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Preparedness planning

What should AOD organisation / service preparedness plans cover?

The preparedness plan should consider:

  1. Impacts on clients:
    • Particularly vulnerable populations such as pregnant women, persons 65 years and older, people with chronic medical conditions, people with impaired immune systems, and Aboriginal and Torres Strait Islander Australians.
    • Protocols for isolation or segregation of clients if required
    • Ability for clients to access treatment, should service closure occur
    • Emergency care for high-risk clients
  2. Staffing:
    • Monitoring of staff wellbeing and fatigue if extended working hours are required
    • Protocols for Isolation or segregation of staff if required and what this means for service capacity
    • Potential for the reduction of staff of up to 30% because of illness, concerns about workplace transmission or caregiving responsibilities
  3. Education and training
    • Education of staff in infection control measures such as hand hygiene and use of Personal Protective Equipment (PPE) and training in outbreak management
    • Delivery of clear information to clients and families regarding the outbreak including respiratory hygiene and cough etiquette, hand hygiene etc.
  4. Resources, service impacts and logistical impacts
    • Implementation of infection control and cleaning procedures
    • Reviewing medication supply and delivery options
    • Using alternate ways to delivering services other than face-to-face (for example, telehealth, digital)
    • Impact of community service closures such as GPs and pharmacies
    • Adequacy of stocks of consumables required during an outbreak, including hand hygiene products and cleaning supplies
    • Usual sources of supplies may be disrupted or unavailable

General considerations

  • Clients and staff should receive information about how to protect themselves from COVID-19 infection. Put up signage with instructions for hand hygiene and physical distancing available at NSW Health COVID-19 Posters.
  • It is important to communicate to clients and staff about the protocols for isolation and treatment access should an individual become infected or be at risk of infection through contact with a known case or travel.
  • Services should also plan for how they will manage fear and anxiety experienced by clients and staff.

Services should identify a staff member to plan, coordinate and manage logistics in an outbreak setting as well as communicate and liaise with the local public health unit and NSW Ministry of Health. Key contacts within your local health district in the event of a suspected COVID-19 case needs to be identified.

Key references

Where can I get more information on preparedness planning?

Resources to support preparedness planning include:.

What support is available to help non-government organisations or services with preparedness planning?

Non-government organisations in NSW should work with their staff, their contract managers, local health districts and the NSW Ministry of Health to prepare for, and respond to COVID-19.

Refer to the NSW Health and Australian Government Department of Health COVID-19 web pages for health professionals for information and resources.

NADA also has resources and links to support NGO service providers at NADA.

Alcohol and other drug service impacts

Is access to needle syringe programs NSPs affected?

The COVID-19 situation is continually evolving. Visit the NSW Health - NSP outlets for more information.

Are AOD services considered 'essential services'?

NGOs contracted by the NSW Ministry of Health to provide AOD treatment services have received a letter from the Ministry confirming that they deliver health services for vulnerable populations. This letter also confirms that employees may be required to travel to deliver contracted health services, and that services need to access food and other necessary provisions.

If you have questions about the impact of movement restrictions on service delivery or your staff contact your contract manager for advice.

AOD Residential Rehabilitation Services

How can the spread of COVID-19 be prevented in residential rehabilitation services?

It is essential that all residential rehabilitation services have a COVID-19 response plan in place so that prevention activities are active and action can be taken quickly should staff or residents present with respiratory symptoms or come into contact with a person with COVID-19.

Staff and residents need to understand with COVID-19 is, its signs and symptoms, how it is spread, and what they can do to limit transmission. Information is updated regularly on COVID-19 - Frequently asked questions. Residential facilities are responsible for ensuring their staff are adequately trained and competent in aspects of outbreak management prior to an outbreak. Staff need to know the signs and symptoms of COVID-19 in order to identify and respond quickly to a potential outbreak, and be competent in implementing infection control guidelines.

Clients, staff and visitors should be practising physical distancing measures to mitigate the spread of COVID-19. These measures are of critical importance for people 65 years and over, those with chronic diseases, people with compromised immune systems and other vulnerable groups, for more information see COVID-19 - Frequently asked questions. It is important that all residential services consider how to implement physical distancing into their service practice and everyday work flows.

Residential services need to follow NSW Health Infection Prevention and Control Policy and carefully consider their protocols for waste disposal, processing of reusable equipment, environmental cleaning, laundering of linen and protocols for food handling and cleaning of used food utensils.

Advice on control and prevention of COVID-19 in residential facilities is provided by the Clinical Excellence Commission and NSW Health at Infection prevention and control COVID-19.

For more information on preparedness planning see the Communicable Diseases Network Australia (CDNA)'s Coronavirus Disease (COVID-19) Outbreaks in Residential Care Facilities.

Also review the NSW Health guidance for residential aged care facilities .

