Residential aged care homes (RACHs) should conduct a local risk assessment to guide the implementation of public health measures for preventing, preparing for and responding to acute respiratory infections (ARI).
NSW Health has developed guidance that RACHs should consider based on their individual context and risk profile, including vaccination ercommendations, entry measures and mask wearing.
In general, masks should be worn by staff when the NSW Respiratory Surveillance Report reports:
Many residents are at higher risk of severe illness if they develop a COVID-19, influenza or respiratory syncytial virus (RSV) infection. Providers of residential aged care should balance their responsibilities to reduce the risk of COVID-19, influenza, RSV and other infections entering residential aged care homes (RACHs) with meeting the physical, social, and emotional needs of residents.
RACHs should have preparedness plans in place to ensure a timely response to acute respiratory infections.
NSW Health has developed Guidance for Aged Care Facilities on the Public Health Management of Acute Respiratory Infections (RACF ARI Guidance) to support RACHs in their outbreak management planning.
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, and balancing infection prevention and control with resident well-being.
Vaccination remains the best protection for residents against serious illness and hospitalisation. The new Aged Care Act 2024 strengthened the requirement for residential aged care providers to provide access to recommended vaccinations for their residents. This includes vaccines such as influenza, COVID-19, shingles and pneumococcal.
Keeping residents up to date with vaccinations is one of the most effective ways to protect their health and prevent outbreaks in aged care homes. Residential aged care homes are responsible for ensuring residents have access to the recommended vaccinations as soon as they are eligible. Providers should support residents who are not yet vaccinated or are eligible for their next vaccination, to get vaccinated as quickly and safely as possible.
These vaccines, except RSV vaccine, are funded by the Commonwealth for older adults.
2 doses of Shingrix® 2-6 months apart for people 50 years and older. (Free under the NIP for people 65 years and older).
2 doses of Shingrix® 2-6 months apart for people 50 years and older. (Free under the NIP).
RACHs can use these resources to discuss the benefits of vaccination with residents and their families:
Informed consent is required (verbal or written) before administering any vaccine. Aged care providers are strongly encouraged to discuss, obtain and record consent from residents (or their families) before vaccination.
A sample online consent form is available for RACHs to use. Residents (or families) only need to complete the consent form once for the recommended vaccines during their entire stay in the RACH. The form can either be stored in electronic form or paper form in a resident’s medical notes. Video instructions on using the online consent form are also available.
For other sample consent forms for individual vaccines, visit:
RACHs can ask their general practitioners (GPs) and community pharmacists to administer vaccinations to residents in the facility.
The Commonwealth funds GPs and pharmacists to administer COVID-19, influenza, shingles and pneumococcal vaccines free of charge to residents in RACHs.
RACHs can also engage a pharmacist under the Aged Care On-site Pharmacist program. Further information about this program is available at The Aged Care On-site Pharmacist (ACOP) Measure - Pharmacy Programs Administrator and through your Primary Health Network (PHN).
Registered nurses can also complete training to become authorised nurse immunisers. This will allow them to administer vaccines without an order from a medical officer.
Talk to your local Primary Health Network (PHN) if you require assistance accessing a primary care provider.
RACHs are recommended to monitor when their residents are due for their vaccinations. The Vaccination tracker is a simple and effective way to track vaccination status. Video instructions on using the vaccination tracker are also available.
If there is a vaccination administration error or adverse event following immunisation (AEFI), staff should follow their internal protocols for managing incidents related to the administration of vaccines.
To report a suspected AEFI, please download the National Adverse Events Following Immunisation (AEFI) Reporting Form and contact your local public health unit on 1300 066 055.
RACHs can refer to Adverse events following immunisation (AEFI) for more information.
Facility and clinical managers of RACHs can now apply on behalf of RACHs to become a recognised vaccination provider with the Australian Immunisation Register (AIR).
This allows facility /clinical managers to access the AIR to check which vaccines residents have received and the date of administration.
An instruction sheet on how to access AIR for RACH staff members is available.
RACHs can order influenza, shingles and pneumococcal vaccines online through the State Vaccine Centre. Please contact the State Vaccine Centre on 1300 656 132 if you have problems accessing your account.
Further information on opening a vaccine account with the State Vaccine Centre is available on Ordering vaccines.
