 as per IRT Screening Checklist Refer to 1.48.003- IRT Resident Screening Checklist- Outbreak Prevention Tool

Local Outbreak Management Folder - Prevent • Residents are isolated, contact and droplets precautions are implemented until

confirmation of a negative swab result or direction from the treating GPs.

• PHU can be contacted for any unwell residents and must be contacted for any confirmed cases of residents/ staff/ contractors or frequent attendees of an aged care centre.

6 Notification Notify Public Health Units (PHU)

1. First steps in a suspected or confirmed outbreak is to notify PHU and establish an Outbreak management Team. After hours PHU contact is available.

2. The Public Health Units should advise and, where appropriate, assist to define the out-break setting.




CENTRAL PUBLIC HEALTH CONTACT DETAILS

NSW - In NSW calling 1300 066 055 will direct you to your local Public Health Unit. QLD - Contact for the Queensland Government’s Department of Health 13 432 584 and Coronavirus hotline 134 268

ACT - Contact for the Australian Capital Territory Government’s Department of Health. Business hours 02 5124 9213; Coronavirus helpline 02 6207 7244

INSERT LOCAL PHU NUMBER HERE FOR EASY REFERENCE:

___________________________________

Notify IRT Critical Incident Management Team (CIMT) Care Manager (CM) must escalate to Business Managers (BM). Immediate notification to Executive General Manager (EGM). EGM notifies IRT CEO immediately. There is no delay in escalation at any time day or night. Utilise ACC Outbreak Management Local Contact List

Notify the Commonwealth Department of Health Quality and Compliance Manager to notify the Commonwealth Department of Health of any confirmed case of COVID-19 - staff or resident Email address: [email protected] Establish an Outbreak Management Team (OMT) The aged care centre is responsible for managing the outbreak and should take a strong leadership role with support from the PHU. 1. Set up an Outbreak Management Team in conjunction with the Local Public Health Unit

(immediately). 2. IRT is to co-chair daily meetings of the Outbreak Management Team until outbreak is

closed.

7 Outbreak Management Team The OMT initially meet within 1 hour of the identification of a case and daily thereafter to: • Direct and oversee the management of the outbreak • Monitor the outbreak progress and initiate changes in response, as required • Liaise with GPs and the state/territory Department of Health, as arranged. This team should be made with a combination of Care Centre employees and IRT Market St Support.

tel:13432584tel:134268tel:251249213tel:262077244mailto:[email protected]




Plan this in advance. List your team members or roles here and store your Outbreak Man-agement Local Contact List and 1.48.006 Outbreak Meeting Minutes template alongside this document for easy access.

• Chairperson IRT Group (EGM - Aged Care Centres): _____________________________

• Co-Chair Public Health Unit (PHU): ___________________________________________

• Secretary (Delegated by EGM): ______________________________________________

• Central Outbreak Coordinator (Quality & Compliance Manager): ___________________ • Local Outbreak Coordinator (Care Manager): ___________________________________

• Infection Control Coordinator (Educator or Senior Clinical Manager). Locally appointed

with support from Quality and Compliance Team: __________________________________________________________________________

• Workforce Co-ordinator (Workforce Co-ordinator with support of the IRT People and Culture team): __________________________________________________________________________

• Resident/ NOK Communications Representative (two allocated roles as determined by EGM. Role competent to co-ordinate and communicate residents condition: __________________________________________________________________________

• Stakeholder Communication Coordinator (Group Head of Media & Communications): __________________________________________________________________________

• PPE Support Co-ordinator:

__________________________________________________________________________

• Other members of the local Aged Care Centre Management team (e.g. Business Man-ager, Care Coordinator, Hospitality Manager, Lifestyle Manager, Maintenance Manager, RN on shift): ____________________________________________________________________

• Outside specialists if available (General Practitioner/ Nurse Practitioner): ____________________________________________________________________

• External support (employees of LHD, ACQSC or any other supporting contingency groups): ______________________________________________________________________




The team will need to meet minimum of daily, including weekends and public holidays, to monitor the outbreak and initiate changes.

Minutes are taken and shared with all members utilising the 1.48.006 Outbreak Meeting Minutes template.

Outbreak Management Team role • It considers the progress of the response, undertakes ongoing monitoring, deals with

unexpected issues, and initiates changes, as required.

• Leads and manages implementation of the OMP in response to the outbreak in the aged care centre.

• Regularly communicates with residents and their representatives — updating them on the outbreak response, including each resident’s circumstances and preferences.

Outbreak Management Team responsibilities

• Notify and liaise with local PHU and Commonwealth Dept. of Health.

• Oversee implementation of infection prevention and control measures as per OMP.

• Restrict visitor and community (including health workers) to minimal essential require-ments. Non-essential visitors will be precluded from face-to-face visits with residents (de-tailed in CDNA Guidelines). Keep a log of all visitors entering the aged care centre, including areas and residents visited.

• Manage staff including rostering and isolation measures for exposed staff.

• Ensure register of staff is maintained who have been caring for residents with COVID-19.

• Engage surge workforce where critical staff are not available to be sourced through other avenues, if required.

• Monitor residents welfare and well-being, regularly communicate with residents and their representatives.

• Assist aged care centres to work with GPs to review/develop advanced care plans for residents.

• Enable access and respond to aged care advocates, provide to residents and their repre-sentatives communication, collateral and materials provided by advocacy services.

• Facilitate pathology requisition orders and timely specimen collection.

• In coordination with the Senior Inter-governmental Oversight Group, liaise with GPs and allied health personnel to ensure approach to acute and chronic disease is addressed, and de-conditioning, grief, cognitive decline and psychiatric sequelae of isolation and loss are addressed.

