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Update: From 24 July, the escalation to Amber Alert requires all NSW Health staff to wear a surgical mask if within 1.5 metres of a patient/resident. This applies to all NSW Health  facilities, including SGRACFs and MPSs. Visitors to any NSW Health facility are also required to wear a mask.

Staff who work or live in certain designated areas​ must wear masks whilst at work.​

Introduction

Residential aged care (RAC) is an essential service for older people and some younger people with complex health conditions and disability who can no longer live at home and need help with everyday tasks or health care. NSW Health operates RAC in nine State Government Residential Aged Care Facilities (SGRACFs) and 63 Multipurpose Services (MPSs).

In response to the COVID-19 pandemic, SGRACFs and MPSs must enhance infection prevention and control measures and review staff moving between RAC sections and Acute/Emergency Departments (EDs), to reduce the risk of transmission. COVID-19 is a significant health risk particularly for older people and individuals with co-morbidities or low immunity. International, national and state reports show residential aged care facilities (RACFs) are particularly susceptible to COVID-19 outbreaks.

Background

Staff, including health workers, may be required to move between many sections of a health facility. In MPSs, staff may need to provide emergency care in ED, acute inpatient care, community health services, and care for residents in the RAC section.

Staff in rural communities often work between many facilities, such as MPSs, private RACFs or other hospitals. In metropolitan communities, staff may work across many aged care facilities or from acute wards to aged care facilities. Under the NSW Health Code of Conduct (4.3.7), full-time staff must seek Chief Executive approval for secondary employment, and part-time staff must seek approval if there is a potential conflict of interest or their total work raises issues about excessive working hours. Such approval for other employment must not be unreasonably withheld.

Purpose

The purpose of this Guideline is to provide general infection prevention and control principles and practical workflow strategies that SGRACFs and MPSs can adapt to the local level to minimise the potential risk of COVID-19 transmission. The decision to implement the proposed strategies remains with the local health district (District), ensuring that they comply with the relevant State and Commonwealth legislation. As legal provisions can change, SGRACFs and MPSs are expected to keep up to date to ensure they remain compliant with the legal requirements.​

Relevant legislation, policy and guidance

Key legislation, policy and guidance about visitor restrictions, include:

The Aged Care Quality Standards, Charter of Aged Care Rights and National Safety and Quality Health Service Standards Guide for Multi-Purpose Services and Small Hospitals still apply during any pandemic.

The Agency for Clinical Innovation’s Pandemic Kindness Movement includes resources to support healthcare workers with the potential challenges of the COVID-19 pandemic. This is based on six key areas: basic needs, safety, love and belonging, esteem, contribution and leadership actions.

Maintain evidence-based practice of ensuring culturally safe work environments (see Aboriginal Health Plan 2013-2023 and the NSW Plan for Healthy and Culturally and Linguistically Diverse Communities 2019-2023).

Complying with the NSW Public Health Orders and directs from the Chief Health Officer and/or Secretary

The NSW Public Health (COVID-19 Residential Aged Care Facilities) Order no. 3 2020 ​is in effect from 23 June until 21 September 2020.

SGRACFs and MPSs must comply with this Order. It applies to all RACFs that provide care or accommodation under residential care subsidies or flexible care subsidies as per the Commonwealth’s Aged Care Act 1997. This includes facilities that provide respite care to residents and transition care for Transitional Aged Care Programme clients in a SGRACF or MPS.

