Download as PDF: Incident action plan for COVID-19 outbreak management in disability residential group homes

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Purpose

The purpose of this Incident Action Plan (IAP) is to provide Disability Group Homes with clear public health advice on actions to manage an outbreak of COVID-19 and prevent further transmission after a confirmed case is identified associated with the home.

The companion documents that may be read together with this IAP are the:

In this document a Group Home is defined as a residential service for two or more people with disabilities. Residential services include those supported by NDIS funding for supported independent living, specialist disability accommodation, short-term and medium-term accommodation, assisted boarding houses and any other facility-based daily living options or respite services.

In most Group Homes the service provider will be registered with the National Disability Insurance Scheme (NDIS). There will be some scenarios where there may be a range of providers contracted by the NDIS participant to provide services funded by the participant's plan.

  • Residents of Group Homes may be more vulnerable to serious complications from COVID-19 infections because of:
  • the nature of their disabilities – including, for example, those that impact breathing
  • co-existing conditions and illness – including those that compromise immune functioning
  • living arrangements – which may make isolation more difficult, and
  • difficulties associated with testing for COVID-19 – including where individuals have:
    • sensory impairments (especially hearing, vision, speech or combinations of these)
    • mobility restrictions – including where the individual needs public transport to get to a testing site
    • disabilities which make it difficult for them to understand the risks or comply with instructions (including those with intellectual, cognitive or psychosocial disability), or
    • behaviours of concern which pose a risk to themselves or others.

The relative mobility of residents in the community, and the environment within their home may make testing and isolation challenging. In many cases, disability support workers and clinicians will have established relationships with residents that can assist communication, assessment of individual needs and appropriate management where COVID-19 testing or further clinical care is required. Residents, families, carers and/or guardians should be included in decision-making wherever this is possible and appropriate.

While there are parallels between an outbreak in a Residential Aged Care Facility and a Group Home, there are key differences, including that in Group Homes there may be:

  • a smaller setting
  • clientele who may be more mobile in the community
  • clients with intellectual or psychosocial concerns, which may make isolation more difficult to achieve
  • communal spaces and shared facilities, which may make isolation more difficult
  • less well-defined management structures, and less well-developed understanding by staff of infection control and health requirements (PPE etc).

Principles

  1. Be prepared: Peak bodies, Local Health Districts (LHDs), NDIS service providers and others require an understanding of, and a clearly defined approach to, preventing and managing an outbreak of COVID-19 in Group Homes. People with disability need to be supported to develop a personal emergency preparedness plan which includes preparation for events including a future rise in community transmission of COVID-19.
  2. Intervene early: A low threshold for investigating and intervening following any notification of respiratory illness in the Group Home is critical. Rapid testing of symptomatic residents and staff is crucial. A single confirmed case of COVID-19 among residents, staff or visitors to the Group Home will trigger the use of this IAP.
  3. Respond rapidly and comprehensively: Quickly control the situation to minimise risks and enact the IAP promptly. Initiate and maintain regular communication with staff, residents and families.
  4. Good governance: Strong leadership, management and follow-through of agreed actions is essential. Unresolved issues must be rapidly elevated to senior management and/or oversight agencies. Identify who is best suited to manage the outbreak within the Group Home and the support they will need to provide an effective response. This person will be referred to as the provider's Outbreak Incident Controller (OIC). The Provider OIC should be a senior officer who can attend meetings, direct staff, authorise expenditure and accept responsibility for the provider to perform actions. Registered providers are required to notify the NDIS Quality and Safeguards Commission of any change in capacity to deliver services, including those related to a COVID-19 outbreak.
  5. Welfare and service concerns are at the core of the response: Open and regular communication with residents, their families and/or guardians, as well as staff, is essential. The gravity of COVID-19 infections in Group Homes cannot be understated. Residents usually live in close proximity to each other and many have multiple pre-existing comorbidities, increasing their risk of complications from COVID-19 infection.

Outbreak Management Team

This IAP focuses on the public health actions to identify key stakeholders and their respective roles and actions in the context of an outbreak. The public health actions include the identification of cases and close contacts to minimise the risk of ongoing transmission. The IAP recognises that the Outbreak Management Team (OMT) is operationally focused. The OMT informs - and is informed by - agencies responsible for governance, standards, and logistics support.

The successful response to an outbreak relies on the:

  • response being rapid
  • roles and responsibilities being clear and unambiguous
  • communication being regular and consistent, and
  • actions being closely monitored and completed.

These factors will require regular meetings of the Outbreak Management Team to support the provider in their response. The primary objectives of the response are to interrupt any ongoing transmission, and meet the clinical and welfare needs of residents and staff.

Disability Outbreak Management Team (OMT)

Lead: Local Public Health Unit (PHU) Director or delegate to co-chair with the Provider Outbreak Incident Controller (OIC)

Entity PositionContact

Provider OIC

NB: Where there are multiple providers, the provider with largest number of staff involved should be the Provider OIC.

