We have been watching the COVID-19 case numbers in Sydney and particularly south west Sydney on a daily basis. In the past week we have had a positive case at a school across the road from one of our larger sites, a case from a church in Bankstown and several restaurants with positive patrons in our area. Yesterday Dr McNulty, from NSW Health, stated in a media briefing that NSW was ‘at a knife’s edge, a critical point’ and today the Premier has confirmed this view. The media has also reported the high rate of community transmission in Melbourne has contributed to the significant number of outbreaks in aged care.
We believe NSW needs to heed the lessons from Victoria and minimising community transmission is one of the best ways of keeping COVID-19 out of aged care homes. Prior to the recent changes to visiting at our BCAC facilities we had an average of 400 people visiting our larger sites per week (over the 4 day visiting times allocated). Whilst it is wonderful to see so many of our residents have contact and important connection with families and friends it does increase the possible exposure to community transmission.
Last night aged care facilities received written advice from Dr Kerry Chant from NSW Health that any visitors who have been in the following local government areas (LGA’s) should be excluded from visiting the facility: Waverley, Woollahra, Randwick, eastern part of Sydney, Parramatta, Fairfield, Liverpool, Campbelltown, Camden, Wingecarribee and Wollondilly.
Based on the information we have available to us, we believe it is prudent to MAINTAIN THE CURRENT VISITING RESTRICTONS we have in place for a further 2 weeks, with one change. During the past 2 weeks visiting was restricted to families of residents needing end of life support, and we are going to broaden this to any resident who has shown a significant deterioration in the past few months. This will allow families to spend time with their loved one who may be approaching the end of life phase. Our clinical team have been updating the primary contact of each resident on a weekly basis and will have mentioned to you if your loved one is stable or if they have noticed a significant deterioration. If you believe your relative fits into this category please call the manager of the facility to discuss this further.
Balancing the risk to our residents and at the same time trying to keep them engaged and connected to those that are important to them is not easy. We absolutely understand that this will be disappointing to many of you that want visit your loved one and we ask for your support and understanding at this time.
OUTBREAK MANAGEMENT AT BCAC
As the nation watches the number of COVID-19 virus outbreaks in aged care homes in Victoria grow each day I know our families and residents are interested in how prepared BCAC is for an outbreak. Before detailing our outbreak plan I would like to remind you our aim is always PREVENTION of an outbreak, however as you will be aware someone who has the virus does not always present with symptoms.
In previous newsletters I have outlined our prevention strategies such as temperature checking, health declarations, masks, targeted cleaning, staff training, strict hand hygiene practices and competencies etc. In addition, any resident with any symptoms are immediately isolated and tested for the virus. Stringent protocols are in place for monitoring staff health and they are not be allowed to work with any symptoms, even mild ones.
Based on the known facts that someone may carry the virus into the facility without being aware they have the virus our next line of defence is EARLY DETECTION AND INTERVENTION. The earlier we know about a positive resident or staff member the quicker we can activate our outbreak management plan. Immediate isolation of the positive person is critical to prevent any further transmission.
What steps will we take once a positive case is identified?
If a resident is in isolation whilst waiting for a test result and the facility is notified that have COVID-19 virus they will remain in isolation.
The nominated primary contact for the resident/s who have tested positive will receive a phone call from a senior member of the organisation and the resident will also be told about the result.
The NSW Public Health Unit will be notified as well as the Commonwealth Department of Health.
ALL other residents will be placed in isolation until the PHU can provide advice on testing.
All non-essential people in the facility will be asked to leave the premises and the facility will be placed into lockdown.
The BCAC Outbreak Management team will immediately commence enacting our protocols based on very clear role delineation. The local Public Health Unit, GP’s, senior nursing staff, Chief Operations Officer, Governance Manager and CEO will oversee all the necessary and critical steps to manage the outbreak.
All residents, staff (not on duty), families and key stakeholders will be informed via email of a COVID-19 diagnosis within the residential aged care facility. This will only occur once the families of the positive residents have been notified via phone.
What will happen if a staff member tests positive?
The Public Health Unit (PHU) will provide advice to BCAC and will review the date the employee last worked and which staff and residents they may have come into contact with whilst they have been infectious. Residents and families will be notified that a staff member is positive and will also be informed about the recommendations of the PHU.
What residents and staff would be tested?
This will be determined by the Public Health Unit and will occur on site for residents. Swabs are sent to a nominated lab and results are fast tracked for all aged care cases.
How many people need to be infected with the virus for an outbreak to be declared?
A single case of either a resident or staff member in aged care testing positive is considered an outbreak.
Do you have enough personal protective equipment for an outbreak?
Stock levels are maintained to ensure we could manage an outbreak at our largest sites for 3 days. The Commonwealth government issues PPE to all facilities when an outbreak is declared and before the BCAC stock levels were low the government supply would be available.
What plans do you have for replacing a large number of staff that may need to self- quarantine once an outbreak is declared?
BCAC has surveyed staff on who would be available to work additional shifts and once roster gaps are evident a text message would be sent to all BCAC staff requesting they contact us to pick up additional shifts. In addition to this we have a written agreement with a nursing agency who have guaranteed to prioritise BCAC to fill our roster.
How will the staff who are not familiar with the resident’s usual care needs be able to provide care?
Last year we implemented a clinical software system called Leecare. All residents care needs are documented in this system and we will be providing orientation to any new staff ON EVERY SHIFT so they can use the information to provide the care needed. We can produce paper reports to use for handover which is a vital way of communicating the needs of a resident.
Have staff been trained in the use of PPE and will the relief/temporary staff know how to use PPE?
All existing staff have completed several rounds of PPE training and have completed a competency assessment. We are also auditing adherence to our protocols and have taken a very tough stance with any staff not following our requirements.
As part of the written agreement with the nursing agency 100% of the staff have completed PPE training (using the government released video) and once they commence work with BCAC they will receive additional training BEFORE being allowed to commence duty.
What types of strategies will the Public Health Unit recommend to protect residents who do not have the virus?
This could be anything from sending the residents who test positive to hospital through to creating a COVID wing (depending on the number residents that may be positive). Grouping residents with the same infection/medical condition is commonly called cohorting. This may mean residents have to move rooms at very short notice within the facility and BCAC will be guided by the Public Health Unit team.
What happens to meals if kitchen staff are required to isolate?
Our dietician has prepared an alternate menu that is balanced nutritionally and is designed to use in circumstances like an outbreak. It will mean the normal menu will not be available during this time.
What communication will families receive once an outbreak is declared?
We recognise communication to our families is CRITICAL and we have carefully thought out how we can ensure we meet your needs and expectations for information, and we want to be transparent about how this will work.
The primary contact of the resident will be notified as soon as a positive result is received.
All families currently on the email distribution list will receive an email advising you of the positive case and the likely next step ie. testing is recommended and approximate timeframes if we know this.
We have a communication plan that will ensure the primary contact is kept informed of all critical information. We have also engaged qualified counsellors to assist families with enquiries and to offer support as required.
What can families do to help during an outbreak?
The best way you can assist us is to have the nominated person/contact that we have listed in our clinical system provide information to the rest of the family and friends of the resident. We have some very large families in our community and although we have a strategy to bring in additional help to answer phones and provide information during an outbreak there are reports of calls in excess of 1000 per day once an outbreak is declared.
We have a plan to facilitate communication between the residents and their loved ones via phone/skype etc and we will do everything absolutely possible to keep you informed and connected to your loved one.
Where do I get more information?
If you have more questions about our plan you can contact our managers. We will also keep a log of all the questions so we can include them in the next newsletter.