What should residential services do if a resident or staff member have cold or flu-like symptoms?

If a resident or staff member develops cold or flu-like symptoms on site provide them with a face mask and isolate the resident or staff member (ideally in a separate room if possible) to reduce the risk of spreading the infection to other residents and staff.

NSW Health recommends anyone with respiratory symptoms or unexplained fever should be tested for COVID-19. This is especially important for anyone who lives or works in a high risk setting, such as a residential facility. The location of COVID-19 clinics can be found at COVID-19 clinics.

Staff who develop symptoms of respiratory illness should be excluded from the facility and remain away whilst a diagnosis is sought. If COVID-19 is excluded, the staff member may return to work once well. If a diagnosis of COVID-19 is confirmed, the staff member must be excluded until they meet the guidelines for release from isolation, see the NSW Health self isolation guidelines for people diagnosed with COVID‑19 infection.

Asymptomatic people do not require testing except in exceptional circumstances; for example, they are recovered cases wishing to return to work in a health care facility or other high-risk setting; or the person is part of a public health unit investigation.

For further advice, please see the COVID-19 Control Guideline for Public Health Units, or call your Public Health Unit on 1800 066 055.

What happens if a COVID-19 case is confirmed in a residential rehabilitation service?

In the event of a confirmed case or outbreak in a residential AOD service, the NSW Health Public Health Units will provide support in relation to testing and identifying the control measures that need to be in place. The residential facility is responsible for managing the outbreak in consultation with the Public Health Unit, and for making decisions about discharge / closure based on specific circumstances and nature of the client population.

The local Public Health Unit will assist residential facilities in confirming outbreaks, provide guidance on outbreak management and assistance with informing relevant stakeholders.

Organisations should have response plans in place, which identify all relevant contacts in preparation for the event of a suspected or confirmed COVID-19 case.

The most relevant guidance on COVID-19 in residential facilities is the Communicable Diseases Australia Network's Coronavirus Disease 2019 (COVID-19) Outbreaks in Residential Care Facilities.

How can people access take-home naloxone?

Take home naloxone is available free of charge without a PBS prescription from participating community pharmacies in NSW and some drug and alcohol services for anyone at risk of experiencing or witnessing an opioid overdose. Further information for alcohol and other drug services is available at NSW Health - AOD services access to naloxone and Your Room - Naloxone.

Protecting against COVID-19

What additional measures do I need to take with regards to infection control at my service?

COVID-19 is transmitted by droplets and fomites during close unprotected contact with an infected individual. Viable coronavirus may persist on surfaces for several days. Faecal shedding of the virus has also been demonstrated in some patients.

Avoidance of exposure is the single most important measure for preventing the spread of COVID-19, combined with proper hand hygiene, more information is at COVID-19 - Frequently asked questions.

Current CEC Recommended Guidance on Mask Use in NSW recommends the use of surgical masks for persons with acute respiratory symptoms and for confirmed cases of COVID-19 (regardless of whether symptoms are present). Use of surgical masks is also recommended for persons coming in close contact (less than 1.5 meters) with symptomatic / confirmed COVID-19 cases.

For more information on appropriate use of personal protective equipment and on best practices for environmental cleaning see the CEC Infection Prevention and Control in Primary and Community Settings resource.

In addition to standard NSW Health infection prevention and control procedures, services should perform a service-specific risk assessment to ensure the risks of a COVID-19 outbreak are as low as possible. This should involve examining the service environment to consider how their workflow (i.e. how people physically move through the service, whether people come into close contact, how waiting rooms are configured) might be altered to allow for keeping safe physical distances.

Clients in AOD services may have a high level of comorbidity, where can I get advice on ensuring the safety for our client population?

Seek advice and support through:

  • local addiction medicine specialists within your local health district - make contact with the AOD service now before an acute issue presents
  • the Drug and Alcohol Specialist Advisory Services (DASAS) on 02 9361 8006 (Sydney metropolitan), 1800 023 687 (regional and rural NSW) is a free telephone service for doctors, nurses and other health professionals from any part of NSW and ACT where local support is otherwise unavailable. More information about DASAS is available at St Vincent's Hospital Drug and Alcohol Specialist Advisory Service.
  • your local health district Public Health Unit.

Testing

Are staff of AOD services able to access coronavirus testing?

The criteria for COVID-19 testing is being updated as the pandemic unfolds. NSW Health recommends that anyone with respiratory symptoms or unexplained fever should be tested for COVID-19. This is especially important for anyone who lives or works in a high-risk setting, such as a residential AOD service. The location of COVID-19 clinics cab be found at COVID-19 clinics.

Any healthcare worker and anyone who works or lives in a residential rehabilitation facility and has respiratory symptoms or unexplained fever is elligible for priority testing.