RACHs can contact the Department of Health, Disability and Aging at racfvaccineclinics@health.gov.au if they have issues accessing COVID-19 vaccines.
RACHs with vaccine fridges should ensure compliance with vaccine storage and cold chain requirements. Vaccines are sensitive medicines that must be protected from light and stored between 2°C to 8°C at all times.
RACHs can engage with their PHN or PHU to review their cold chain procedures to ensure they are up to date with the National vaccine storage and guidelines.
An annual cold chain audit should be completed by all RACHs that hold an account with the State Vaccine Centre.
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 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. This authorisation ensures that facilities 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.
Facilities can order Tamiflu® directly from the State Vaccine Centre by completing the online RACF influenza antiviral treatment access form for orders up to 250 doses. RACHs do not require a Vaccine Account Number (VAN) to complete the form. For orders over 250 doses, facilities will need to contact their PHU on 1300 066 055.
When ordering Tamiflu® stock (i.e. when there are no residents with influenza), please 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 facilities 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 (e.g., parainfluenza virus infection, human metapneumovirus infection, pertussis (whooping cough) and pneumococcal disease) can pose risks to residents.
Facilities should continue to follow IPC measures, including good hand hygiene, use of masks/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 testing based on RACH protocols.
If illness persists or another respiratory infection is suspected, RACHs should consult their local PHU or the resident’s GP for advice on further investigations and management.
All residents, staff, volunteers and visitors to aged care and long-term residential homes are recommended to receive an annual influenza vaccine.
Providers must comply with the Department of Health, Disability and Aging’s mandatory influenza vaccination program, which includes:
NSW Health has developed resources to promote influenza vaccine uptake in aged care staff.
Although the Department of Health, Disability and Aging is not mandating COVID-19 vaccinations for workers, aged care workers are encouraged to get a COVID-19 vaccination every 12 months. Residential aged care providers are responsible for making COVID-19 vaccinations available to their staff.
For further information, visit:
Staff, including students, contractors, volunteers, pathology collectors and therapists, should not enter a RACH if they have:
Managers should refer to Table 1 and Appendix 2 of the RACF ARI Guidance for when staff can safely return to work, particularly if they are critical to service delivery.
Facilities are encouraged to provide free RATs to staff to promote testing when there are moderate to high levels of COVID-19 or high levels of influenza or RSV in the community, as indicated by the NSW Respiratory Surveillance Report.
Staff with respiratory symptoms should be tested prior to any shift. Staff with symptoms should not attend work even with a negative RAT result.
RACH staff should refer to the RACF ARI Guidance for further guidance on PPE and mask wearing when caring for residents with ARI symptoms.
Please remember that masks can be removed for staff:
Staff removing a mask for one of the above reasons can decrease the risk of transmission by physically distancing from others, if appropriate.
Visitors are essential for resident wellbeing by reducing social isolation. Strategies RACHs can use to reduce the spread of respiratory infections from visitors to residents include:
Visitors should not enter the facility if they have:
If a visitor with symptoms or a positive test must visit, the visitor must wear a mask when moving through the facility and minimise movement within the facility.
NSW Health has developed a poster for RACHs to display to remind visitors not to enter if they have symptoms. This poster has been translated into multiple languages.
In situations where residents are infected, RACHs should manage visitors on a case-by-case basis to limit transmission, guided by frequent internal risk assessments and in consultation with the family or caregivers. Additional public health measures may be implemented to reduce the risk of transmission to staff and visitors.
Visitors wearing masks is a simple way to reduce the spread of respiratory infections to residents and staff.
RACHs are encouraged to review the weekly NSW Respiratory Surveillance Report to monitor the levels of circulating respiratory viruses in the community and consider their local RACH’s context when determining mask guidance for visitors. Local context considerations include high COVID-19 and influenza vaccination coverage among residents and staff, the number of high-risk residents, the ability of residents to isolate, etc.
In general, masks should be worn by visitors when the NSW Respiratory Surveillance Report reports:
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 re-circulating indoor air (for example, a fan) is not effective.
Natural ventilation should be used wherever possible. RACHs can consider seeking professional advice from an occupational hygienist or ventilation engineer. Carbon dioxide (CO2) monitors and HEPA filters may play a role, but require users to have a good understanding of how to use them.
The Australian Commission on Safety and Quality in Health Care has published guidance on Optimising ventilation for infection prevention and control in healthcare settings.