CEO or appropriate senior manager

As relevant

Local Health District

Public Health Unit (PHU) – Director or senior delegate

Clinical representative

Infection Prevention and Control (IPC) clinical lead

Email: Use specific PHU address

Phone: 1300 066 055

State Health Emergency Operations Centre (SHEOC)SHEOC Aged Care Director or delegate

Email:

MOH-SHEOC-COVID19Operations@health.nsw.gov.au
moh-sheocagedcare@health.nsw.gov.au

Phone: 0477 369 576

Public Health Response Branch (PHRB)Deputy Controller & Operations Team

PHRB Operations

Email: moh-pheooperations@health.nsw.gov.au /
MOH-PHEODeputycontroller@health.nsw.gov.au

Phone: 02 9391 9542

National Disability Insurance Agency (NDIA)NDIA COVID-19 Lead

Phone: 0472 801 092 or 1800 800 110

Website: https://www.ndis.gov.au/

NDIS Quality and Safeguards CommissionNSW State Director

Phone: 0413 018 620 or 1800 035 544

Email: contactcentre@ndiscommission.gov.au

Website: https://www.ndiscommission.gov.au/

Office of the Public Guardian / Private GuardianNSW Deputy Guardian

Phone: 0411 592 168 or 1300 360 466

Email: informationsupport@opg.nsw.gov.au

Website: https://www.tag.nsw.gov.au/public-guardian

Roles and responsibilities

The OMT for a Group Home will convene where there is:

  • a confirmed case of COVID-19 in a resident of the Group Home
  • a staff member who worked in the Group Home while infectious with COVID-19, or
  • a visitor who attended the Group Home while they were infectious with COVID-19.
  • a significant risk, as determined at a state/national level.

Primary Group Home Facility Provider

Role

  • To manage the outbreak in accordance with public health advice and in accordance with any guidance from the NDIS Quality and Safeguards Commission.
  • To direct, monitor and oversee the outbreak response within the facility.

Tasks

  • Co-chair meetings of the OMT
  • Liaise with the PHU
  • Initiate their business continuity/emergency response plans,
  • Immediately initiate infection prevention and control measures
  • Ensure regular cleaning to appropriate standards throughout the Group Home
  • Manage the infection risks created by the arrival of staff and visitors
  • Manage staff, including isolation measures for exposed staff, and cohorting of staff to minimise potential transmission
  • Monitor and maintain resident welfare and well-being
  • Proactively communicate with residents, their families and/or guardians at least once daily
  • Coordinate the OMT liaison with GPs, nursing, allied health and any other external/internal providers to assess the need for ongoing health supports for residents to prevent deterioration of non-COVID-19 conditions
  • Where the Group Home is a registered NDIS provider, notify the NDIS Quality and Safeguards Commission of any change or events impacting services as a result of the outbreak

Local Public Health Unit (PHU) Director (or delegate)

Role

Lead the public health response and support the Group Home OIC and staff in executing their role.

(Where the PHU has limited capacity to respond, or the nature of the outbreak has a high level of complexity, discuss with PHRB)

Tasks

  • Notify the OIC and Public Health Response Branch (PHRB) of any confirmed cases associated with the Group Home (thus triggering this IAP).
  • Establish the OMT immediately, convene as soon as possible, and arrange daily meetings (or other frequency as required) until outbreak is closed.
  • Co-chair meetings of the OMT.
  • Ensure active surveillance, investigation and management of all infection among staff and residents.
  • Advise the Group Home on management of residents and close contacts within the Group Home.
  • Support the Group Home OIC to respond to the outbreak by working collaboratively through early communication, clarification and advice when required.
  • Support Group Home OIC in communication activities with residents and their families.
  • Ensure that public health and initial infection control measures are implemented to control the outbreak.
  • Regularly liaise with the PHRB on the response and seek support immediately where further transmission or other challenges are identified.
  • Develop a plan for ongoing testing of residents and staff following assessment of the initial rounds of testing.

State Health Emergency Operations Centre (SHEOC)

Role

Co-ordinate and escalate NSW Health's emergency response capability to COVID-19 within a group home.

Tasks

  • Operationalise an emergency response commensurate with risk under the direction of the SHEOC Controller.
  • Co-ordinate and escalate surge requirements for critical services, including workforce, personal protective equipment, waste management, testing, infection, prevention and control and cohorting
  • Liaison will encompass:
    • Communicating with Local Health Districts
    • Notifying and sharing information with key external stakeholders including the NSW Department of Communities and Justice, Department of Health, NDIA, NDIS Quality and Safeguards Commission and Department of Social Services, in support of the emergency response
    • Clarity and accuracy of messaging where relevant to government and external media requests.

Public Health Response Branch (PHRB) Team

Role

  • Support the local PHU and provide the key liaison point for the public health response

Tasks

  • Support the PHU in ensuring effective management of the public health aspects of the incident.
  • A PHRB Deputy Controller/Senior Medical Adviser and Operations team member will be assigned to join the OMT to assist in the management of the outbreak.
  • Public health liaison will encompass:
    • Communicating with other LHDs
    • Sharing information with the OMT and other stakeholders, in support of PHU
    • Providing regular updates to the Chief Health Officer
    • Providing clear and accurate messaging to government and external media requests
  • Notify SHEOC Operations of suspected or confirmed cases: MOH-SHEOC-COVID19Operations@health.nsw.gov.au copying in SHEOC Aged Care at moh-sheocagedcare@health.nsw.gov.au

Local Health District (LHD)

Role

Support and coordinate clinical needs of the outbreak response, including testing requirements.