Asympomatic people may also be eligible for testing in certain circumsatcnes, for example recovered cases wishing to return to work in health or other high-risk settings, or persons who are part of a public health unit outreack investigation. For further advice on testing, contact your Public Health Unit on 1300 066 055.

My client is refusing to be tested, what should I do?

There is no specific guidance for dealing with people who are symptomatic but refuse to be tested, but this will be dealt with on a local level. It is recommended that you contact your local Public Health Unit for advice and assistance if there are any concerns about specific circumstances or individuals. If a person is flagrantly breaching the Public Health Order on essential movement and travel, they should be reported to Crimestoppers. For more information on penalties for breeching orders visit the NSW Government COVID-19 website

Isolation

When should a client / staff member self-isolate?

Isolation is strongly encouraged for clients and staff with cold or flu symptoms. This means keeping workers at home even if they have only mild cold symptoms. "Sick" should be defined as any sign of respiratory infection or unexplained fever, and persons with even mild symptoms should be tested for COVID-19.

Persons who have been diagnosed with COVID-19 must self-isolate until there has been a resolution of symptoms. NSW Health self isolation guidelines for people diagnosed with COVID‑19 infection are available.

If a client or staff member develops any respiratory symptoms while on site, they should put on a mask, be isolated (in a separate room if possible) and arrangements made for testing. In the case of clients who cannot self-isolate at home, contact your local Public Health Unit (1300 066 055) for advice.

My client is refusing to be isolated, what should I do?

In NSW, heavy penalties are in place for individuals breaching an order to self-isolate. People refusing to self-isolate may be reported to NSW Police. For more information about self-isolation, mandatory quarantine and related matters visit NSW Government - COVID-19.

Reporting

Who do I need to inform about a suspected case of COVID-19?

If a client or staff member is suspected to have COVID-19 they should be tested as soon as possible. This is especially important for high-risk settings such as residential AOD services. The location of COVID-19 clinics can be found at COVID-19 clinics.

In the event of a positive test your local Public Health Unit (1300 066 055) will advise and assist with tracing and screening contacts and identifying any control measures that need to be put in place. You will need to be prepared to provide information to the Public Health Unit, including the number of clients / staff with symptoms, date of onset and nature of symptoms and information about your service including set up and total number of staff working in the facility where you are based.

Do I need to file a clinical incident report if a staff member and / or client has suspected of confirmed COVID-19?

Please complete the 'Serious Clinical Incident Report for Alcohol and Other Drugs Funded NGOs Report' in the event that a staff member and / or client is diagnosed with confirmed COVID-19. It is not necessary to report a clinical incident in the event of a suspected COVID-19 case where testing subsequently returns a negative result. Instructions and a form is available at Serious Clinical Incident Report.

Implications for contractual obligations and funding

Will our funding be affected if we cannot meet our performance indicators due to the impact of COVID-19 on our ability to deliver services?

No. NSW Health understands that there may be a requirements to vary your service delivery while the COVID-19 pandemic is ongoing, and that such changes may have an impact on client volumes and other performance indicators. Contract managers at the NSW Ministry of Health or local health districts should be advised of events / actions causing a disruption or scaling back of service delivery. Subsequent performance reviews will take into account legitimate service disruptions attributable to COVID-19. Services should let all funders - state and federal know what your issues are and how you plan to respond.

If we reduce bed numbers will we lose funding?

NSW Health understands that in order to ensure client and staff safety and to maintain continuity of service delivery some services may temporarily reduce bed numbers. Existing funding agreements will not be affected by such a decision and payments will continue as outlined your funding schedule. Similarly, if a residential services goes into quarantine or if temporary closure is required due to a COVID-19 outbreak, these events will not affect current funding agreements. Please contact your contract manager if you are planning to make changes to your bed availability.

If our client volume declines, or if we change our service delivery model in response to COVID-19, will we be in violation of our contract?

No. NSW Health understands that there may be a requirement to vary your usual service delivery model due to the risks to your clients and staff posed by COVID-19, that it may not be possible to accept the usual volume of clients, and that referrals may decline. Existing funding arrangements will not be affected by such a decisions and payments will continue as outlined in your funding schedule. Please contact your contract manager to keep them informed if you plan to make changes to your service delivery.

Other

For people who are released early from a corrections facility, what is being done to maintain them on OTP?

Justice Health the NSW Ministry of Health are working to ensure people have a pre-release treatment plan and where appropriate moving people to depot buprenorphine prior to release. The NSW Ministry of Health and Justice Health are working together. In cases where people are released early and not known to Justice Health, and / or do not have a plan in place, then services should contact the local health district for support. The Opioid Treatment Line is also available for support on 1800 642 248.

For answers to more questions about COVID-19, visit COVID-19 - Frequently asked questions.

The National Coronavirus Health Information Line is available on 1800 020 080..

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Page Updated: Thursday 7 May 2020