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NZACA Industry Advice

COVID-19 Q+A – 26 March 2020

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26 March 2020

COVID–19 Questions and Answers

NZACA Nursing Leadership Group, compiled by Rhonda Sherriff, NZACA Clinical Advisor

Click here to download this as a PDF

1. Wearing Personal Protective Equipment – are face masks effective against COVID-19?

  •  Surgical masks (face masks)The Centers for Disease Control and Prevention (CDC) does not recommend that people who are well wear a face mask to protect themselves from respiratory diseases, including coronavirus(COVID-19).

A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. Surgical masks are not to be shared and may be labelled assurgical, isolation, dental, or medical procedure masks.

If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping themfrom reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others.

While a surgical mask may be effective in blocking splashes and large-particle droplets, by designitdoes not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.

Surgical masks are not intended to be used more than once. If your mask is damaged or soiled, or if breathing through the mask becomes difficult, you should remove the face mask, discard it safely, and replace it with a new one. To safely discard your mask, place it in a plastic bag and put it in the trash. Wash your hands after handling the used mask.

Infected people should be asked to wear masks to prevent the spread of infected droplets from person to person and to avoid contaminating surfaces.Washinghands is essential to stop the spread of the virus and this should be reinforced at all times.

  • N95 Respirators

A N95 respirator is a respiratory protective device designed to achieve a close facial fit and very efficient filtration of airborne particles.

The ‘N95’ designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of face masks. However,even a properly fitted N95 respirator does not completely eliminate the risk of contracting an illness.

  • PPE in ARC facilities

PPE equipment needs to be worn correctly by all staff and visitors to be effective. All staff and visitors need to be educated and trained in good infection control practices including how to wear PPE equipment safely and appropriately, along with proper disposal techniques. Checks for compliance should be completed frequently by senior management and infection control champions on site to ensure staff are using the equipment competently.

Surgical masks are mainly available in aged care as a barrier protection, but quickly become contaminated by the wearer with their own breath and saliva. Surgical masks should be worn by all staff when they are at risk of contamination by resident cares (splashes, saliva, urine, faeces, etc),or used in management of residents who are isolated/infected (i.e. norovirus, Influenza A,COVID-19 etc.)

Staff should not be wearing surgical masks if they themselves are unwell -they should not be at work.

Visitors should not be visiting residents in aged care if they are unwell.

Patients/residents with COVID-19 should be encouraged to wear masks to prevent the spread of infected droplets, saliva, particles to others.

It is recommended that N95 masks be worn as protection in highly infectious areas due to their greater effectiveness (95%) against smaller particles.

2. How do we manage staffing of facilities and dedicated staffing areas?

Facility management should now be looking at how they manage their staff and delivery of care to residents within their facilities in the likelihood that a COVID-19 outbreak occurs. It is recommended that they consider having groups of staff rostered to specific areas of the facility, and not have them moving all through the complex. If there is an outbreak or contact with the virus, this will help limit the numbers of staff that will require self-isolation.

Rostering staff to a specific wing rather than across the facility will lessen their exposure and risk whilst caring for residents.

3. Must there be 48 hours clearance before sick staff can return to work?

Facilities should have a system in place to document all staff sickness,bothfor reporting purposesand for identifying trends, as the risk of COVID-19 increasesin the community. Staff will be asked to identify any flu-like symptoms when calling into site managementas a precautionary actionandthey will be expected tokeep management fully informed of the progression of their illnessand any positive test results.Staff must have 48 hoursclearance of any illness (symptom free) prior to returning to work.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz.

Rhonda Sherriff
NZACA Clinical Advisor

COVID-19 Q+A, NZACA – 18 March 2020

By Covid-19, NZACA Industry AdviceNo Comments

18 March 2020

COVID–19 Questions and Answers

Rhonda Sherriff, NZACA Clinical Advisor

Click here to download this PDF

How do we support staff who are fearful and anxious?

