Activity Risk Management in COVID-19

Risk management planning for activities just got a whole lot harder with the COVID-19 outbreak.

Where we used to simply need to look at the physical issues that related to an activity (for example, perhaps the daily temperatures, the physical environment that the activity would be held in, and the participants themselves), we now need to also include planning for social distancing and stricter monitoring of participant health on the actual day.

Let’s look at what will be included in the planning and running of activities over the next year because let’s face it, we’re probably not getting a vaccine until early 2021. We can’t sit around twiddling our thumbs until then!

Any activity planning should always consider the risks that could be involved in running that activity, and what you need to do to mitigate these. Now they also need to consider the additional infection risk as well.

State and Territory Health Departments have provided advice on what is allowable in relation to the provision of activities, for example, numbers per square metre in restaurants, cafes, clubs, and pubs.

Spatial risks

Firstly, consider the spatial environment where you hold activities. Many workplaces are restricting meetings and contact opportunities, such as meal breaks, to less than 15 minutes of face-to-face time to minimise the time spent in close contact with others. This is designed to limit the potential for passing on the virus between work teams, as the longer you are in contact with an infected person the greater the potential for infection.

If you are running activities though, you are more likely to spend an extended time in closer proximity to others, increasing the risk to yourself and older consumers. Check your State/Territory guidelines, as some specify a maximum of two hours.

When planning an activity, you always need to consider the location of an activity. Is the terrain suitable for the clients? Does it have amenities? Are there any inherent dangers to the clients?

Now you also have to consider how likely a person is to come in contact with coronavirus. The general consensus has been that there is a lower risk of acquiring the coronavirus in outdoor settings, as the fresh air dissipates infectious droplets faster.

However, this doesn’t mean that outdoor settings are always the best or without risk. If clients are touching handrails or sitting on shared park benches or at public picnic tables or even using public amenities, they may come in contact with the virus as it can remain viable (able to infect someone) on surfaces for a few days. This is why the frequent use of hand sanitiser and appropriate cleaning is incredibly important.

Should you decide to hold your activity inside, you’ll need to consider social distancing rules and identify surfaces that are touched often, such as cards or balls that the virus may adhere to. The general rule is one person per 4 square metres. Where people are able to maintain social and physical distancing, then you will also need to consider what measures are needed to manage individual behaviours.

Mitigating the risk

Briefing Sessions

To address some of these risks, you may need to hold briefing sessions for staff and provide clear information for clients. Highlight to them the risks involved in participating in activities and how you will be changing processes to keep people safe.

Printing out posters and storyboards, like the ones that the Aged Care Quality and Safety Commission have recently published on their website, and placing them on the walls around the centre also reinforces new habits and serves as a reminder.

Location

When considering the location of an activity, reflect on how likely it is for a person to be exposed to the coronavirus. A trip to a busy shopping mall might pose too high a risk, especially during school holiday periods, but a trip to the local beach might be perfect, especially if clients are encouraged to bring their own folding chairs to sit on, minimising the contact with shared facilities. Bottom line is – do not take vulnerable people to crowded places where it's difficult to ensure social and physical distancing.

Hand Washing and Sanitiser

While not a replacement for washing hands with warm, soapy water, hand sanitiser is useful for times when hands may have accidentally come in contact with an infected surface, such as handrails or tabletops. Pulling together a COVID-19 safety pack that goes out with the group on activities is useful, especially if clients don’t think to bring hand sanitiser with them.

Clients should also be encouraged to either wash their hands or use sanitiser before eating or drinking and after getting back into the bus or car to minimise the risk of infection.

At centres set up sanitiser stations around the room and encourage people to use these regularly. Staff should set a good example by using the stations regularly as they circulate to assist participants and by reminding participants whenever relevant.

Cleaning

Where activities occur at a centre, regular cleaning and disinfecting of the centre and equipment is important, including wiping down table tops and door handles.

Try to minimise cross-contamination contact by requiring participants to either wash their hands or sanitise before participating in an activity. Try to run activities that don’t require sharing of objects or items, for example, playing bingo with disposable cards rather than playing a game of poker where cards get passed around from hand to hand.

When out and about on excursions, it’s likely that someone will need to use public toilet facilities. I’ve noticed lately that a lot of facilities are being cleaned more regularly, however, it is worth considering taking additional cleaning products and giving facilities a quick clean to be doubly sure before clients use them.

Disposable cups and plates

Yes, I know that we have become very aware of the disposable society we have become. We’ve been trying really hard to minimise single-use, disposable items and then along comes COVID-19 and we’re back to using disposable cups again.