To comply with the requirements under the Order, SGRACFs and MPSs must ask staff and visitors to answer screening questions and check their temperature (with a non-contact infrared thermometer, if available). Screening questions should include:
  1. Have you returned from overseas travel, a cruise ship or been to Victoria  in the last 14 days?
  2. Have you been in a location and time associated with NSW community transmission​ in the last 14 days?
  3. Have you had any close contact with a confirmed or suspected case of COVID-19?
  4. Are you in close contact or caring for someone who is currently unwell?
  5. Do you currently, or in the last 7 days, have any symptoms of acute respiratory infection (e.g. cough, sore/scratchy throat, runny nose, shortness of breath, fever)?
  6. Have you received an up-to-date vaccination against influenza, or can you provide a completed Influenza Vaccine Medical Contraindication Form, issued by a medical practitioner, certifying that you have a medical contraindication to the flu vaccination? 
If the staff or visitor answers yes to questions 1-5, or no to question 6, or their temperature is 37.5°C or higher, they cannot enter the SGRACF or an MPS residential aged care section. 

If the staff or visitor answers yes to questions 1-5, advise them to: 
  • call the National COVID-19 Helpline (1800 020 080) 
  • stay home and self-isolate for 14 days
  • get tested, even if you have no symptoms
  • watch for COVID-19 symptoms and get retested should any symptoms recur.
If the staff or visitor answer yes to question 1-4 advise them to:
  • ​stay in isolation for 14 days, even if you get a negative test, because it can take 14 days before you may show symptoms or test positive
  • (for staff) follow the usual sick leave protocol. Special leave may apply – staff should consult local Workforce/Workplace Relations.
If the staff or visitors answer yes to question 5, advise them to:
  • stay home and self-isolate 
  • get tested immediately. 
If your test result is negative and you answered no to questions 1-4, then you no longer need to stay in self-isolation.

It is important to note that a person with very mild symptoms or no symptoms can be infected or transmit the virus.

Screening staff and visitors on entry does not replace any other essential arrangements and practices that must be in place for all residential aged care services, including hand hygiene using the correct technique, physical distancing wherever possible, environmental cleaning with the required cleaning products. 

From 24 July 2020 the Secretary advised that NSW Health’s risk level has been escalated to moderate (Amber). This requires all NSW health workers to wear a surgical mask if they are within 1.5m of patients/residents. Residents in State Government RACFs and MPSs are not required to wear a mask. Further advice on the Amber risk requirements is available in COVID-19 Infection Prevention and Control: Response and Escalation Framework - FAQs.

The NSW Health Chief Health Officer, is providing regular updates to residential aged care facilities. This advice includes recommendations regarding mask wearing by staff and visitors and visitation limitations in certain local government areas.

SGRACFs and MPSs must follow all directions from the NSW Chief Health Officer or public health alerts regarding  measures to protect residents from being exposed to COVID-19 including entry to certain staff and/or visitors. 


From 17 April 2020 until further notice, NSW public hospital and health services are screening staff and visitors before they enter a NSW Health facility. This includes temperature checks to measure for the presence of a fever. Current NSW Health COVID-19 clinical testing criteria for temperature is a fever of 38°C or greater. However, under the Public Health Order, entry to all NSW Health RACFs (SGRACF and MPS) requires a temperature of less than 37.5°C.

Temperature to enter RACF: Less than 37.5°C

Flu vaccination requirement

The Australian Health Protection Principal Committee (AHPPC), the key medical advice committee for health emergencies, advised National Cabinet that all residential aged care staff, visiting workers, and visitors should be vaccinated with this season’s flu vaccine by 1 May 2020. All states and territories issued a Public Health Order following this recommendation.

Under the NSW Public Health (COVID-19 Residential Aged Care Facilities) Order No.3, staff and visitors must not enter or remain on the premises of a RACF if they do not have an up-to-date flu vaccination. However, staff and visitors are exempt from this requirement if they provide a completed Influenza Vaccine Medical Contraindication Form issued by a medical practitioner, certifying that they have a medical contraindication to the influenza vaccine. The Ministry of Health has developed an approved form for General Practitioners to use when someone would like to confirm a medical contraindication to the influenza vaccination requirements set out in the Order.

SGRACFs and MPSs must take all reasonable steps to comply with the Order. If a visitor refuses to comply, staff must advise that they cannot enter the facility.