Outbreak Management Team Roles and Responsibilities are further outlined in P.24




8 Public Health Unit (PHU) Line List • Continue line listing all suspected and confirmed cases of residents and staff.

• The PHU will provide a preferred case list (‘line list’) template to use when an outbreak is notified.

• The PHU must be provided with an updated copy of the line list daily (including week-ends and public holidays) or as instructed. The Quality and Compliance Team should be copied into the email [email protected].

• If any residents pass away during an outbreak, the department must be notified as soon as possible within 24 hours.

• The line list must indicate the residents room and location, whether they are in a single room and an updated location if moved e.g. for the purposes of cohorting.

• Hospitalisation of residents should be noted on the case list and sent to the department daily.

• Resident details should include; o Date the resident became unwell o Room location o Is the resident in a single room? o New location if moved

9 Isolation or cohorting • Wherever possible, confirmed case residents should be transferred to hospital for

specialised care in a health care setting.

• Transfers must be discussed with the resident/representative and medical practitioner.

• A transfer letter must accompany the resident in addition to their Platinum transfer documentation. See item 24.3.

• Where a transfer is not available, or is pending, residents with suspected or confirmed COVID-19 should be isolated and cared for in single rooms.

• Aged care centres must be prepared with a clearly marked site map and plans for an isolation zone/s in place. See item 12, page 19 of OMP for isolation zone checklist.

Placement of residents with suspected or confirmed COVID-19

• Residents should be isolated while they are infectious (as determined by the PHU). o During this period, if they are ambulatory and well enough, they may leave the room

for exercise. They must be supervised and avoid contact with other residents. PPE is required for supervising staff.

o If residents must leave their room while infectious they should wear a surgical mask, perform hand hygiene and avoid touching surfaces and objects in communal areas.

o The preference is that this occurs in an outdoors area where weather permits. Alternately a dedicated area may be able to be made available. Identify the most direct route to and from the resident’s room.

mailto:[email protected]




• Remind staff and residents of the need for cough etiquette and respiratory hygiene.

• Staff and visitors in contact with ill residents should follow standard, contact and droplet precautions (see below).

• Supplies of PPE should be readily available and placed strategically outside the room.

Placement of residents with suspected or confirmed COVID-19 that have challenging behaviours • Anecdotal evidence indicates increased risk of transmission where there is behaviours

such as shouting (increased aerosol transmission) or an inability of to follow instructions around social distancing or etiquette.

• Special arrangements may be needed for care of residents with dementia, cognitive impairment and/or challenging behaviours who need to be isolated.

• These may include additional PPE requirements including the additional use of P2 mask, specialised one-on-one care and/or hospital transfer.

• Consultation is required with the Public Health Unit and Central Outbreak Coordinator in this circumstance. Reference document: Infection Control Expert Group - COVID-19 Infection Prevention and Control for Residential Care Facilities Local Outbreak Management Folder- ACT

If a single room is not available, the following principles can guide resident placement: • Residents with the same pathogen1 who are assessed by the aged care centre as

suitable roommates, can share a room (i.e. be cohorted).

• Ill residents sharing a room should be more than 1.5 metre apart. There should be a privacy curtain between them to minimise the risk of droplet transmission.

• Staff in direct contact with ill residents should follow contact and droplet precautions.

• Staff caring for residents who have COVID-19 should also be cohorted to minimise the risk of the virus spreading to other staff and residents.

Things to consider when cohorting: • If a resident needs to be moved into a room other than their own, explain to the resident

and or their representative the reason for the move and reassure them it is temporary.

• Ensure the resident and the representative are aware of the timing of the move.

• Ensure that the resident has access to their belongings.

• Give regular updates on the ongoing need for them to remain in the different room.

• Monitor emotional status and support residents to adjust to their changed environment.

• Document the reason for the move and the communication with the resident and or their representative.

1 An acute respiratory illness may be due to COVID-19 or many other respiratory viruses. Laboratory tests are required to identify the cause. It is important that ill residents be separated until the causative pathogen for each ill resident is known. Only residents with the same respiratory pathogen may be cohorted together.




Ceasing isolation precautions for residents who have had COVID-19 should be as approved by the PHU. Outbreak precautions for the aged care centre should remain in place until at least 14 days after the last case is diagnosed, or on advice from the public health unit.

Placement of residents who are close contacts of a confirmed COVID-19 case • Any resident who remains well but has been in close contact with a confirmed or

probable case, in the period extending 48 hours before symptoms began in the confirmed or probable case, should be quarantined in a single room for 14 days.

• They should be monitored for symptoms of COVID-19 (at least daily).

• They should be tested periodically in consultation with the PHU.

• They may leave their room for exercise or activity, with supervision by a staff member, if necessary, to ensure that they avoid contact with other residents.

• If a single room is not available, residents in quarantine can share a room.

• The same rooms sharing, PPE and exercise precautions are required as for confirmed cases (see above).

• Close contact residents should be tested and assessed frequently and if COVID-19 is later confirmed in one of the residents, they should be separated. The resident who has COVID-19 should be isolated. The other resident should remain in quarantine.

10 Infection Prevention Control (IPC) Routine IPC measures to be in place at all times include:

1. Hand hygiene - using soap and water or alcohol-based hand rub. 2. Cough etiquette and respiratory hygiene for staff, residents (if possible) and visitors. 3. Maintaining entry records. 4. Wellness checks including temp less than 37.5. 5. Staying at home if unwell. 6. Frequent cleaning and disinfection of frequently touched surfaces. 7. Annual influenza vaccination of residents, staff and all visitors to aged care centres. 8. Limiting unnecessary movement of residents and staff within and between aged care

centres. 9. Awareness of quarantine and hotspot requirements. 10. Health promotion signage and alerts.