All the china needs to be packed away for now. Stick to disposable items when providing morning teas and lunches, and have bins strategically placed around the room or venue so that people can put the rubbish directly into a bin themselves, minimising the need for others to touch used items.

Serving clients food instead of letting people pick up shared serving utensils is also a measure that needs to be considered.

Transportation Risks

Many activity programs include an element of transportation. This could include picking up participants and transporting them to a venue, or transportation may form part of the activity, such as going out to a park or other venue off-site.

Again, there are risks relating to infection transferral that need to be considered and mitigated as much as possible when transporting clients. Travel, often in a small bus, is an activity that occurs in a confined ‘indoor’ space and there is little possibility of social distancing being maintained under normal operating conditions. For example, in a standard Hiace vehicle, you can maintain appropriate distancing by going ‘corner to corner’ and blocking alternating seats.

Mitigating the risk

Social Distancing

Transport practices need to change, at least in the short term while we wait for a vaccine. Instead of the drivers going out and picking up everyone and dropping them off to the centre for the activity, they may need to make a few runs.

This might mean picking up fewer clients each run and asking clients to space themselves out in the bus, perhaps one person to every two seats to maintain the necessary distance. The shorter run will also mean people are not ‘confined’ in a small space with others for an extended period of time which reduces the potential for picking up an infection.

If clients are picked up individually and transported by car it is best for the person to sit in the rear seat of the car to maintain the required distance.

Checking with clients on their health status

It is essential that transport drivers check the health status of clients before they get on the bus or into the car. The driver should be briefed with a simple set of questions to ask each person and know what to look out for. Questions may include:

• Have you been overseas or travelled on a cruise ship in the last 14 days?
• Have you been in contact with a confirmed or suspected case of COVID-19 in the last 14 days?
• Are you in close contact with or caring for someone who is currently unwell?
• Have you currently, or within the last 7 days, been unwell?
• Have you had any of the following symptoms: fever, night sweats or chills; cough; runny nose; sore or scratchy throat; shortness of breath.

If the driver has any concerns about the health status of the person they need to be able to respond appropriately (tactfully and respectfully let the person or their carer know they will be unable to board the bus until cleared) and alert management of their concerns so this can be followed up immediately.

Cleaning

Of course, it goes without saying that the cleaning of vehicles is an important part of infection control. The driver should ensure that the vehicle is cleaned and disinfected between groups if picking up multiple groups, and also before transporting clients home again and at the end of the day. Yes, we’re all going to have sparkling clean transport vehicles over the next few months!

Participants

Participants themselves have the potential to be the biggest risk. The virus needs a host and that host is us. Humans spread the disease to each other and unfortunately, that could include the clients themselves. Clients attending activity sessions need to understand the risk to themselves and their friends, family and companions and that they could be carriers of the disease without realising it.

Most people will understand and be alert to the potential of passing on or picking up an infection from another person, however it can be difficult for some people to understand or remember to practice social distancing. This can include people with dementia and people with cognitive impairment, or it could be people who simply don’t understand the risks.

There are also the ingrained habits that people have. Do you have group members who naturally reach out to give a hug to someone? Group organisers need to be aware of this and come up with ways to make others aware and limit contact, e.g. promote ‘elbow or foot’ greetings. This quirky new alternative to shaking hands and greeting with a kiss has started to become a new ‘norm’.

Mitigating the Risk

Education and Awareness

Every person attending group activities should be briefed on expected social distancing behaviours during the activities. This could be delivered as part of a ‘return to activities’ education session or in education materials that are distributed to attendees prior to the recommencement of group activities.

Additional Support

While we never want to exclude someone from attending activities, we do need to ensure there are practices in place to support and encourage appropriate behaviours to protect other vulnerable clients. This might include encouraging family carers to accompany a person to activities and support the person to maintain social distancing and assist in hand washing and sanitising activities.

Temperature checking

Most services are asking staff to carry out a simple temperature check and maintain a log each day before they attend work. This is designed to pick up a rise in temperature that might indicate the person has picked up a virus or some sort of infection. It might also be relevant for temperature checks to be carried out on activity participants before activities commence, especially if there is an active outbreak in the community.

While we don’t want to see people live out the last years of their life in fear of the wider community and environment, we want to make sure that any activities programs include risk planning and mitigation. What other aspects of risk planning do you think that people need to include?

At CDCS, we’re proud to have partnered with the Aged Care Quality and Safety Commission to develop a series of storyboards that emphasise key issues and topics of importance at this time for consumers, residents, family members and support staff. The StoryBoard on ‘Social and Physical Distancing – Keeping Safe’ is a key resource that you can access now to help reinforce messaging for staff and consumers.

Click here to go directly to the storyboards page. Look out for more that will be uploaded over the next few weeks.

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.