NSW Health is taking a reasonable approach to this requirement. If a person is attempting to access the vaccine but is having supply issues, or a person is allergic to the vaccine or has a medical reason for not being able to have it, then the vaccine is not ‘available’ to them. There are only limited medical contraindications for not having the vaccine (anaphylaxis after a previous dose of any influenza vaccine or anaphylaxis after any component of an influenza vaccine). For more information about flu vaccine contraindications and precautions, see the Australian Immunisation Handbook – Influenza.

In an emergency, where NSW Ambulance, Fire and Rescue NSW or NSW Police Force are attending a RACF or where tradespeople are required for urgent repairs, it is considered reasonable for them to enter even if they have not been screened or cannot show they have a flu vaccination. If possible, they should limit contact with residents and staff. However, if such personnel, and Patient Transport Officers, are attending the RACF in a non-emergency or non-urgent situation (such as planned attendances), they must have had an up-to-date flu vaccination, or provide a completed Influenza Vaccine Medical Contraindication Form from a General Practitioner stating that the person cannot have the vaccine for medical reasons.

In all other circumstances, staff and visitors must be vaccinated with this season’s flu vaccine and providers must seek evidence from the staff member or visitor that this is the case. Facilities should consider maintaining immunisation records to demonstrate compliance if required. 

Staff must comply with the Public Health Order, which aligns with updated NSW Health PD2020_017 Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases​, published 27 May 2020. Section 4.1 outlines the flu vaccination requirements for staff working in NSW Health RACFs and NSW Health staff working in government and non-government RACFs. 

Strategies to minimise the risk of staff transmitting COVID-19 in residential aged care

Staff entering and leaving residential aged care sections

All staff working across many facilities should follow strict infection prevention and control practices when entering and leaving each facility. As required under the NSW Public Health Order, staff must pass screening questions and temperature checks before entering the residential aged care section and facilities should consider documenting screening details.

Infection prevention and control practices include:
  • regular hand hygiene and respiratory hygiene/cough etiquette
  • face masks
  • showering, wearing a clean uniform and shoes each day
  • disinfecting personal devices daily and shared devices between each use, including phones and tablets
  • keeping personal phones in a plastic zip lock bag and only accessing them during meal breaks
  • entering and exiting the residential aged care section/facility through one point – not walking through other areas of the facility, such as the Acute Ward, if next to the facility
  • attending residential aged care before other areas by prioritising and consolidating tasks.

See the Clinical Excellence Commission’s (CEC) COVID-19 Information Sheet for healthcare workers: Scrubs, uniforms, aprons and gowns for more information. This information sheet states that there have been no documented cases of novel coronavirus transmission via clothing at this point of the pandemic. Health workers can wear a uniform outside the hospital/health facility and for community visits if they used PPE due to close contact with a person who has suspected, probable or confirmed COVID-19 and they are within 1.5 metres. The choice to change out of a uniform before leaving work is a personal choice.

To minimise possible COVID-19 transmission, consider:
  • encouraging staff to take meal breaks in the staff dining room or open areas such as outdoor gardens and maintain physical distancing and hand hygiene
  • residents not leaving the facility for gate passes or outings at this time, unless under exceptional circumstances which are assessed on a case by case basis (for example, visiting a dentist)
  • arranging direct transport for residents attending appointments outside the facility, asking the resident to wait inside the car rather than the waiting room, and screening on return (see CEC’s Guidance for Home Visits – Transport section on page 15).

Consider using the guides for staff arriving and leaving the SGRACF or MPS at Appendix A and Appendix B.​​​​​​​

Staff who work or live in certain designated areas​ must wear masks whilst at work.​

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Key principles for infection prevention and control

All staff must practice physical distancing to limit COVD-19 transmission. Where practical, health workers and residents must keep 1.5 metres apart, except when providing direct care, assessment or diagnostics.

Standard infection prevention and control precautions are covered in CEC guidelines, the Infection Control Expert Group COVID-19 Infection Prevention and Control for Residential Care Facilities and the Department of Health’s COVID-19 Environmental cleaning and disinfection principles for health and residential care facilities.

