If the staff or visitor answers yes to questions 1-4, advise them to:
It is important to note that:
- call the National COVID-19 Helpline (1800 020 080) and go to the closest COVID-19 Clinic (NSW Health recommends that anyone with respiratory symptoms or unexplained fever should be tested for COVID-19)
- stay home and self-isolate until temperature is below 37.5°C and they receive a negative test result for COVID-19
- (for staff) follow the usual sick leave protocol. Special leave may apply – staff should consult local Workforce/Workplace Relations.
- a recent negative COVID-19 test does not guarantee that the person is still negative
- 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 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 Order, 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.
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.
SGRACFs and MPSs must request that visitors 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.
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
- 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.
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’s 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)
- 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.
- 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.
- 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.
- 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.