Tasks

  • Support clinical governance within the Group Home, support the service provider to ensure the regular health, social and wellbeing needs of residents are met.
  • Determine clinical lead and outreach model (GP/Hospital in the Home/outreach/telemedicine) with specialist clinician support (e.g. disability, infectious diseases, mental health) to maximise clinical care of residents (both COVID-19 positive and negative).
  • Determine (through the LHD Clinical Governance mechanisms) the level and type of specialist and support care required (for example, infectious disease, mental health, disability support, allied health).
  • Provide clinical staff and laboratory resources to support swabbing of all residents and staff (See Appendix 4). Support for phlebotomy may also be needed.
  • Support Group Home staff/GPs/other clinicians to provide appropriate resident-centred care.
  • Liaise regularly and provide clinical advice and support to GPs/other clinicians.
  • Determine processes to respond to clinical deterioration including care in Group Home or transfer to hospital.
  • Provide expert advice to Group Home for initial infection prevention and control, with support for monitoring as needed (CEC may be consulted).
  • Establish clinical outreach team (if necessary) and support infection control measures
  • Coordinate clinical teams who manage resident welfare and case management, including engagement with the relevant NSW Health Disability Hub and Mental Health Intellectual Disability Network.
  • Maintain regular communication with the PHU.

NDIS Quality and Safeguards Commission

The National Disability Insurance Scheme Quality and Safeguards Commission (NDIS Commission) is an independent body working with providers to improve the quality and safety of NDIS supports and services, investigate and resolve problems, and strengthen the skills and knowledge of providers and participants across Australia.

Registered providers are required to notify the NDIS Quality and Safeguard Commissioner of events or change related to a COVID outbreak. It also provides links to relevant resources, training for NDIS workers during COVID and updates of Australian Government advice and communications.

The NDIS Commission supports the response through:

  • Communication with providers to reinforce public health messaging, including links to public health resources
  • Liaison and engagement with NSW Health and NSW Department of Communities and Justice (DCJ - who lead the NSW engagement with the Commonwealth to support people with disability during the COVID response)
  • Provision of support for NDIS providers, including access to the National Medical Stockpile for PPE when providers are unable to source equipment from usual suppliers

National Disability Insurance Agency (NDIA)

The NDIA is the Commonwealth agency that operates the NDIS and makes decisions on funding for NDIS participants. The NDIA supports the response through:

  • Rapid adjustments to funding in participant plans, including for alternative accommodation for isolation of residents and staff (as required), additional staffing, and equipment (for example, laptops or tablets to allow telehealth or contact with families)
  • Access to the Recruitment, Consulting and Staffing Association (RCSA) Workforce Response team at 1800 943 115 or NDISworkforce@rcsa.com.au, and
  • After hours responses to disruption of NDIS funded supports via the NDIA After Hours Crisis Response Hotline (1800 800 110).

PPE Access

National Medical Stockpile – PPE access

NDIS Commission is advising disability providers who require further PPE supplies to email the National Medical Stockpile at NDISCOVIDPPE@health.gov.au for information on eligibility and access to PPE.

NSW State Stockpile

SHEOC Aged Care will coordinate these requests: MOH-SHEOCAgedCare@health.nsw.gov.au or MOH-SHEOC-COVID19Operations@health.nsw.gov.au

Tasks of the Outbreak Management Team

The OMT must be convened by the PHU as soon as the case is confirmed. The OMT must immediately adopt a regime that ensures a rigorous and comprehensive approach and support this regime until there is confidence that the OMT can safely withdraw.

Establish strong management structures and processes to manage the outbreak

The OMT must support the Group Home OIC to assume control of the Incident. The PHU (supported if needed by PHRB) should raise any concerns about the response at the first opportunity with the Disability Outbreak Management Oversight Group (DOMOG). The DOMOG is charged with the responsibility of ensuring effective coordination of government response to people with a disability during an outbreak and taking appropriate action where required. The DOMOG is chaired by the NSW Department of Communities and Justice (DCJ) and its members are from the Commonwealth Government (Department of Social Services, NDIS Quality and Safeguards Commission, the National Disability Insurance Agency) and the NSW Ministry of Health (State Health Emergency Operations Centre and the Public Health response Branch & the Clinical Excellence Commission) )See Appendix 5.

Implement control measures

The OMT will support and advise the Group Home with infection prevention and control measures. These will include managing staff and visitor arrivals, provision of PPE, hygiene, and staff and visitor education.

Identify and investigate all cases

The OMT will develop a program of testing for each affected and non-affected resident and staff member until the outbreak is considered controlled. The PHU will determine frequency of the testing regime, based upon the circumstances of the incident. Typically, all affected and non-affected residents will be tested initially, then 2 or 3 times over a 14-day period.

Resident welfare and appropriate management of cases

Resident welfare and appropriate management of cases is maintained by the clinical teams, including virtual care service, Hospital in the Home, Allied Health, Nursing and General Practice. A Group Home Clinical Lead (through the LHD) will be identified to coordinate this process.

Advise on the closure of outbreak and measures to be undertaken in an enhanced surveillance phase

Through evaluation of cases and response activities, the OMT will advise the Group Home OIC when infection control measures can be stepped-down and the outbreak can be considered 'closed'. The OMT will also provide advice on steps to be undertaken after closure of the outbreak phase. These measures can include ongoing monitoring of resident symptoms and asymptomatic screening of staff (amongst other considerations) in line with guidance from the PHU.

