Be Prepared for Winter – Good Infection Practices are not just for COVID

On the 11th March 2020, the World Health Organisation (WHO) declared COVID-19 a pandemic.

Although they downgraded the status of the pandemic from a ‘public health emergency of international concern' in May 2023, it still remains a global health risk. This means we can't get complacent. COVID, like the influenza virus, is here to stay. It's circulating widely and evolving – it's just that it is no longer an unusual or unexpected event.

Every year the cases of “flu” and other respiratory illnesses, including COVID-19, rise during winter, placing older people whose underlying health condition may be impaired at increased risk. During winter, people tend to remain indoors more often, allowing viruses to pass more easily from one person to another. And the dryer air caused by warm, airconditioned rooms doesn't help.

This is why we need to remain vigilant and follow good infection control practices that minimise the spread of infectious diseases.

Before COVID-19, we probably all had some level of policies, procedures and practices for managing infectious outbreaks. In residential care, we had annual influenza training and processes to address the seasonal risks. We had Infection Control Practitioners (IPC) and PPE (although in a much smaller volume).

Most of us probably thought we were well-equipped… but we had never lived through a pandemic.

For many of us in aged care, the legacy of COVID-19 is a far more robust Infection Control (IC) system. Today we have extensive IC policies, procedures, and practices, IPC Leads, a plethora of support materials, and an abundance of training resources that we can call on. Let's put that to good use this winter.

Avoiding Transmission

Infection prevention and control (IPC) is about protecting consumers and staff from avoidable infections and minimising the rise of antimicrobial resistance. If we can eliminate the risk (one of the first steps in IPC) we’re going to be more successful in protecting vulnerable seniors.

One of the fundamentals of IC prevention is breaking the chain of infection. Breaking that chain means following your organisation’s Hierarchy of Controls.

This begins with avoiding transmission to start with. People who are feeling unwell should not ‘soldier on’ as the cold and flu tablet manufacturers would have us believe. This message certainly aged very quickly during the worst of the pandemic and has no place in an aged care service where there are large numbers of vulnerable seniors. If you are ill, stay home.

And since we often don’t know the infection status of others, our first line of defence is to treat everyone as though they may have an infection (incubating). That way, you protect yourself as well as everyone you meet or are caring for.

Standard precautions are used for all resident/client care. You know – washing your hands, following good respiratory hygiene and coughing etiquette, and using personal protective equipment (PPE) such as masks and gloves.

Vaccination

Where does vaccination fit into the equation?

We’ve discussed this before in another blog post. Vaccination, also part of the elimination phase of the IPC hierarchy, is one of the ways we can help minimise risk in the aged care workplace. The more people, both staff and residents or clients, who are vaccinated against infectious diseases such as influenza and COVID, the lower the virus load circulating in the community, which lowers the chance of people coming in contact with the virus.

Cleaning

We got super focussed on cleaning surfaces during the peak of the COVID pandemic – let’s not drop the ball.

We still need to apply good cleaning and sanitisation practices to maintain a clean environment. Just think of how many hands touch that door handle or light switch each day!

You can update your knowledge on cleaning practices with this free online training from Gamma Health Care. Your workplace is also likely to have a number of training resources related to cleaning, so check those out as well.

Substitute where necessary

Another learning we took from the pandemic was how easily virus particles could be aerosolised. Workplaces replaced practices that were more hazardous, such as administering aerosolised medicines using spacers instead of nebulisers, to prevent exposure to aerosols. Where relevant, use these safer options when you have an infectious outbreak or a person is showing signs of infection.

Engineer your infection control

Reduce the infection risk by applying environmental controls.

For example, isolate people who are unwell or displaying symptoms of respiratory infection. Optimise ventilation and air quality, such as opening the window for airflow (if it’s not too cold), and follow your cleaning and sanitising protocols between resident rooms or between groups of clients using a space such as a communal meeting or activities room.

Change the way people work

You can put in place Administration controls that change the way people work. Policies and procedures are not static documents, and they should be reviewed and updated to reflect learnings and new requirements.

The team at CDCS are constantly reviewing our policy suite for the benefit of our TQP subscribers. If you need up-to-date, reform-compliant policies, you may want to consider becoming a member to get access to up-to-date policies, procedures and work instructions, as well as a range of other resources to support your team and help take the stress out of your next quality review or audit.

Training staff is also important. In residential care, education on the benefits of the annual flu injection has been in place for a number of years, and we are now seeing more home care providers implementing this training as well. The Australian Commission on Safety and Quality in Health Care has a free learning module suitable for aged care staff.

Check out the signage on your walls and ask yourself, “Is this still correct?” Too often, we become so immune to the message of a sign it no longer holds any meaning or becomes invisible; we don’t see them.

An outbreak may be over but your signage still says, “Stop, do not enter.” Add checking signage to your weekly environmental checklist.

But what about PPE?

Yes, I know, PPE is often the first thing we think about when we are talking about infection control, but in the hierarchy of controls, it is one of the last things we think of.

Just think back to the time when we were all wondering whether to ‘mask or not’. This was because all the other measures, combined with social distancing, were mostly successful in controlling the spread of COVID.

But in aged care settings, you are working closely with vulnerable seniors, so additional barriers such as masks, shields, aprons and gloves provide that extra protection. After all, you can’t shower someone from three metres away.

One other consideration when applying PPE is to wear it properly. How many people did you see wearing a mask in 2020/21 that was sitting under their nose or even their chin? That wasn’t going to protect anyone!

If you are asked to wear a mask in your workplace to protect residents or clients, make sure it fits properly, and you don and doff it correctly. This should form part of your staff training practices, both in orientation and through updates each year. Of course, if there is an infectious disease outbreak, you might need to run refresher sessions for all relevant staff.

If there has not been an outbreak for a while, the first question may be what PPE is required to manage this infectious disease? This link is a great quick list for standard and transmission-based precautions.

And here is the link to the various posters on PPE and outbreaks, which is also a great resource in the case of an infectious disease outbreak.

Issues regularly observed in audits

When the Aged Care Quality and Safety Commission auditors visit to conduct a review, they are not only looking at your written policies and procedures, they’re observing staff.

One area that they’ve concentrated on over the past few years has been an organisation’s infection control practices. Even during the height of the pandemic, auditors noted a number of concerning issues that placed residents or clients at risk. These include the staff:

• wearing masks incorrectly
• frequently touching their face or mask
• not routinely cleaning shared resident equipment such as hoists
• donning and doffing stations not clearly identified
• failing to have PPE (such as gloves, masks, hand washing/alcohol-based hand sanitiser, and disinfectant wipes) readily available
• shared equipment, such as phones or computers not routinely being wiped down between users
• lack of physical distancing between staff

So if you have an outbreak of influenza or COVID or even another infectious disease, keep these issues in mind and put in place processes to address these and mitigate the risks to vulnerable people.

The Australian Commission on Safety and Quality in Health Care has some awesome resources, and you can subscribe to their weekly updates.

It is the responsibility of everyone working in healthcare, aged care and home care to practice good infection control as part of their duties and accountabilities. Do your bit for those you support.

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.