Infection Prevention Control (IPC) when a resident has suspected or confirmed COVID-19 10.1.1 Standard precautions Standard precautions are IPC practices used routinely in healthcare. They should be used in aged care centres with a suspected or proven COVID-19 outbreak and apply to all staff and all residents. Key elements are:

• Hand hygiene before and after each episode of resident contact and after contact with potentially contaminated surfaces or objects (even when hands appear clean). o Gloves are not a substitute for hand hygiene. Staff should perform hand hygiene

before putting gloves on and after taking them off.

• Use of PPE if exposure to body fluids or heavily contaminated surfaces is anticipated (gown, surgical mask, protective eyewear, and gloves).

• Cough etiquette and respiratory hygiene o Cough into a tissue (and discard the tissue immediately) or into the bend of the

elbow; perform hand hygiene.

• Regular cleaning and disinfection of the environment (at least daily) and equip-ment and more frequent cleaning of frequently touched surfaces.

• Provision of alcohol-based hand sanitiser at the entrance to the aged care centre and other strategic locations.

• Ensure tissues and bins are available throughout the aged care centre. • Ensure staff are bare below the elbows with no jewellery or long sleeve clothing. • Hand wipes available for residents who need assistance to use prior to meals. Note: aged care centres must ensure all staff are trained in hand hygiene, infection control and prevention and the correct use of PPE, appropriate to their role. This includes Hospitality, Lifestyle, Maintenance and Admin staff. Incorrect use, donning, doffing or discarding of PPE increases the risk of personal contami-nation and spread of infection. Transmission-based precautions These are IPC practices used in addition to standard precautions, to reduce transmission due to the specific route of transmission of a pathogen. Respiratory infections, including COVID-19, are most commonly spread by contact and droplets. Airborne spread may occur during aerosol generating procedures.




10.1.2 Contact and droplet precautions These precautions apply to: • Health care workers and aged care centre staff during the clinical consultation and

physical examination of residents with suspected or confirmed COVID-19, or who are in quarantine.

• All staff when in contact with ill residents. Key elements are: • Standard precautions (as above) • Use of PPE including gown, surgical mask, protective eyewear, and gloves when in con-

tact with an ill resident. o Protective eyewear can be in the form of safety glasses, eye shield, face shield,

or goggles.

• Isolation of ill residents in a single room. If a single room is unavailable see: “Place-ment of residents with suspected or confirmed COVID-19” (as above).

• Enhanced cleaning and disinfection of the ill resident’s environment. • Limit the number of staff, health care workers, and visitors in contact with the ill

resident.

• Nebulisers have been associated with a risk of transmission of respiratory viruses and their use should be avoided. A spacer or puffer should be used instead.

Refer to - High Risk Therapies- Nebulisers

Local Outbreak Management Folder- ACT Note: When caring for an asymptomatic resident in quarantine, contact and droplet pre-cautions should be followed (PPE includes a gown, surgical mask, protective eyewear, and gloves). 10.1.3 Airborne precautions Use of P2/N95 respirators, instead of surgical masks, are recommended, in addition to all other precautions outlined above, when performing certain high-risk (aerosol generating) procedures on patients with COVID-19. The Infection Control Expert Group advises that the use of a particulate filter respirators (PFR) such as P2 or N95 respirator are not commonly required when managing COVID-19 in the aged care centre setting however, may be considered when one or both of the following apply: 1. For the clinical care of residents with suspected, probable or confirmed COVID-19, who

have cognitive impairment, are unable to cooperate, or exhibit challenging behaviours. 2. Where there are high numbers of suspected, probable or confirmed COVID-19 residents

AND a risk of challenging behaviours and/or unplanned aerosol-generating procedures (e.g. including intermittent use of high flow oxygen). Reference document: Infection Control Expert Group - COVID-19 Infection Prevention and Control for Residential Care Facilities Local Outbreak Management Folder- ACT




Other examples of required use may include: • Care of a resident who is highly symptomatic.

• When obtaining a COVID swab in circumstances where the resident is highly symptomatic.

• Care of a resident with nebuliser in use. Note: nebulisers are not recommended due to increased risk of transmission and alternatives should be sought with the resident’s medical practitioner.

FIT CHECKING: P2/N95 respirators should only be used by staff who have been trained in their use. They should be fit checked with each use to ensure an adequate face seal. It is important to know that any amount of facial hair around the chin may NOT be able to achieve a seal with a disposable half face respirator (P2/N95). Refer to poster: Principles of Fit Checking Local Outbreak Management Folder- ACT FIT TESTING: Fit testing is to be performed to determine whether a specific type, model and size of mask is a suitable fit for the wearer and that it is worn correctly to achieve a facial seal and comfort. This must be conducted by an assessor who has completed an annual compe-tency in fit testing of masks. Other – faecal shedding Faecal shedding of the virus has been demonstrated from some people. PPE would be worn when changing incontinence pads of an infected person and these items must be considered as contaminated waste. Residents with ongoing diarrhoea or uncontained faecal incontinence who may have limited capacity to maintain standards of personal hygiene should continue to be isolated until 48 hours after the resolution of these symptoms.

11 Room set up • Make PPE, including surgical masks, eye protection, gowns, and gloves, available imme-

diately outside of the resident room.

• Position a disposal receptacle near the exit inside any resident room to make it easy for employees to discard PPE.

• Place a disposal outside of the resident’s room for removal of masks.

• Post signs on the door or wall outside of the resident room clearly describing the type of precautions needed and required PPE.

• Post signs on donning and doffing PPE.

• Equipment and items in resident areas should be kept to a minimum. Ideally, reusable resident care equipment should be dedicated for the use of an individual resident. If it must be shared, it must be cleaned and disinfected between each resident use.