Process

In preparation for an outbreak

Group homes should:

    • Keep up to date with current Chief Health Officer advice, and additional guidance
    • Prepare clinical care plans for residents, including arrangements for appropriate isolation
    • Have current plans, expertise and resources for:
      • outbreak management – this should include plans at an organisational and facility level as well as individual resident plans. Residents should be supported to develop their own plans which should travel with them and be informed by best practice (see Person-Centred Emergency Planning)
      • infection prevention and control (IPC), and
      • workplace health and safety. This should include protocols for screening of staff and active surveillance of respiratory symptoms
    • Keep PPE stocks up to date – for business-as-usual and outbreak scenarios
    • Ensure staff receive regular training in infection control activities, especially hand hygiene and PPE use
    • Establish relationships between group home management and local PHU
    • Initiate influenza-like-illness preparedness activities including staff and resident vaccination
    • Have a robust plan for quickly replacing disability support and clinical staff who may need to isolate following an outbreak
    • Have plans for providing care during an outbreak to residents who will require ongoing health care to prevent a deterioration of their non-COVID related health conditions (e.g.: daily insulin administration, catheter changes, respiratory supports, etc)

Notification of suspected or confirmed cases

    1. The PHU establishes the OMT when it receives notification of a suspected or confirmed COVID-19 case in a Group Home. The PHRB notifies SHEOC of the case: MOH-SHEOC-COVID19Operations@health.nsw.gov.au and copies in SHEOC Aged Care: MOH-SHEOCAgedcare@health.nsw.gov.au
    2. The PHU and PHRB should confirm with each other the lead responder and the respective roles and responsibilities of PHRB and PHU.
    3. The PHU informs the Group Home manager of the positive test result and includes the Group Home Provider senior leadership and the PHRB in initial planning. Outbreak measures may already have been implemented if the Group Home has been aware of possible or suspect cases.
    4. Group Home identifies an OIC who notifies the NDIS Commission of any change or events impacting their services as a result of COVID-19 via NDIS - Notification of event form – COVID-19 (registered providers).

Immediate response

    1. The PHU works with the Provider OIC to consider immediate activities to mitigate potential risk while public health investigations are ongoing. These include putting in place infection control measures such as separation and isolation of residents, PPE and hand hygiene stations for staff, and suspension of group activities and visitors
    2. The PHU and the Provider OIC should collaborate to ensure the ongoing delivery of essential care by external clinicians.
    3. The PHU will interview the case(s) using the NSW Health Notifiable Conditions Information Management System (NCIMS) Case Questionnaire, ('NCIMS Case Questionnaire') and confirm swab/serology results. Undertake contact tracing and management of contacts outside the Group Home. Note: People with disability may require reasonable adjustment to the NCIMS Case Questionnaire depending on their cognitive function and communication needs.
    4. All staff and residents to undergo testing (bilateral oropharyngeal and bilateral nasal swab – single swab) as soon as the outbreak is declared. Specimen collectors should use the Laboratory Request Form (Appendix 4) to support prioritisation and rapid interpretation of results. The technique is described in the CDNA Guidelines. Changes to this recommendation should be checked against any update of the CDNA Guidelines. The Local Health District is able to assist with resources to assist in initial testing rounds (if required) and should liaise with the relevant Infectious Diseases Hub for advice on engaging with anyone with a cognitive disability where there may be barriers to testing. Information on alternative approaches for COVID-19 testing for people with disability will be available shortly.
    5. The PHU will confirm laboratory capacity and processes to ensure expedited testing (for example, GeneXpert) and results (including negative results) communication. Specimens should be labelled as priority (Group Home outbreak) and the microbiologist notified of urgent testing requirement.
    6. The Group Home will maintain a line list of all residents and staff detailing key information about each case
    7. Staff are to be notified directly of their results through usual mechanisms; resident results will be communicated through Group Home OIC to residents and/or their families/guardians.
    8. Complete case questionnaire for staff and consider the need for resident case questionnaire. See the Case questionnaire.
    9. If the case is a resident, the Group Home should:
      • isolate the case in a single room with a private bathroom.
      • If not available, alternative accommodation arrangements are required. This may require negotiation with NDIA.
    10. All staff who need to enter the resident's room should wear full PPE (gown, gloves, eye protection and surgical mask). Establish hand hygiene stations throughout the facility to increase routine hand hygiene, particularly before entering and after leaving the resident's room
    11. Utilise effective communication and communication aids when discussing the need for isolation. Easy Read factsheets are available at the Council for Intellectual Disability website and on the NSW Health website. The NDIS also has tailored information for participants and providers at NDIS Coronavirus. Further advice is available from MOH-DisabilityYouthandPaediatricHealth@health.nsw.gov.au.
    12. The resident should not attend communal meals, but rather have their meals and any other care needs managed in their room. They should not share bathroom facilities. Any items that are removed from their room that may be contaminated with body fluids should be treated as infectious.
    13. Conduct a teleconference of the OMT as soon as possible, preferably within 12 hours of notification. The primary goals are to identify the respective team members involved, clarify the Group Home's responsibilities and plan for the outbreak management. All members of the OMT should attend if possible but, if not possible, essential participants include: the Group Home's OIC (co-chair), PHU (co-chair), PHRB Ops, IPC and Clinical Nurse Consultant (CNC) from LHD, and SHEOC Aged Care.
    14. Restrict visitors and all other people entering the facility (including health workers) to the minimum required. Non-essential visitors need to be advised that they cannot meet face-to-face with residents during the isolation period (guidance in the CDNA Guidelines and CEC IPC Guidelines). Keep a log of all visitors (clinical and social support) entering the facility, including details of the areas and residents visited. Initiate a screening program for all people arriving at the facility, including staff.