  • Hold regular and frequent meetings to ensure staff are kept fully informed of all the latest developments from New Zealand and overseas along with recommendations from the NZ Ministry of Health(MOH)on the management of COVID-19.
  • It is essential that you continue with an open-door policy for staff to be able to access management for discussions and support about staff’s concerns regarding the virus and its implications.
  • Electronic newsletters and messages can be provided quickly to staff and this will also keep them updated and knowledgeable on how to manage any outbreak.
  • Continued updates and reminders on good infection control practices and hand washing techniques are imperative to ensure staff feel confident in their abilities to manage an infection outbreak.
  • Be supportive of staff who are sick and off work for any period of time, and ensure you provide ongoing support to them on their return to work.
  • Provide access to external independent support or EAP (Employee Assistance Programme) for staff requiring additional support.
  • Continual support and reassurance will be required for all staff during the pandemic.

Do we need to have more than the usual back up supply of medicines?

  • It is essential that you hold good stocks of the following on your sites for pandemic symptom management: paracetamol as a first line defence in managing fevers (pyrexia/high temperatures), along with other types of analgesia for pain management, antibiotics for secondary infections and other base stock medications useful in managing people with infections. Your pandemic plan should have reference to the medication stocks that should be held on your site.
  • It is worthwhile having a discussion with your facility’s dispensing pharmacy on the service that can be expected from them during a pandemic outbreak, including access to more medications should you require them on your site, and the expected speed of delivery. This will then be considered part of your pandemic planning protocol.

What do we do if we can’t access PPE from the local DHB?

  • You should firstly hold significant stocks on your individual sites for a pandemic outbreak and be continuing to order stock supplies of PPE equipment from your suppliers in the advent of an imminent viral outbreak.
  • The MOH have informed us that DHBs should have adequate supplies stockpiled. Regional DHB Infection Control personnel are contacting sites to ensure they are prepared for the viral outbreak should it occur.
  • You should also contact your regional planning and funding manager now to ascertain the availability and accessibility of their stocks to our sector along with the process to be undertaken should it be required. This may vary amongst each regional DHB. Many DHB’s are already sending out information and holding ARC meetings around the country to provide this essential information to the sector, so ensure you attend these to be kept fully informed. Should we be restricting visitor access to our facilities?
  • We recommend that you diligently screen visitors before they enter your facilities, ensuring that they have not been overseas in the last 14 days, are not feeling unwell or have COVID19 symptoms, and have not been in contact with anyone who has recently returned from overseas, or has COVID-19 symptoms.
  • You should have signage in place around all entries to your facility with the instructions to visitors clearly displayed.
  • Should New Zealand move to widespread community transmission, you will need to implement stronger restrictions on visitors, but this has not happened yet. The MOH will provide recommendations should this occur and we will keep you informed and updated. How do we get APCs for nurses who have retired?
  • The Registered Nurses themselves will need to apply to the NZ Nursing Council and provide the required information for their APCs to be renewed, prior to them making themselves available to help in a pandemic outbreak.
  • The MOH and the NZACA have already been in discussions with the Nursing Council on how to expediate the process of APC renewal for retired Registered Nurses.

How do we staff our facilities if our workers are getting sick?

  • You will need to develop a contingency plan (if not already written into your business continuity plan) that describes how the site is to provide residents care with a diminished workforce. This will include a structure of revised care delivery able to be provided with fewer staff.
  • This is an opportunity to be creative in managing the care for residents with reduced access to staff and resources. Ultimately, we will need to be able to manage our sites and resident care with the onsite resources available. When developing a plan, I recommend you consider:
  • How you manage the residents’ care in a time of pandemic outbreak. This will include a review of all service delivery (meals, cleaning, laundry, maintenance, care delivery, medication administration/management, infection control practices, activities, etc) and what you can safely reduce (or increase) without putting residents’ lives at risk.
  • How the facility runs with the least numbers of staff available (night shift) and whether this is feasible and can be modified to work over a longer period. Determine what are the resident care priorities.
  • How communicating with residents/families will occur and how this will be achieved.
  • Can your staff multi-task and if so, how? I.e. can your activity coordinator work as a cleaner or carer?
  • When rostering, is there scope to change hours of duties (longer or shorter), have teams of people sleep over, and provide meals to staff as well as residents to maintain the workforce?
  • Are there any volunteers who can assist with some tasks following full infection control training? Should I be recording where my staff have travelled to, or are travelling to?
  • Yes, you should keep a record of where staff have travelled to or are travelling to and be encouraging staff to reconsider their travel plans to destinations that would put themselves at risk.
  • You should be compiling a list of staff who have returned from overseas travel and are selfisolating for 14 days, should the MOH or government departments require this information.
  • As with all pandemic and infection outbreaks you will be required to submit a list of affected staff (and residents) to the Public Health Department.