12 Isolation room/ zone checklist Consider the following when setting up an isolation room/zone: • Dedicated PPE outside of zone, consider what to store this on • Signage appropriate for the room/zone

Refer to Poster- PPE special requirements for COVID-19 Designated Zones Local Outbreak Management Folders- ACT

• Equipment kept to a minimum including soft furnishings

• One entry point to dedicated zone (if able)

• External entry (for deliveries)

• Isolated medication trolley/ resident equipment

• Cleaning products in place to accommodate shared equipment

• Adequate handwashing facilities

13 Raise awareness/ signage • Inform all aged care centre staff and support services including GPs.

• Keep residents informed through regular communication. Encourage reporting of all symptoms including mild, support personal protection measures including respiratory hygiene, cough and sneeze etiquette, and hand washing.

• Aged care centre communication representatives (OMT) make personal calls to NOK on a priority basis.

• IRT Communications team will assist aged care centres with resident and NOK communications as required and will manage all other stakeholder communication as per the COVID Outbreak Stakeholder Communications Plan.

• Signage should be placed at the entrances to rooms/units/isolation wards to identify the need for additional precautions in addition to standard precautions for infection control.

• Signage should be placed at the aged care centre entrance, restrict to a single entry point where possible.

• Donning and doffing instruction signage should also be displayed at all PPE stations/ trollies.

14 Specimen collection in the context of suspected or confirmed COVID-19 Specimens for diagnosis of COVID-19 and other respiratory viral infection should be collected by a pathology collector or medical practitioner, as a last resort the Registered Nurse may collect the swab if they have had their competency assessed. The PHU should be notified of any swabs collected for suspected COVID-19 residents and staff so they can facilitate fast tracking of the results. The collection of samples from deep nasal and oropharynx is recommended to optimise the chances of virus detection. If collecting swabs from residents with challenging behaviours, help and support should be sought from the aged care centre’s local Public Health Unit.




15 Workforce management • The number of health care workers available to provide care may be reduced by up to

one-third because of isolation requirements, personal illness, concerns about transmission in the workplace, and family/caregiving responsibilities.

• To ensure identification of risk and to assist with PHU contact tracing, Care Management must work with the workforce team to identify any staff who have worked across the multiple aged care centres or lodges in the 14 days prior to the first identified case. See item 3.1 p.10 Contact Tracing.

IRT workforce management strategies 1. Continued “Wellness Screening” of all staff. 2. Staff members must self-monitor for signs and symptoms of acute respiratory illness and

self-exclude from work if unwell. 3. Request to be made to IRT Workforce Planner and People and Culture Business Partner

to source additional staff and to implement staffing contingency or surge workforce as required (including contact list for casual staff members or external nursing agencies).

4. IRT OMP Workforce V2 & COVID Outbreak Contingent Workforce Training Standard are activated.

5. Remove all non-essential staff/services. 6. Assigned dedicated staff - a register of staff members caring for residents with

COVID-19 should be maintained. Staff members must not move between their allocated room/ section and other areas of the aged care centre, or care for other residents including RNs and medication staff

Considerations when choosing dedicated staff:

• Ensure staff have recently completed infection control training.

• Ensure staff have current influenza vaccination (i.e. not medically exempt).

• Do not assign staff who have risk factors for COVID-19.

• Advocate for IRT employees to remain part of the roster arrangement for every shift to allow for continuity of care.

• Activate IT support for use of IRT Connect and Platinum remote access – this will allow well staff in quarantine to log in and video call in, providing support to both the contingency workforce and the residents.

Information on people who are more at increased risk can be found on the link below https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/what-you-need-to-know-about-coronavirus-covid-19




16 Contingency workforce guidance Emergency induction for agency/surge workforce

Local electronic folders should be established that will inform the external/agency workforce on the following;

• Isolation plans

• Site maps

• Local contact lists (see COVID-19 Local Outbreak Management Folder Index pg. 3)

• Staff “dispo” sheet

• Staff secondary employment details

• PPE stocktake information

• High risk register

• Staff influenza vaccination report

• Latest line list

Priorities of care during COVID-19 Outbreak Priorities of care during COVID-19 outbreak has been developed to guide the workforce on expectation of IRT and non-IRT staff should care tasks require to be prioritised during an outbreak. The document has two resident types and outlines priority one and two task care processes. Refer to - Priorities of Care during COVID-19 Outbreak

How to Card- Acute Care Needs Care Support Plan

Local Outbreak Management Folder- ACT To support a contingency workforce the following documents are to be provided:

• 1.48.005 IRT COVID-19 Outbreak Management Plan (Aged Care Centres)

• 1.14.001 Clinical Documentation Contingency Pack

• Platinum Detailed Handover (print with photo)

• Platinum Emergency Care Plans

• Summary Care Plans

• Copy of Acute Care Needs/ Care Support Plan

• Primary Medication Chart and signing sheets

• Floor Plan

• Local contact details list (doctors, PHU, pharmacy, hospital, emergency services).

• Ensure all residents have identification armbands

IRT Connect/ Video Conferencing can be used with contingency workforce




17 Key clinical care considerations Note this list is not exhaustive and case by case consideration is required in consultation with the resident/representative with consideration of enduring guardianship. Clinical considerations/ interventions: • Unwell residents must be medically reviewed by their GP

o Telehealth to be made available where this is GP preference o Where a GP is not available, seek medical support from Local Health District in

consultation with PHU

• Commence food and fluid charting and encourage >1000mls/24 hour period (unless otherwise directed by a medical practitioner).

• Consider “lighter” meal options when resident is refusing normal menu items (taking into consideration assessed dietary consistency). Liaise with Hospitality Manager where required.

• Monitor 4-hourly vital signs and record in clinical notes, for temperature more than 38c. o Administer paracetamol as charted or consult the medical officer to have it charted. o The Registered Nurse can follow usual processes to access the nurse initiated

medication’s (NIM) if there is no Panadol charted regular or PRN.