Basic principles include:
  • hand hygiene and respiratory hygiene (cough etiquette)
  • face masks (if within 1.5 metres of patients/residents)
  • PPE if in contact with bodily fluids, including donning and doffing of PPE if required
  • aseptic techniques for clinical procedures
  • disposing waste
  • disinfecting home environment and equipment shared by patients or residents each time – staff should wear impermeable disposable gloves, a surgical mask, and eye protection or a face shield while cleaning and avoid touching their face, especially their mouth, nose, and eyes when cleaning.
Use transmission-based precautions and standard precautions, when standard precautions alone are insufficient to prevent transmission. The three types of transmission-based precautions are:
  • contact precautions to protect healthcare workers from transmitting COVID-19 from direct physical contact with the patient or resident, shared patient care equipment, or from environmental surfaces directly contaminated by another person.
  • droplet precautions to protect health care workers nose, mouth and eyes from droplets produced by coughing and sneezing
  • airborne precautions to protect healthcare workers respiratory tract from very small unseen airborne droplets that become suspended in the air.
Staff should assess and monitor risk by:
  • routinely screening and monitoring risk at each point of the episode of care
  • monitoring and reporting their own health and risk factors associated with COVID-19 to ensure their own safety and the safety of those they are providing care to:
  • identifying vulnerable patients and residents and consider COVID-19 risks in care
    • minimise the number of staff contacts as much as possible, while maintaining the health and wellbeing of patients and residents.

Where an MPS is a designated district COVID-19 MPS, follow local district Protocol with advice on symptomatic management and self-isolation (CDNA Guidelines), and Public Health Unit advice.

Where an MPS is a designated district non-COVID-19 MPS, refer patients to testing and further management at a larger facility if required, as per local district Protocol.

Staff moving across many areas of health facilities

Where staff provide services across multiple sections of an MPS (Acute, ED and residential aged care), minimise movement to other areas where possible, by:
  • rostering certain staff to only work in the residential aged care section in their shift
  • workflow streaming – prioritising and consolidating tasks in the residential aged care section first, before other areas.

SGRACFs and MPSs may consider implementing some of the strategies below. Local district requirements apply.

Strategies to minimise staff moving across the facility and reduce risk of transmitting the virus

Please note: It is recognised that implementing some strategies may not be practical for many NSW Health facilities and these strategies are provided as a guide to consider.

Staff working in ED / Inpatient area

  • Allocate roles to areas
    • designate RN to remain in and attend to ED/Inpatient area
    • segregating staff into teams for RAC and Inpatient.
  • Technology
    • nursing/medical staff could consult residents virtually if required to attend to RAC
    • handover virtually to reduce staff needing to enter either zone at the beginning/end of shift and ensure physical distancing.
  • PPE
    • donning and doffing PPE between RAC and inpatient areas
    • enable staff to safely remove and dispose PPE and contaminated clothing
    • if non-nursing staff required to attend to direct patient care (within 1.5m), wear mask/gloves and remove after seeing the patient or between procedures.
​​Staff working in RAC
  • Staff duties
    • designate staff to RAC (may require surge staffing)
    • if staff are required to also work outside RAC, start shift in RAC and attend to resident personal hygiene before attending to duties outside RAC
    • if a resident is COVID-19 positive, maintain a register of staff caring for them and ensure staff remain in RAC, except for responding to time critical treatment in ED/Inpatient.
  • RAC setting and signs
    • create a barrier to segregate RAC from other areas, for example, by relocating furniture
    • post signs on the entrance to the residential aged care section clearly describing the requirements for entry including screening precautions and the required PPE.
  • Hygiene and distancing
    • follow strict hand hygiene on entry to RAC
    • if accessing ED for medications/ drug checks, keep >1.5m from others.