A broad range of COVID-19 case presentations needs to be considered in these settings: Residents may not report or display 'classic' symptoms of respiratory infection. Providers should be alert for more subtle signs, such as behaviour disturbance, low grade temperature, loss of appetite or smell, tiredness or gastrointestinal upset. Staff and residents may experience very mild symptoms or be asymptomatic, while still posing a transmission risk. Staff may experience barriers and disincentives to reporting symptoms or seeking testing, such as not having access to paid leave entitlements and fear of repercussions. Staff should be supported to access early and repeated testing, as required.

Situational assessment

    1. The facility provider should send the PHU a site/floor plan. The PHU will work closely with the staff to conduct a risk assessment, identify mitigation strategies and determine whether a site visit is required.
    2. Where possible, clinical and infection prevention and control (IPC) staff from the PHU should consider visiting the facility to enable assessment of facility layout (understanding pathways of infection, cohorting possibilities, ventilation flows), personnel and roles, standards of infection prevention and control, etc. The site visit should be restricted to essential staff. A site visit should not happen unless the staff attending:
      • have accurate information about infection risks at the facility and determine what methods should be employed to minimise the risk of transmission to any field staff
      • have received a current influenza vaccination
      • are trained in the use of, and supplied with, appropriate personal protective equipment (PPE)
    3. A site visit may pose challenges in regional areas; alternatives in these settings should be considered (for example, linking with a local health facility).
    4. Site visit will assess communal and non-communal areas, resident's records (to support identification of any earlier symptoms (this should go back at least 4 weeks prior to the first identified case), staff contact lists and rosters, and visitors.
    5. An onsite IPC assessment by the LHD is required in the early phase of the response. Identifying IPC expertise and consultation early is a priority, to prevent ongoing transmission between residents, residents and staff, and between staff. Ideally, there should be a champion/expert for IPC from within the staff of the Group Home, or alternatively sourced through the Commonwealth's surge initiatives. This can be supported by the Clinical Excellence Commission via the PHRB.

Case Management and Public Health assessment

    1. The PHU conducts the case interview and determines all close contacts. All residents identified as close contacts should be isolated in their own single room, preferably with a private bathroom, for 14 days and managed with the same infection control procedures as a confirmed case.
    2. Provide information sheets to close and casual contacts ensuring they are in Easy Read format. Templates for PHU letters to close and casual contacts can be found in Appendix 1 and Appendix 2.
    3. Any staff members who are close contacts should be sent home immediately to isolate for 14 days. This may have a substantial effect on rostering in the Group Home. The Group Home should be supported to identify surge staff resourcing, including escalating to the Commonwealth, if required. This may include activation of the Provider's emergency response and business continuity plans for engaging surge workforce. See further at NDIS Finding Support Workers.
    4. Where the Group Home is unable to isolate cases or contacts appropriately (for example, because of a lack of single rooms) alternative accommodation (for example, hospital or serviced apartment) should be arranged for residents by the Group Home. This can be done in collaboration with:
      • in business hours - the NDIA's National Delivery Branch. During business hours, providers should contact the NDIA on 1800 800 110 or contact their local NDIA office, or
      • after hours – the NDIA's Exceptionally Complex Support Needs (ECSN) Program operated by Marathon Health. As part of the ECSN Program Marathon Health provide the NDIS After Hours Crisis Response (AHCR) Hotline. All NSW mainstream emergency services (police, ambulance, hospitals, acute mental health services, corrective services etc.) have access to the Hotline.

        This will be supported by the LHD through the OMT. The decision to move residents needs to consider any negative health impacts on residents, the clinical and disability needs of the residents, and the staffing needed to provide care in the alternative facilities.

Testing

    1. Testing can be supported by LHD COVID-19 clinical staff. Testing should be undertaken for all close and casual contacts. In the case of Group Homes, this will include all staff and residents of the Group Home who were present while the case was infectious and attended the facility. An alternative to full resident and staff testing should be considered by exception only. PCR testing should be repeated at staggered periods over the course of the outbreak as recommended by the PHU. See Guidance for health care service providers and carers on alternative approaches to COVID-19 testing for people with disability.
    2. Testing of symptomatic individuals should include both COVID-19 and multiplex PCR screen (a highly sensitive, highly specific test for the detection of viral nucleic acids in respiratory secretions) as soon as the individual shows any symptoms.
    3. GeneXpert testing (or other rapid result platform) may be preferred, if available, where the timeliness of testing results will direct immediate action.
    4. All results (positive and negative) should be returned to the PHU. All resident results will be forwarded to the Provider OIC. Staff results will be communicated directly to staff members by the testing laboratory (text message for negative results) and/or PHU.
    5. All samples related to the outbreak should be sent to a single laboratory. Use of multiple laboratories is discouraged due to the risk of confused communication.
    6. NSW Health Pathology couriers can collect samples collected by PHU and Group Home staff. The Appendix 4 (Laboratory Request Form) should be used for all specimens collected in connection with the Group Home outbreak.
    7. Serology testing for COVID-19 may be requested for specific residents or staff, to assist with the investigation of the source of the infection or to confirm a test result.
    8. Find additional cases through regular clinical review, in addition to the testing regimen. A high level of vigilance is required to identify any symptoms including low grade fever, or subtle deterioration of condition (e.g. off food, fatigue, loss of balance etc). Regular observations, with intensity tailored toward the level of risk, should be implemented