• Nebulised medication should not be used. o Consult with medical practitioner re nebuliser alternatives. o Inhalers with spacers (clean mdi mouth piece and spacer between each use and do

not share between residents).

• Oxygen may be helpful to relieve respiratory symptoms sp02 < 94%.

o Contact the medical officer to arrange the charting of the oxygen. It must clearly state the amount of oxygen to be administered and how often on a medication chart.

o Ensure supply of oxygen and delivery sets are monitored and bolstered.

• Ibuprofen or any anti-inflammatory medication is contraindicated in the treatment of COVID-19 symptoms.

o Paracetamol is a preferred analgesic. o Ensure ward stock levels are monitored. o Seek medical advice for pain management from medical practitioner.

• Consider the impact that infection or reduced food intake may have for resident with diabetes.

o Consider need for increased BSL monitoring and diabetic plan enacted. o Consideration of supplements.

• If respiration rate is >25 bpm or the resident appears to be in respiratory distress, contact the medical officer for further advice.

• Monitor for complications such as: o Pneumonia (secondary bacterial infection) o Respiratory failure o Septic shock o Multi-organ dysfunction/failure




• If any of the above are present then contact the medical practitioner for advice/ ambulance NSW (dependent on the ACD and resident/enduring guardian wishes)

• For a productive cough the medical officer could chart expectorant medication as appropriate.

• Antibiotics may be charted by the medical practitioner for secondary infections.

• For mild symptoms of cough or sore throat these may be relieved by home remedies such as lemon and honey drinks, depending on the resident’s preference.

• Nurse in a semi fowlers position, seated in an upright position in bed or chair.

• Consider increase pressure risk from spending more time in bed – put air mattress in bed and start 2 hourly turning chart if not able to self-reposition.

• Use of Platinum Acute Care Plan to communicate care needs of affected residents.

• Review Care Plans regularly particularly for at-risk and vulnerable residents.

• Continued close communication with resident NOK/ person responsible of affected residents to provide status updates, aiming for at least twice per day.

18 Cleaning and environmental hygiene Refer to Ecolab COVID-19 Information & Action Plan

Local Outbreak Folder- PREPARE/ACT Regular, scheduled cleaning of all resident care areas is essential during an outbreak. Frequently touched surfaces are those closest to the resident, and should be cleaned more often. During a suspected or confirmed COVID-19 outbreak, an increase in the frequency of cleaning with a neutral detergent is recommended. Cleaning AND disinfection is recommended during COVID-19 outbreaks. Either a 2-step clean (using detergent first, then disinfectant) or 2-in-1 step clean (using a combined detergent/disinfectant) is required. Detailed information on environmental cleaning and disinfection is available in the Commonwealth Department of Health factsheet – COVID-19 Refer to COVID-19 Environmental cleaning and disinfecting principles for health and RACF

Local Outbreak Folder- ACT Environmental cleaning and disinfection principles for Health and Residential Care Facilities. The following principles should be adhered to for resident’s rooms that are well and the communal areas.

• Frequently touched surfaces should be cleaned at least twice daily. These include: o bedrails, bedside tables, light switches, remote controllers, commodes, doorknobs,

sinks, surfaces and equipment close to the resident o walking frames and sticks o handrails and table tops in communal areas, and nurses station counter tops o floors should be cleaned using a detergent solution o carpets should be vacuumed using a vacuum equipped with a high efficiency

particulate air (HEPA) filter. Do not vacuum in a room or space that has people in it.

https://www.health.gov.au/resources/publications/coronavirus-covid-19-environmental-cleaning-and-disinfection-principles-for-health-and-residential-care-facilities




• Rooms of ill residents should be cleaned AND disinfected. This includes cleaning AND disinfecting: o frequently touched surfaces at least daily o equipment after each use o surfaces that have been in direct contact with, or exposed to, respiratory droplets o rooms should undergo a ‘terminal clean’ when an ill resident is moved or

discharged. • Cleaners should:

o wear appropriate PPE, including impermeable apron/gown disposable gloves and a surgical mask plus eye protection or a face shield while cleaning. If there is visible contamination with respiratory secretions or other body fluid, the cleaners should wear a full length disposable gown

o adhere to the cleaning product manufacturer’s recommended dilution instructions and contact time

o 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.

• Equipment and items in resident areas should be kept to a minimum. Ideally, reusable resident care equipment should be dedicated for the use of an individual resident. If it must be shared, it must be cleaned and disinfected between each resident use.

• Removal of all furnishings that are fabrics that cannot be easily wiped over or cleaned easily.

19 Laundry and kitchen

• Adhere to AS/NZS 4146:2000 Laundry practice. • At the point of generation, linen used for a person with confirmed, probable or suspected

COVID-19 infection should be placed in a red alginate bag and then into an appropriate laundry receptacle.

• A long-sleeved fluid-resistant gown or apron and disposable gloves should be worn during handling of soiled linen to prevent skin and mucous membrane exposure to blood and body substances.

• The long-sleeved gown or apron and disposable gloves should be removed and discarded into the clinical waste repository.

• Hand hygiene must always be performed following the handling of used linen. • Ensure linen is washed using hot water (>65 degrees for 10 minutes) with standard

laundry detergent. • Ensure shared linen is dried in a dryer on a hot setting. • Ensure personal laundry is laundered on site and not taken home by family members. • Restrict family members entering laundry. • Soiled linen trolleys are not over filled and are stored in a designated area. • Crockery and cutlery should be washed in a hot dishwasher or if not available, by hand

using hot water and detergent, rinsed in hot water and dried. Where possible move to disposable items.