All staff​

  • Staff uniforms*
    • change into uniform at work, shower and change into new clothes at end of shift
    • remove uniforms at end of shift to reduce cross-contamination risk during travel
    • ensure employees know how to handle, transport and disinfect potentially contaminated clothing and items used at work.
      ​​​​​* see CEC’s COVID-19 Information Sheeton scrubs, uniforms, aprons and gowns.​

  • Hygiene/PPE
    • wash hands before and after interacting with staff, patients or residents
    • provide sanitiser/wipes to wipe down personal items such as shoes, phones and identity badges
    • provide adequate facilities for employees to safely put on, remove and dispose of PPE when required
    • Clean and sanitise shared devices/care equipment such as mobile phones, stethoscope, IV pumps, blood pressure monitors, food trolleys, and wheelchairs after each patient/resident use. Minimise use when required (e.g. suspected COVID-19 case).

Support / complementary services

  • Food service
    • serve RAC first, then inpatient area
    • clean dining area when empty, sanitise outside of condiments after each meal
    • designated staff to RAC (where possible) to serve plated meals at the table.
  • Cleaning
    • clean RAC first (resident’s rooms, communal area, bathrooms) before inpatient/ED.
  • Laundry
    • attend RAC before other areas.
  • Allied health
    • attend to residents first before inpatients.
  • Activities officer
    • remain in RAC only.
  • Hairdresser
    • one on one, observing infection control and cleaning principles between each client.

Workforce surge planning

To prepare for possible staff illness and self-isolation, apply the district’s workforce surge plan or develop staff contingency plans, by:
  • identifying the minimum staffing levels required to adequately maintain services
  • adapting ‘Business as Usual’, temporarily reduce or redirect less urgent/non-urgent services, such as outpatient and community health services
  • liaising with Human Resources to identify minimum requirements for rapid recruitment of surge staff, including appropriate criminal and working with children checks
  • preparing orientation resources for surge staff.
Consider engaging staff with various backgrounds to provide the diverse skills required, including:
  • other clinical staff that may be located onsite, such as those providing a district role or nurse educators
  • public health professionals (including students or retirees in extreme circumstances)
  • other health professionals, such as GP, nurse, community health, sexual health, ambulance officers, pharmacy staff, oral health staff, health administrators and human resources staff
  • HealthShare NSW and Pathology staff
  • office managers
  • data entry and management, such as staff registered to access Notifiable Conditions Information Management System (NCIMS)
  • recalling staff from leave – part-time/casual/agency working additional hours
  • Allied Health staff with transferrable skills, e.g. physiotherapists, occupational therapists, and speech pathologists
  • tertiary education and TAFE students from nursing, hospitality, health services areas
  • other government agencies, such as Department of Primary Industries, local council, NSW Police and emergency services
  • not-for-profit sector, including charitable organisations, Royal Flying Doctor Service (RFDS)
  • agency staff in addition to those already under district contract (e.g. senior nurses)
  • other staff and volunteers willing to upskill in areas of need (e.g. community groups)
  • telehealth services.

Staff or residents suspected of COVID-19

The Registered Nurse should notify the Nurse Manager/Health Service Manager of all suspected, probable or confirmed COVID-19 cases and if they require after-hours admission to the ED’s red/hot zone. This is a designated area for patients presenting to ED with respiratory symptoms, fever or a positive response to screening questions. All other patients may be placed in the green/cold zone.

The Nurse Manager/Health Service Manager should arrange a residential aged care staffing replacement as necessary.

Staff: Any staff member with flu-like symptoms or fever must stay at home, see Complying with the NSW Public Health Orders and directions from the Chief Health Officer and/or Secretary. Staff who treated a resident who is then a confirmed case, must stay at home for two weeks.

