Residential aged care homes (RACHs) are encouraged to make their own decisions on public health measures based on regular internal risk assessments. This ensures that RACHs can adapt their public health measures, including mask-wearing advice, advice to visitors and entry requirements, to their local circumstances. RACHs should find the right balance between protecting residents from respiratory infections and providing them with social connections, care and support.
Factors that RACHs can consider in their risk assessment to inform public health measures include:
The outcome of the risk assessment should guide public health measures that can be escalated or de-escalated in proportion to risk, while balancing infection prevention and control with resident wellbeing to prevent acute respiratory illness outbreaks in RACHs.
GPs and RACHs are encouraged to establish and annually update a Pre-assessment action plan for respiratory infections in aged care facility residents for all residents in case they develop COVID-19 or influenza. This ensures timely testing and access to antiviral medicines.
Administering antiviral treatment as soon as possible after symptom onset reduces the risk of severe disease, reduces the risk of transmission to other residents, and can prevent hospitalisation and death.
Residential care homes must comply with the NSW Poisons and Therapeutic Goods legislation when storing and administering certain medicines, including antivirals and vaccines. Vaccines also require appropriate cold chain management in accordance with the National Vaccine Storage Guidelines 'Strive for 5'. This authorisation ensures that RACHs can legally possess and supply Schedule 4 and Schedule 8 medicines under strict safety and record-keeping requirements.
COVID-19 antiviral medicines are available on the Pharmaceutical Benefits Scheme (PBS) for eligible aged care residents.
COVID-19 antivirals can be obtained through community pharmacies.
RACHs are encouraged to maintain a supply of Tamiflu® (oseltamivir) in case there is an influenza outbreak.
RACHs can order Tamiflu® directly from the State Vaccine Centre by completing the online RACF influenza antiviral treatment access form for orders of up to 250 doses. RACHs do not require a Vaccine Account Number (VAN) to complete the form. For orders over 250 doses, RACHs will need to contact their Public Health Unit (PHU) on 1300 066 055.
When ordering Tamiflu® stock, when there are no residents with influenza, select "No" for "Lab confirmed influenza diagnosis" and leave the date blank under "Symptom onset date" in the online form, as shown below.
The pre-ordered Tamiflu can only be used for residents of aged care homes following prescription by an authorised prescriber.
For further information on antivirals, refer to Guidance on use of antivirals in residential aged care facilities (RACF).
Alongside RSV, COVID-19 and influenza, other respiratory infections, such as parainfluenza virus infection, human metapneumovirus infection, pertussis (whooping cough) and pneumococcal disease, can pose risks to residents.
RACHs should continue to follow infection prevention and control measures, including good hand hygiene, use of masks and PPE when caring for symptomatic residents, enhanced cleaning of high-touch surfaces, and encouraging residents to report symptoms early. When a resident is symptomatic but RSV, COVID-19 or influenza are not detected, staff should ensure prompt clinical assessment and full respiratory panel testing based on RACH protocols.
If illness continues to spread or another respiratory infection is suspected, RACHs should consult their local PHU on 1300 066 055 or the resident's GP for advice on further investigations and management.
Ventilation is important to minimise the spread of respiratory infections. The key principle is to bring in fresh air to dilute the indoor air. Simply recirculating indoor air, for example using a ceiling fan, is not effective.
Natural ventilation should be used wherever possible. Residents and staff should be encouraged to spend time outside. RACHs can consider seeking professional advice from an occupational hygienist or ventilation engineer. Carbon dioxide (CO2) monitors and high-efficiency particulate air (HEPA) filters may play a role but require users to have a good understanding of how to use them.
During outbreaks, RACHs should review their ventilation practices. For example, turn ceiling fans to their lowest setting to avoid blowing air from one person to another and close bedroom doors of unwell residents to avoid airflow into shared spaces.
Ventilation can also be strengthened during an outbreak by placing portable air cleaners in shared rooms where there is a high risk of transmitting infection and people are close together with little ventilation. Use exhaust fans or pedestal fans facing out the window in rooms with poor airflow to expel air outdoors.
Staff should be educated about ventilation and how ventilation can be improved during outbreaks of respiratory infections.
The Australian Commission on Safety and Quality in Health Care has published guidance on Optimising ventilation for infection prevention and control in healthcare settings. There is also guidance on ventilation in the Aged Care Infection Prevention and Control Guide and the National Aged Care Design Principles and Guidelines. The Australasian College for Infection Prevention and Control also delivers webinars on infection prevention and control advice for aged care, including ventilation.