• Trolleys and trays used for delivery of food should be cleaned and disinfected after use. • Hand hygiene should be performed after collecting or handling used crockery/cutlery.

https://tga-search.clients.funnelback.com/s/search.html?query=&collection=tga-artghttps://tga-search.clients.funnelback.com/s/search.html?query=&collection=tga-artg




20 Waste management Clinical waste includes waste from residents known or suspected to have COVID-19. The following should be considered clinical waste:

• Personal protective equipment (PPE).

• Any items soiled with blood or body fluids (urine, faeces and vomitus) such as dressing and wound care items, incontinence aids, tissues etc.

• Any disposable items that have come into contact with a resident with suspected or confirmed COVID-19 such as disposable cups, plates, cutlery etc.

Storage and collection

All clinical waste must be stored in a dedicated storage area. The following requirements must also be adhered to:

• The area must be signposted with the biohazard symbol

• The area must be secure and not visible to the public with access restricted to employees only

• The site should not affect nearby residents from odour or other

• The storage area must be weatherproof (have a roof and side walls)

• Have adequate containment measures to contain spills

• A spills kit must be available to clean up any spills containing disinfectant, bucket, gloves, disposable overalls, safety googles/shields, plastic waste liners

• A record of any spills, causes and corrective actions should be captured in Protecht. Collection frequency must be increased with waste licensed contractors to a minimum every 24 hours to prevent decay of certain wastes which starts to occur after this time. The amount of yellow clinical waste bins available at the aged care centre also needs to be increased with the contractor. 20.1.1 Preparing clinical waste for collection Follow these steps when preparing clinical waste for collection.

• Place yellow clinical waste bags directly into the clinical waste bins or if there are no clinical waste bins available double-layer in the yellow clinical waste bags and place in another suitable container such as a wheelie-bin or other rigid leak proof container.

• Ensure clinical waste bags are tied off with knots facing upwards and ensure all clinical waste bins are kept closed.

• Disinfect the lids, handles and top of the bins when you open, close and move them.

• After handling clinical waste ensure you wash your hands for at least 20 seconds using soap and water or use alcohol hand rub containing 60 percent alcohol.




21 Staff stations/desk areas Ensure the following

• Free of clutter

• No shared food or drinks

• Free of personal mobile devices

• Personal drink bottles/cups must be cleaned and labelled

• Regular shift cleaning of shared electronic equipment e.g. phones, computers

• Maintain physical distance when able to.

22 Stock control Refer to IRT- Aged Care Centres- PPE Stocktake Process

Local Outbreak Management Folder- PREPARE • Monitor stock of essential supplies – discuss available stock at each OMP meeting

• Ensure stocks of essential supplies are secured but accessible as needed

• Escalate stock issues immediately through your supervisor

• OMT maintain close contact with PPE Co-ordinator Note: Aged care providers that require PPE during an outbreak (free)

mailto:[email protected] IRT Quality & Compliance and Procurement Team can assist with this application process.

23 Visitors and communal activities During a COVID-19 outbreak, where possible, the movement of visitors into and within the aged care centre should be restricted. Aged care centres should implement the following:

• Suspend all group activities, particularly those that involve visitors (e.g. musicians)

• Postpone visits from non-essential external providers (e.g. hairdressers and allied health professionals)

• Facilitate and encourage phone or video calls or visits with a physical barrier (e.g. win-dow, balcony or fence) between residents and their families to maintain social contact.

• Inform regular visitors and families of residents of the COVID-19 outbreak, and request that they only undertake essential visits. Young children should not visit the aged care centre as they are generally unable to comply with standard precautions and PPE re-quirements

• Ensure visitors who do attend the aged care centre to visit an ill resident are recorded on a register of visitors and comply with the following guidance: o report to the reception desk on arrival o visit only the ill resident o wear PPE as directed by staff





o stay 1.5 metres away from residents, if possible o practice cough etiquette and respiratory hygiene o enter and leave the aged care centre directly without spending time in communal

areas o perform hand hygiene before entering and after leaving the resident’s room and the

aged care centre o a register is maintained and sign in includes a wellness check and screening for

association with COVID hotspot or other risk.

24 Admissions and transfers Admissions

Admission of new residents to an affected unit during an outbreak should not take place unless unavoidable. New residents and their families must be informed about the current outbreak and the control measures in place. Families may wish to make alternative arrangements until the outbreak is over. EGM – Customer and Marketing will be responsible for informing new residents via the CCC/Sales Team of the above.

Re-admissions Residents who were hospitalised for the infection can be re-admitted, provided appropriate accommodation and infection prevention and control requirements can be met.

• All readmission and transfers must be medically assessed for symptoms. A negative COVID-19 swab should also be requested where possible.

• Resident is monitored for signs and symptoms of respiratory infection 14 day including temp check minimum of daily.

• Resident may need to be isolated on admission/readmission where risk exists. The re-admission of residents that have not been on the COVID-19 outbreak case lists (i.e. they are not a known case) should be avoided during the outbreak period if possible.

Transfers • Wherever possible, confirmed case residents should be transferred to hospital for specialised

care in a health care setting.

• Transfers must be discussed with the resident/representative and medical practitioner.

• A transfer letter must accompany the resident in addition to their Platinum transfer documenta-tion. See item 24.3.

• If transfer to hospital is required, the ambulance service and receiving hospital must be notified of the outbreak/suspected outbreak verbally and through using a resident transfer advice form.

• Any resident that is suspected or confirmed to have COVID-19 must wear a surgical mask on transfer as tolerated.

1.48.005 (C) IRT COVID OMP- IRT Transfer Advice Form




Relocation Relocation of unwell or well residents may be advised to preventing the spread of infection. This must be done in consultation with the resident, NOK, Business Manager, EGM – Aged Care Centres and PHU. See item 9 of OMP Isolation and cohorting

Unaffected residents In some circumstances, it may be feasible to transfer residents who are not symptomatic to other settings (e.g. family care) for the duration of the outbreak. A risk assessment should be done to understand the family circumstances and health status prior to transferring residents. The family or receiving aged care centre should be made aware that the resident may have been exposed and is at risk of developing the disease. They should be provided with information regarding the symptoms of COVID-19 and the use of appropriate personal protective measures. Note: In residential aged care centre settings, security of tenure provisions of the Aged Care Act 1997 will need to be considered.