Will my insurance cover me for having to pay staff to self-isolate for 14 days when they only get 5 days sick leave?

  • Most insurance companies do not provide cover for pandemic outbreaks in their insurance policies and have a clause that precludes them from having to pay out cover in this type of situation, however this is individual to each facilities/company’s policy.
  • I recommend that you read your insurance documents clearly, especially the fine print regarding pandemic outbreaks and clarify with your individual insurer whether they cover this type of event, or not.
  • Refer to the Government’s Employer COVID-19 wage subsidy and leave payment scheme announced on 17 March 2020.

Rhonda Sherriff
NZACA Clinical Advisor

COVID-19 An update for members

By Covid-19, NZACA Industry AdviceNo Comments

COVID-19 An update for members

Simon Wallace, Chief Executive

The NZACA has sought an urgent meeting with the Associate Minister of Health, Hon Jenny Salesa, to brief her of all the risks associated with COVID-19 (formerly known as coronavirus) should there be an outbreak in an aged residential care (ARC) facility. While the ARC sector is set up to deal with viral outbreaks such as norovirus and influenza, it does not have the staffing to deal with what could be a significant COVID-19 outbreak.

As advised last Friday, we are also waiting for further information from the Ministry of Health (MOH) and District Health Boards (DHBs) as to how they will be supporting the ARC sector, a point we will also emphasise with the Minister. We have asked the DHBs if they have enough medical supplies for our members in the case of pandemic and we are also seeking confirmation of what other steps the DHBs have put in place to support us, particularly if we need to move a resident to a public hospital.

The NZACA and the Retirement Villages Association (RVA) are setting up a taskforce of key members and clinical advisers to act as a conduit between the wider sector and government agencies, Ministers and MPs. This is so they are aware of the impact of COVID-19 on the sector and its residents.

Should you receive any approaches from the news media about COVID-19, in the first instance could you please direct them to me at the Association.

It is important that members stay abreast of the information that is being updated regularly on the Ministry of Health website and Immigration New Zealand’s website.

The NZACA’s clinical advisor, Rhonda Sherriff, has provided some useful information and tips below with respect to preventing, but also managing an outbreak should it occur in an ARC facility.

COVID-19 Clinical Management in Aged Care

Symptoms:

COVID-19 makes people sick, usually with a mild to moderate upper respiratory tract illness, similar to a common cold. Symptoms include a runny nose, cough, sore throat, headache and a fever that can last for a couple of days.

For those with a weakened immune system, the elderly, and the very young, there’s a chance the virus could cause a lower, and much more serious, respiratory tract illness like a pneumonia or bronchitis.

ARC staff will need to be extremely vigilant with continued assessments of residents showing these types of symptoms; confirming diagnosis, monitoring symptoms and providing treatment due to the increased risk of residents’ weakened immune systems and a higher likelihood of acute decline from pneumonia and bronchitis in the aged population.

How does it spread?

Person to person transmission happens when someone comes into contact with secretions, such as droplets in a cough, from an infected person.

Depending on how virulent the virus is, a cough, sneeze or handshake could cause exposure. The virus can also be transmitted by coming into contact with something an infected person has touched and then touching your mouth, nose or eyes. Caregivers can sometimes be exposed by handling a patient’s waste, according to the Centre for Disease Control (CDC).

The virus appears to mainly spread from person to person.

“People are thought to be most contagious when they are most symptomatic (the sickest),” the CDC says. “Some spread might be possible before people show symptoms; there have been reports of this occurring with COVID-19, but this is not thought to be the main way the virus spreads.”

Surveillance and Risk Assessment: Staff will need to ensure all infection control practices are fully implemented immediately, with the resident placed into full isolation and protective measures/practices totally adhered to. This will include the wearing of masks (due to infected secretions), gowns and gloves (due to the risk of touching resident body secretions, infected surfaces, etc.), and management of all waste that exits the resident’s room.

How is it treated?

There is no specific antiviral treatment, but research is underway.

Experts advise seeking care early. If symptoms feel worse than a standard cold, see your doctor. Doctors can relieve symptoms by prescribing a pain or fever medication. The CDC says a room humidifier, or a hot shower can help with a sore throat or cough. Most of the time, symptoms will go away on their own.