Ongoing response

    1. Residents who test positive for COVID-19 should remain in the Group Home if they choose to and if this can be achieved while preventing further transmission. Consider transfer of resident cases to hospital if their clinical situation warrants this level of care. If necessary, seek specialist advice from the Local Health District Intellectual Disability Hub staff or Healthdirect (1800 022 222)

      The Provider OIC should ensure that the Group Home advises the PHU if any resident needs to be transferred to hospital. The Group Home will also need to inform the ambulance and hospital beforehand that the resident is from a facility with a COVID-19 outbreak and has tested positive to COVID-19
    2. Ongoing infection prevention and control support is vital to reduce ongoing transmission. This is best achieved through the presence of onsite IPC staff (identified and allocated by the Provider OIC), who are able to monitor the use of PPE and provide ongoing education and reinforcement of best practice. The hours that the IPC staff need to be onsite should be determined by the size of the facility and complexity of the outbreak. The initial onsite assessment to support the public health investigation will address capacity (by local Infectious Disease or IPC staff, or PHRB). PHRB or the LHD may advise the Commonwealth that urgent support to provide oversight is needed. Consultation by the provider with the Clinical Excellence Commission (CEC-Info@health.nsw.gov.au) is advised.

      Infection control measures should include:
      • Maintaining adequate supplies of surgical gloves, masks, gowns and hand sanitiser through usual suppliers. If a provider is unable to access stock from their usual supplier, an email request for PPE can be sent to the National Medical Stockpile. Escalate supply issues to SHEOC Aged Care to access the NSW Health stockpile. Local health districts should support immediate PPE supply needs.
      • Implementing cleaning and waste disposal to appropriate standards (see the Environmental Cleaning and Disinfection Principles for health and residential care and the CEC IPC Guidelines).
      • Cleaning of all resident care areas daily. The rooms of all residents and communal areas should be cleaned daily. Staff who are cleaning should do so in appropriate PPE. Rooms of ill residents should be cleaned and disinfected including:
        • frequently touched surfaces at least daily
        • equipment after each use
        • surfaces that have been in direct contact with, or exposed to, respiratory droplets, and
        • terminal clean on discharge from room/zone.
      • Maintaining consistent staff in each Group Home and restrict staff from working at other facilities while residents are in isolation
      • Reviewing all food preparation/distribution, handling of crockery/cutlery, handling of residents linen/laundry and disposal of waste to minimise risk of infection transmission.

        Any barriers to good infection control should be escalated by the PHU to the OMT to ensure appropriate resourcing and outcomes.
    3. The PHU/PHRB will manage public health follow-up, including further contact tracing, if any subsequent cases are identified.
    4. The PHU will manage close contacts who are not Group Home staff or residents (for example, visitors). The PHU should provide details of close contacts who reside in other LHDs to the PHRB for forwarding to the relevant PHU. If the PHU in that LHD is not able to reach close contacts, assistance can be requested from the Centralised Contact Tracing Team (within PHRB).
    5. Close contacts of all cases associated with the Group Home outbreak will be followed up on a regular basis by the PHU or the Centralised Contact Tracing Team.
    6. Release from hospital: If a case has been transferred to hospital and is clinically ready to be discharged, then their transition back to the Group Home should occur in line with the Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units.
    7. Ensure an appropriate level of clinical monitoring is introduced for all residents with COVID-19, as clinical deterioration can be rapid. Document sentinel indicators of resident deterioration (for example falls, weight loss, pressure sores) and raise with appropriate/ regular clinicians. The LHD can offer support if further assistance is needed to address clinical needs.
    8. Ensure regular medical needs are addressed for all residents. Consideration should be given to engagement of general practitioners and other allied health practitioners to address these. Health care staff providing routine care to residents will need to consider the impacts of de-conditioning, grief and isolation. Ensure:
      • communication arrangements are established with the usual GP for each resident
      • mobilisation needs of each resident are identified and they receive appropriate advice.