25 Monitoring outbreak progress Increased and active observation of all residents for the signs and symptoms of COVID-19 is essential in outbreak management to identify ongoing transmission and potential gaps in infection control measures. 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.

Updated information will be reviewed by the PHU for evidence of ongoing transmission and effectiveness of control measures and prophylaxis. The PHU will discuss this with the aged care centre OMT and advise of any required changes to current outbreak control measures. The OMT should review all control measures and consider seeking further advice from PHU if:

• the outbreak comprises more cases than can be managed.

• the rate of new cases is not decreasing.

• three (3) or more residents are hospitalised related to COVID-19, or

• a resident passes away due to COVID-19: telephone to notify the PHU of this.

Specialised advice is available from the following sources:

• A local state, territory or regional PHU.

• Infection control practitioners may be available for advice in local hospitals, state and territory health departments, or as private consultants.

• Geriatricians or Infectious Disease physicians may be approached for specialist manage-ment of complex infections.

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm




26 Declaring the outbreak over The time from the onset of symptoms of the last case until the outbreak is declared over ca vary. Repeat PCR testing of the quarantined cohort allows for close observation of the out-break and clarity regarding 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, who may recommend a longer period prior to declaring the outbreak over.

• Once the outbreak is over, it should be ensured that cluster reports are provided to relevant stakeholders and that data is summarised appropriately.

The OMT may make decisions about ongoing aged care centre surveillance after declaring the outbreak over, considering the following needs:

• To maintain general infection control measures.

• To monitor the status of ill residents, communicating with the public health authority if their status changes.

• To notify any late residents who pass away due to COVID-19 to the PHU.

• To alert the PHU to any new cases, signalling either re-introduction of infection or previously undetected ongoing transmission.

• To advise relevant state/territory/national agencies of the outbreak in an aged care centre, if applicable.

27 Review and debrief Consider debrief for any outbreak, a prolonged outbreak, or one with unusual features in relation to outbreak management – the PHU may participate in this.

• Involve all members of the OMT and any others who participated in the response to the outbreak.

• Identify strengths and weaknesses in outbreak response.

• Review what worked well during the outbreak and which policies, practices or procedures need to be modified to improve responses for future outbreaks.

• Platinum audit of clinical and nursing practice. A tool to assist in assessing outbreak response against best practice and is available at https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-47

https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-47




28 Key resources Communicable Diseases Network Australia (2020). Coronavirus (COVID-19) guidelines for outbreaks in residential aged care facilities. Australian Government Department of Health. https://www.health.gov.au/resources/publications/cdna-national-guidelines-for-the-preven-tion-control-and-public-health-management-of-covid-19-outbreaks-in-residential-care-facili-ties-in-australia Infection Control Expert Group (2020). Coronavirus (COVID-19) guidelines for infection pre-vention and control in residential care facilities. Australian Government Department of Health. https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infec-tion-prevention-and-control-in-residential-care-facilities First 24 hours- managing COVID-19 in a residential aged care facility. https://www.health.gov.au/resources/publications/first-24-hours-managing-covid-19-in-a-resi-dential-aged-care-facility

Communicable Diseases Network Australia (2020). Coronavirus Disease 2019 (COVID-19). Australian Government Department of Health. https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-corona-virus.htm

Protocol to support joint management of a COVID-19 outbreak in a residential aged care fa-cility in NSW Protocol to support joint management of a COVID-19 outbreak in a residential aged care facility (RACF) in NSW COVID-19 Outbreak Preparedness. Assessment for Residential Aged Care Facilities. http://cec.health.nsw.gov.au/__data/assets/pdf_file/0005/596588/COVID-19-Outbreak-Man-agement-Preparedness-Assessment-for-Residential-Aged-Care-Facilities.pdf Personal protective equipment (PPE) for health workforce during COVID-19 https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coro-navirus-covid-19-advice-for-the-health-and-disability-sector/personal-protective-equipment-ppe-for-the-health-workforce-during-covid-19

https://www.health.gov.au/resources/publications/cdna-national-guidelines-for-the-prevention-control-and-public-health-management-of-covid-19-outbreaks-in-residential-care-facilities-in-australiahttps://www.health.gov.au/resources/publications/cdna-national-guidelines-for-the-prevention-control-and-public-health-management-of-covid-19-outbreaks-in-residential-care-facilities-in-australiahttps://www.health.gov.au/resources/publications/cdna-national-guidelines-for-the-prevention-control-and-public-health-management-of-covid-19-outbreaks-in-residential-care-facilities-in-australiahttps://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilitieshttps://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilitieshttps://www.health.gov.au/resources/publications/first-24-hours-managing-covid-19-in-a-residential-aged-care-facilityhttps://www.health.gov.au/resources/publications/first-24-hours-managing-covid-19-in-a-residential-aged-care-facilityhttps://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htmhttps://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htmhttp://cec.health.nsw.gov.au/__data/assets/pdf_file/0005/596588/COVID-19-Outbreak-Management-Preparedness-Assessment-for-Residential-Aged-Care-Facilities.pdfhttp://cec.health.nsw.gov.au/__data/assets/pdf_file/0005/596588/COVID-19-Outbreak-Management-Preparedness-Assessment-for-Residential-Aged-Care-Facilities.pdfhttps://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-for-the-health-and-disability-sector/personal-protective-equipment-ppe-for-the-health-workforce-during-covid-19https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-for-the-health-and-disability-sector/personal-protective-equipment-ppe-for-the-health-workforce-during-covid-19https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-for-the-health-and-disability-sector/personal-protective-equipment-ppe-for-the-health-workforce-during-covid-19




29 Outbreak Management Team (OMT) – roles and responsibilities

Role Function

Chairperson (Senior Clinical Manager/EGM - Aged Care Centres).