​Resident: Consider any resident with flu-like symptoms or fever as a suspected COVID-19 case until test results are available. To minimise risk of transmission:
  • designate a room for suspected resident or residents to isolate
  • post signs on the door or wall outside of the resident room clearly describing the type of precautions needed and required PPE
  • consider only allowing designated care staff and Health System Support staff to work in this area to avoid potential risk of COVID-19 transmission
  • staff entering the room should not work elsewhere across the MPS, SGRACF or health facility until the resident/s are cleared of COVID-19
  • staff must wear PPE as per CEC Guidelines when entering the room.

If an MPS tests or admits COVID-19 positive patients, consider reinstating unused clinical spaces for patient care.

​​Where possible, a designated self-contained area or zone of the facility/hospital should be used to manage people with COVID-19, as per NSW Health’s COVID-19 Surge Capacity Management: Adapting and commissioning clinical spaces. Where possible, this should include:
  • controlled access/dedicated reception with access control and video intercom
  • segregation by closed doors
  • touchless entry automatic doors
  • wall and floor signage
  • designated area to don/doff PPE
  • designated area for staff breaks
  • limit resident access, e.g. veranda or garden.

If a resident is identified as COVID-19 positive, notify the district Public Health Unit and the Department of Health via agedcareCOVIDcases@health.gov.au. Liaise with PHU to implement local Incident Action Plan.

​​​​​Appendix A: Guide for staff arriving at the SGRACF or MPS

SGRACFs and MPSs may wish to consider using this checklist.

  • Uniforms/Clothing
    • shower and wear clean uniform/outfit daily
    • remove outer clothes such as cardigans, hats and scarfs on arrival at work and store in locker
    • outer wear can be worn if freshly washed.
  • Hand hygiene
    • sanitise hands on entry and before touching anything in facility (including the front door)
    • practice appropriate hand hygiene at work (minimum 20 seconds)
    • limit jewellery to 1 ring only.
  • On arrival
    • pass screening questions and check temperature
    • add daily temperature check sticker to ID badge
    • proceed directly to locker and store bag/outer wear
    • wear a face mask.
  • Personal items
    • store all personal items in your locker/locked room on arrival
    • use washable work bag.
  • Phones/equipment
    • wipe phone clean and place in a new, clear zip lock bag
    • wipe zip lock bag over after each use
    • throw zip lock bag away at the end of shift
    • sanitise all items and equipment on entry or before use such as COWs/WOWs, stethoscopes, phones, food trolleys, hairdressing equipment and items used for residents’ activities (personal phones should only be used on breaks).

Appendix B: Guide for staff when leaving the SGRACF or MPS​​​​​​

SGRACFs and MPSs may wish to consider using this checklist.

  • End of shift
    • remove shoes, clean with antiseptic wipes, put in a sealed plastic bag, and store in a designated place such as your locker, car or garage
    • remove uniform and put in a sealed plastic bag to take home for washing
    • change into clean clothes for travel to and from work
    • travel straight home and keep 1.5m from others if using public transport.
  • Arriving home (and before greeting other people at home)
    • disinfect car steering wheel, buttons, and door handles
    • sanitise hands before entering your house or touching anything, including the front door
    • empty phone from zip lock bag and throw bag away
    • disinfect phones, pens and any other items from work
    • shower and change into clean clothes
    • hold the hugs until you’ve showered and changed – explain to your family/household that you need disinfect items, shower and change before spending time together, to reduce the risk of possible transmission
    • wash hands at home (minimum 20 seconds).
  • Uniforms/clothing
    • separate dirty uniforms and work clothes from yours and others’ clothes.
See CEC's COVID-19 Information Sheet​ for scrubs, uniforms, aprons and gowns.

Document information

Developed by

Aged Care/Aged Health community of practice Stream 2: Residential Aged Care Facilities – Working Group.

Consultation

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.

Reviewed by

Aged Care Unit, Public Health Response Branch​.​

For use by

Staff working in NSW State Government Residential Aged Care Facilities (SGRACFs) and NSW Multipurpose Services (MPSs).​​​​​​​​​​

Page Updated: Wednesday 21 October 2020
Contact page owner: Health Protection NSW