Communication

    1. Regular contact should be maintained between PHU, PHRB, and the Group Home until the outbreak is declared over through the regular OMT meetings and as required.
    2. PHU and PHRB should establish and maintain regular communication with other agencies as appropriate, including the NSW Health Media Team. PHRB should provide relevant updates to the NDIS Quality and Safeguards Commission.
    3. A daily running sheet of decisions and agreed actions determined at the OMT should be maintained by the PHRB Operations Team. All verbal advice will be confirmed by email to the Provider OIC (and other Provider contacts as advised by the OIC) and tabled at the next OMT meeting.
    4. Residents, staff and relevant support people associated with the Group Home should be kept informed of actions and progress. The media liaison for the managing body should keep in contact with the NSW Health Media Team. PHU and PHRB should plan for relevant communication with casual contacts and families of residents. This may include 'Prodocom' (automated) text messaging or email to a large contact list. Note that the communication needs of people with disability may require adjustment of usual processes (including those with sensory, intellectual, psychosocial and physical disabilities).
    5. Death certification: Any deaths that occur are to be certified by the treating medical team or the resident's general practitioner. The certifier should assess whether COVID-19 was a primary cause of death, a precedent to the primary cause of death, or an incidental co-morbidity. The certifying medical officer should be familiar with WHO International Guidelines for Certification and Classification (Coding) of COVID-19 as a Cause of Death (April 2020). Any deaths in a Group Home (including non-cases) should receive a post-mortem COVID-19 swab unless one was collected in the 12 hours prior to death.

Closure of the outbreak

    1. Step-down strategy: A number of infection prevention and control measures are utilised to assist the opening up of the facility as the incident is controlled. The risk of resident de-conditioning is balanced against infection transmission. The PHU (with support of PHRB if needed) will develop a matrix of actions around resident isolation, mobility, visitor contact, staff movement and testing regime, giving careful consideration to risk of transmission at every increment.
    2. The PHU should declare the outbreak as being 'over' 14 days after the last confirmed case is effectively isolated (consistent with CDNA Guidelines). The PHU must notify all stakeholders including NDIS Quality and Safeguards Commission.
    3. Depending on the scale of the outbreak, the PHU may consider allowing two incubation periods (that is 28 days) to pass after the last confirmed case is effectively isolated before declaring the outbreak as being over.

The OMT should consider conducting a debrief with all parties involved after the outbreak is declared as being over. This provides an opportunity to identify strengths and weaknesses in outbreak response and investigation processes, and to provide information to help improve the management of similar outbreaks in future.

Appendix 1 - Template letter, casual contact

Dear

Re: COVID-19 at <NAME OF GROUP HOME>

As you may be aware, a resident/staff member at <NAME OF GROUP HOME> has recently been diagnosed with COVID-19 (Coronavirus Disease 2019). When someone is diagnosed as having COVID-19 they are referred to as a 'confirmed case'.

NSW Health is working closely with the Group Home service provider to maintain the health and safety of all residents and staff. This includes identifying close contacts of the confirmed case(s). A close contact is someone who has had unprotected exposure to a confirmed case.

You have been identified as a casual contact of the confirmed case. A casual contact is someone who has been in the same setting with a confirmed case in their infectious period, but does not meet the definition of a close contact.

Because of your potential exposure to the virus, you should get tested and isolate until you receive a negative result. You can find your nearest COVID-19 testing clinic.

Because of your potential exposure to the virus, you should monitor yourself for any symptoms of COVID-19, such as:

  • fever
  • cough
  • tiredness
  • sore throat
  • shortness of breath
  • runny nose
  • changes in your sense of smell or taste, or
  • other less common symptoms - such as muscle aches or pains, conjunctivitis, headache or rash.

If you develop any of these symptoms – even if they are mild - please visit a COVID-19 clinic or contact your doctor (call ahead to alert your doctor about the possibility of COVID-19 before visiting and show this letter to the doctor).

If you have a health condition or complex health needs, please discuss this letter with your medical specialist.

A factsheet for COVID-19 Casual Contacts is available from NSW Health at: /Infectious/factsheets/Pages/covid-19-casual-contact.aspx

Further information and updates about COVID-19 are available at: /Infectious/covid-19/Pages/default.aspx

If you have any further questions, please contact 1300 338 679.

Yours sincerely

<PHU>

<date>

Appendix 2 – Template letter, close contact of confirmed case

Dear

Re: COVID-19 at <NAME OF GROUP HOME>

As you may be aware, a resident/staff member at <NAME OF GROUP HOME> has recently been diagnosed with COVID-19 (Coronavirus Disease 2019). When someone is diagnosed as having COVID-19 they are referred to as a 'confirmed case'.

NSW Health is working closely with the Group Home service provider to maintain the health and safety of all residents and staff. This includes identifying close contacts. A close contact is someone who has had unprotected exposure to a confrimed case.

You have been identified as a close contact.

Because of your potential exposure to the virus, you must remain in home isolation until <DATE> (which is 14 days from your last possible contact with the confirmed case) and arrange to get tested for COVID-19. You will also be required to have another test on day 12 of your isolation period and return a negative result prior to leaving isolation. More information about COVID-19, home isolation and testing is included in the attached COVID-19 Close Contact Factsheet*.

During isolation, you should monitor yourself for any symptoms of COVID-19, such as:

  • fever
  • cough
  • tiredness
  • sore throat
  • shortness of breath
  • changes in your sense of smell or taste, or
  • other less common symptoms - such as muscle aches or pains, conjunctivitis, headache or rash.

Please visit a COVID-19 clinic or contact your doctor if you develop any of these symptoms, even if they are mild. Call ahead to alert your doctor about the possibility of COVID-19 before visiting and show this letter to the doctor. Call the Group Home to let them know you have developed symptoms.

If you have a health condition or complex health needs, please discuss this letter with your medical specialist.

A Factsheet for COVID-19 Close Contacts is available from NSW Health at: /Infectious/factsheets/Pages/advice-for-contacts.aspx

More information and updates about COVID-19 are available at: /Infectious/covid-19/Pages/default.aspx

If you have any further questions, please contact 1300 338 679.