The Chairperson is responsible for coordinating outbreak control meetings, delegating tasks, communicating with IRT shared service supports etc.

Co- Chair Public Health Unit (state/territory)

Lead the public health response and support the aged care centre in executing its role. PHU has specific roles and responsibilities outlined. Notify PHEOC Department of Health of any confirmed cases, residents who pass away, and recovered cases associated with an aged care centre (thus triggering the incident).

Secretary (Site Admin) The Secretary’s tasks may include organising OMT meetings, recording and distributing meeting minutes, coordinating printing and distribution of toolkit resources such as posters, assisting with approved resident and NOK communication, monitoring signage, restricted visitor wellness checking and sign in procedures.

Outbreak Coordinator (Qual-ity and Compliance Man-ager)

The Outbreak Coordinator needs to have a good understanding of infection control. The Outbreak Coordinator needs to ensure all infection control decisions of the OMT are carried out, coordinate activities required to contain and investigate the outbreak, and manage the line listing and PHU communication. IRT Quality & Compliance Team must be copied into daily line listing and OMT meeting minutes - [email protected].

Infection Control Coordina-tor (Educator or Senior Clini-cal Manager)

The Infection Control Coordinator’s responsibilities include promoting standard precautions, coordinating outbreak stock control, auditing infection control practices, including room set up and appropriate placement of signage. Consider this position to be covered after hours if able. Escalate PPE breaches to the OMT.

Workforce Coordinator The Workforce Coordinator resources staffing, assists with implementing a dedicated staff model including ensuring staff are appropriately rostered in terms of vaccination and training. Maintains casual pool list and contact with staff support resources such as trusted agencies

Resident/ NOK Communica-tion Representative (RN competent to co-ordinate and discuss residents condi-tion).

The Resident/NOK Communication Representative works closely with EGM – Aged Care Centres and the IRT Communications Team to ensure clear communication with residents and representatives. If able, two employees will be allocated to this role. One role specific to discuss the residents affected by COVID-19, the other to contact non-affected residents. Affected residents will be contacted up to two times per day.





Role Function

Stakeholder Communica-tions Coordinator

The Stakeholder Communications Coordinator works closely with EGM – Aged Care Centres and EGM – Customer and Marketing to ensure clear communication with all stakeholders.

PPE Co-ordinator Supports the aged care centre to maintain adequate levels of PPE during outbreak. • Assist to co-ordinate PPE • Assist to arrange PPE transport

General Practitioner/ Nurse Practitioner

Some GPs/Nurse Practitioners may be available to participate in the OMT and their role should be identified during the planning process. It is valuable to identify a clinical lead amongst those GPs/ NP who attends an aged care centre. In the management of an outbreak, the role of this person is important in facilitating assessment and management of ill residents, and in working with the aged care centre and the department to implement control strategies.

IRT Market St Support IRT CIMT • Support and oversee implementation of the OMP in

response to the outbreak in the aged care centre • Escalation team for issues not able to be re-solved within

the OMT • Ensure stakeholders are appropriately informed and IRT’s

brand/reputation is protected IRT Group CEO • Final decision maker for CIMT actions/decisions EGM – Strategy - CIMT Chair • Ensure efficient running of CIMT • Ensure action items are closed out in a thorough and timely

manner EGM - Aged Care Centres • Aged care centre expert on CIMT • Final decision maker for infection control risks • May chair OMT EGM - Customer and Marketing • Key responsibility for stakeholder engagement and

communication • Key responsibility for decisions/actions related to brand/

reputation EGM - Finance • Key responsibility for budget • Responsible for supplier/procurement issues • Responsible for outbreak procedures for IRT Catering




Role Function EGM - Quality and Risk • Responsible for development and maintenance of risk

register • Responsible for legal and insurance matters EGM - People and Culture • Key responsibility for workforce issues • Key contact for EAP support EGM - Information Technology • Key contact for technology equipment and support EGM - Retirement Villages • Responsible for outbreak procedures for Retirement

Villages (particularly relevant for co-located sites) EGM - Home Care • Responsible for outbreak procedures for Home Care Quality & Compliance Manager • Outbreak co-ordinator • Communication with ACQSC as required • Provision of additional resources, support and guidance as

needed • Outbreak Management Plan oversight and review as

required

Support to CIMT Executive Support Officer • Admin support/ minute taker CIMT Quality Support Co-Ordinator • Maintenance of IRT Group line listing register People and Culture Business Partner Assists Outbreak Coordinator and Workforce Planner to activate dedicated staff model and to implement staffing contingency or surge workforce as required.




30 Governance Trigger events requiring escalation to the Senior Inter-governmental Oversight Group: It is expected the provider, with support from the PHU, will lead the outbreak response, with support and advice from other parties including Commonwealth Government, ACQSC, NSW Government Local Public Health Unit (PHU), Local Health Districts, NSW Ministry of Health Public Health Emergency Operations Centre (PHEOC). The following issues are triggers that require decision making by the Senior Inter-govern-mental Oversight Group (described below):

• Rapid deterioration of the situation

• The provider does not demonstrate capability to effectively lead and manage the outbreak response

• The aged care centre premises are unsuitable to manage the outbreak effectively

• The Local Health District does not have capacity to provide a clinical outreach response

• Any other issue impacting on the effective management of the outbreak.

Aged care approved provider (IRT CIMT) not included in local OMP rol

irt group covid-19 outbreak management plan · document: 1.48.005 – irt covid omp (acc) page 1 of...

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