People with COVID-19 should receive supportive care to help relieve symptoms. In some severe cases, treatment includes care to support vital organ functions, the CDC says. People who think they may have been exposed to the virus should contact their healthcare provider immediately.

Residents will require treatment for their symptoms that includes an increase in the consumption of fluids to maintain hydration, rest, treatment for pain and high fevers (use of Panadol, tepid sponging or showering etc), similarly as for the influenza symptoms.

How long is the incubation period?

Quarantine is usually set up for the incubation period – the span of time during which people have developed illness after exposure. For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar illnesses.

To ensure the prevention of spread of COVID-19 it is imperative to isolate any resident with exposure to the virus or exhibiting these symptoms and implement all full isolation practices. As recommended, the quarantine period is 14 days.

How can you prevent it?

There is no vaccine to protect against COVID-19, at least not yet.

The US National Institutes of Health is working on a vaccine, but it will be months until clinical trials get underway and more than a year until it might become available.

Meanwhile, you may be able to reduce your risk of infection by avoiding people who are sick. Cover your mouth and nose when you cough or sneeze and disinfect the objects and surfaces you touch.

Avoid touching your eyes, nose and mouth. Wash your hands often with soap and water for at least 20 seconds.

Awareness is also key. If you are sick and have reason to believe it may be COVID-19, you should let a healthcare provider know and seek treatment early.

Actions for facilities to undertake prior to an outbreak:

  • Read and review your outbreak/pandemic policy to ensure management and staff are familiar with all protocol.
  • Keep updated with the daily updates on the Ministry of Health website.
  • Revisit and review your onsite infection control practices, along with educating and reinforcing these to all staff who work within your facility. Infection control practices should be reinforced at staff, resident, and family meetings. This includes repeating infection control competencies (handwashing, use of personal protective equipment, cleaning schedules, waste disposal etc).
  • Review and plan how you would allocate staff to work with those affected by COVID-19. Have nursing staff specifically allocated to manage the affected residents. Identify those staff who already have health compromising issues, (i.e. pregnant, asthmatic or respiratory-compromised staff) and ensure that these staff remain safe.
  • Review the delivery of communal activities (meal delivery, activities etc.) and what actions are to be taken (i.e. cancellation) until the risk to residents is considered over.
  • Review the stocks of personal protective equipment on your site and ensure you have good stocks of face masks, disposable aprons, disposable gloves, etc. There appears to be limited stocks available currently from NZ suppliers, but America is increasing production to meet current world demand.
  • Review and increase your current base stocks of food, fluids, chemicals and medications to ensure you have enough to manage any outbreak, as supply could be affected. These should be dated and used in general circulation if they are not required to be used during the outbreak.
  •  Review the supply of oxygen cylinders and oxygen concentrators you hold on site and determine whether this would be sufficient to manage higher numbers of residents who experience respiratory distress. Older severely compromised residents may develop acute respiratory distress as a result of this virus.
  • Review the cleaning and waste management/disposal systems you have in place – and what is required during an outbreak (protocols for cleaning staff instructed to chemically wipe down surfaces, disposal of waste from affected residents etc) to maintain high infection control standards.
  • Consider limiting access by identifying one point of entry to your facility, thereby ensuring you monitor all staff/visitors access to the site.
  • Contingency planning: think about how you would manage staffing within your facility if you had significant staff sickness (i.e. staff affected by the outbreak and unable to work) and no access to bureau staff (who will unlikely be available). How would you provide continuity of care with less available staff? This will be individual to each site but document the plan for reference. • Consider now how you will maintain communication/contact with residents, families, staff and visitors to update them with the management of an outbreak. This will include messaging, emails, phone calls etc.
  • Have a system ready to implement to maintain records of infected residents, treatment and outcomes, to provide to Public Health.
  • Ensure you are aware of who your local DHB Planning and Funding Contact and Infection Control specialists are and how to contact them for advice and additional resources.
  • Discuss how transfers of any infected resident to hospital would occur with your local St Johns ambulance service to ensure all infection control protocols would take place (prior to an outbreak).

This advice will continue to be revised and updated as changes occur.

New Zealand Aged Care Association
PO Box 12481, Wellington 6144
p: 04 473 3159 | w: www.nzaca.org.nz | e: office@nzaca.org.nz

Simon Wallace
Chief Executive