Yours sincerely

<PHU>

<date>

*Attach COVID-19 Close Contact Factsheet from /Infectious/factsheets/Pages/advice-for-contacts.aspx

Appendix 3 – NDIS After Hours Crisis Response Hotline

Not for public use or disseminiation.

Appendix 4 – Laboratory Request Form for PCR Specimen

Appendix 5 – Protocol to support joint management of a COVID-19 outbreak in a NDIS-funded residential services in NSW

WORKING DRAFT December 2020

Parties

The Commonwealth Government (Department of Social Services, NDIS Quality and Safeguards Commission, the National Disability Insurance Agency) and the NSW Government (NSW Ministry of Health, Local Health Districts, and NSW Department of Communities and Justice).

When parties meet as a result of the triggering of this response they will come together as the Disability Outbreak Management Oversight Group (DOMOG).

Purpose

The purpose of this protocol is to support a collaborative response and effectively coordinate efforts during COVID-19 outbreaks in NDIS funded disability residential services, reflecting the accountabilities and functions of each agency. Residential services includes supported independent living (SIL) in specialist disability accommodation (SDA), short term and medium term accommodation (STA/MTA), Assisted Boarding Houses (ABH) and any other facility-based daily living options or respite services.

This protocol outlines the roles and responsibilities of relevant parties, governance structures, escalation procedures and expectations around information sharing and timeframes.

Objectives

The primary objectives of this protocol are to promote the health, safety and wellbeing of NDIS participants in impacted service settings, to contain and control an outbreak and bring it to an end as quickly and safely as possible. Staff in impacted service settings are also a target group.

When to implement this protocol

A single positive COVID-19 case within a disability residential service[1] (resident or staff member) will trigger the use of this protocol. Each outbreak will differ according to the circumstances of the service setting; therefore, the application of the protocol will be applied based on identifying and understanding the features of the outbreak.

Overarching Documents

NSW Public Health Orders and specific advice issued by the NSW Chief Health Officer from time to time. Specific information for disability service providers and people with disability can be found at /Infectious/covid-19/Pages/disability-public-health-orders.aspx

NDIS Quality and Safeguards Commission NDIS Code of Conduct and NDIS Practice Standards. Possible COVID-19 infection of service provider staff and people otherwise engaged by a provider to deliver NDIS supports, and the risk of infection of NDIS participants, present risks that are expected to be managed in the context of the service provider's obligations under the NDIS Code of Conduct and relevant NDIS Practice Standards. More information can be found at https://www.ndiscommission.gov.au/resources/coronavirus-covid-19-information

Australian Government Department of Health Management and Operational Plan for People with Disability. The Australian Health Sector Emergency Response Plan for Novel Coronavirus guides the Australian health sector response. The management and operational plan focuses on people with disability and can be found at https://www.health.gov.au/resources/publications/management-and-operational-plan-for-people-with-disability

Australian Human Rights Commission (AHRC) Guidelines on the rights of people with disability in health and disability care during COVID-19 (August 2020). More information can be found at https://humanrights.gov.au/our-work/disability-rights/publications/guidelines-rights-people-disability-health-and-disability

Principles

The key principles underpinning this protocol are:

  • All parties will uphold the rights and promote the health, safety and wellbeing of NDIS participants:
    • The clinical and welfare needs of residents are paramount. Decisions on the most appropriate clinical care, including location of the care and whether transfer to hospital is required, are made in consultation with clinical care staff and residents. Decisions are regularly reviewed, and made on an individual basis, but also take into account the safety and welfare needs of all residents and staff.
    • NDIS participants in residential services continue, as do other people in the community, to have a right to access public health services (including hospital) based on their clinically assessed need.
    • Communication to residents is coordinated by the provider and occurs as frequently as indicated by the changing profile of the outbreak and the communication preferences of the residents.
  • Rapid response and decision making:
    • Support for providers will take into account the assessed capability and capacity of the provider and as well as the ability of surrounding health services to respond to the outbreak. Supports provided will also be informed by the provider's Business Continuity Plan (BCP) which must address the potential impact of coronavirus (COVID-19) on their service delivery.
    • All parties should mobilise and implement actions within their defined roles and responsibilities rapidly and in coordination with other parties.
    • Parties escalate issues according to clear governance processes with agreed criteria on when new decisions might need to be made, or existing ones revised.
    • Parties work collaboratively and are focussed on finding solutions.
  • Timely information sharing:
    • The early days of an outbreak will be particularly challenging therefore it will be vital that mechanisms are rapidly agreed, appropriate to the circumstances of the outbreak, to ensure information is shared between parties in a timely manner to coordinate an approach.
    • Limitations, or perceived limitations, of parties involved in the response are raised early.
  • Accountability of disability service providers:
    • Providers are expected to comply with their responsibilities under relevant legislation to support the safety, care and wellbeing of residents and their staff.
    • Providers are expected to prepare and maintain up-to-date BCPs.

Providers will lead implementation of their BCPs in the event of an outbreak in their service.

* Specific complex cases outside of residential services could be considered under this protocol as required, dependent on level of community and individual participant risk.


Current as at: Friday 19 November 2021
Contact page owner: Health Protection NSW