Social care approach to respiratory viruses, spring/summer 2023

Beyond the emergency response to the pandemic, we need to consider the vulnerability of people accessing social care. We will build on our knowledge following excellent uptake by care home residents and social care staff of the COVID-19 vaccine. On behalf of residents and staff, social care workers still prevent and control Acute Respiratory Infections (ARI).

'Acute respiratory infection' covers illnesses like COVID-19, influenza and respiratory syncytial virus (RSV).

Some safeguards and good practices will continue to be advised where ARI symptoms are present. Also we will encourage care home providers to move confidently towards greater normality in homes and the lives of the people in their care. It's important that we all remember that care homes are a person’s home and not a clinical environment. For this reason, there will always be some inherent risk of acquiring infection. While we do our best to prevent this risk and recognise residents are vulnerable, actions taken must consider wider harms.

We advise public facing workers with respiratory infection symptoms and/or high temperatures to stay at home. They should tell their employer as soon as possible too.

When no longer unwell and/or with a high temperature and ready to return to work, they may want to discuss with their employer ways to minimise any risk. This is because some people may still be infectious.

Also discuss with your line manager ways to minimise transmission if you are a household or overnight contact of someone who has:

• tested positive for COVID-19
• COVID-19 or other respiratory virus symptoms

Find further details on our advice page for health and care staff on respiratory viruses.

Testing for staff and residents

When the prevalence of an ARI including COVID-19 is lower, testing is no longer recommended for staff or residents. This is based on the latest clinical advice about the benefits of asymptomatic testing.

Further details can be found at: Advice for health and care staff on respiratory viruses including COVID-19: guidance | GOV.WALES

PPE requirements

PPE should meet the requirements of the National Infection Prevention and Control Manual Wales. This notes using Standard Infection Prevention and Control Precautions (SICPs). Also it discusses applying Transmission Based Precautions (TBPs).
 
Wear gloves and aprons when providing close personal care. If blood and/or body fluid contamination to the eyes/face is anticipated/likely, wear eye/face protection.

Find current PPE advice on Public Health Wales's website.

Residents are not required to wear a mask.

Visitors and visiting

Visitors should be welcomed, encouraged and enabled when there is no outbreak at the care home. Visiting arrangements should be as open and flexible as possible. Whilst visitors may be offered PPE, they are not required to wear a face mask unless they choose to do so.

People are asked not to attend a care home if they:

• have symptoms of a respiratory infection including COVID-19
• have a high temperature,
• do not feel well enough to go to work
• have someone in their household with a known positive case in in the last 10 days

Testing for staff and residents

Symptomatic people should be tested if vulnerable and/or eligible for antiviral treatment or at the request of a clinician. The health board in collaboration with the Health Protection Team will organise this test.

Asymptomatic testing for ARI including COVID-19 is not recommended for staff or other residents.

Further details can be found at: Advice for health and care staff on respiratory viruses including COVID-19: guidance | GOV.WALES. See the gov.uk website for COVID-19 guidance for people with a compromised immune system.

PPE requirements

PPE used should meet the requirements of the National Infection Prevention and Control Manual Wales. It notes using Standard Infection Prevention and Control Precautions (SICPs). Also it discusses the Transmission Based Precautions (TBPs).

Wear gloves, aprons, and fluid resistant surgical masks when providing close personal care to people. If blood and/or body fluid contamination to the eyes/face is anticipated/likely, wear eye/face protection.

All staff if in two meters of the symptomatic individual should wear a fluid resistant surgical mask.

The symptomatic person should be isolated and supported to wear a face mask when others are in the room, if tolerable.

Asymptomatic residents or staff who may have been in contact with the symptomatic individual are not required to wear a mask.

Visitors and visiting

When there is no outbreak at the care home, welcome, encourage and enable visitors. Visiting arrangements should be as open and flexible as possible. Whilst visitors may be offered PPE, they are not required to wear a face mask unless they choose to do so.

People are asked not to attend a care home during a period where they:

• have symptoms of a respiratory virus
• do not feel well
• have been a close contact of a positive case within in the last 10 days

Encourage visitors giving direct care to use a face covering in 2 meters of a service user with a suspected or known respiratory infection. However, they are not required to wear a face mask unless they choose to do so.

Testing for staff and residents

Where there are two or more people with symptoms of ARI, they should be tested to identify the cause. The health board in collaboration with the health protection team will organise the test.

Subsequent individuals who develop symptoms are to be tested if they are:

• vulnerable
• eligible for antiviral treatment
• at the request of a clinician

Asymptomatic testing for ARI including COVID-19 is not recommended for staff or other residents.

Further details can be found at: Advice for health and care staff on respiratory viruses including COVID-19: guidance | GOV.WALES. See the gov.uk website for COVID-19 guidance for people with a compromised immune system.

PPE requirements

PPE used should meet the requirements of the National Infection Prevention and Control Manual Wales. It describes using Standard Infection Prevention and Control Precautions (SICPs). Also, it discusses Transmission Based Precautions (TBPs).

When giving close personal care to symptomatic people, wear:

• gloves
• aprons
• fluid resistant surgical masks

If blood and/or body fluid contamination to the eyes/face is anticipated/likely, wear eye/face protection.

When there is a known or suspected cluster transmission of ARI, all staff should wear fluid resistant surgical masks.

Asymptomatic residents are not required to wear a face mask, though they may choose to do so by personal preference. However in some settings as in oncology/haematology, patients are at high risk of infection due to immunosuppression. There, non-infectious patients may be encouraged to wear a facemask.

Isolate symptomatic individuals and supported them to wear a face mask when others are in the room, if it can be tolerated.

Visitors and visiting

Visiting arrangements should remain as open and flexible as possible during an outbreak/incident. Continue to support visiting. Only implement restrictions to visiting after a risk assessment. As a minimum, essential visitors can continue to visit during an outbreak/incident.

Residents may nominate 2 essential visitors. This is for greater flexibility without greatly raising footfall into the home during an outbreak. They may visit separately or at the same time.

Whilst visitors may be offered PPE they are not required to wear a face mask unless they choose to do so.

People are asked to not attend the care home during this period if they:

• have symptoms of a respiratory virus
• do not feel well
• have been a close contact with a positive case within in the last 10 days

Incidents/outbreaks should be declared if two or more patients or staff cases of ARI occur in a setting with suspicion of:

• nosocomial infection
• ongoing transmission

Further information on reporting is in Public Health Wales's page on infections in care and residential settings. Also see section 5 of Public Health Wales's page on infection prevention and control.

For outbreaks to be declared over, no new outbreak-associated symptomatic or confirmed COVID-19 cases can occur for 14 days.

Admissions to care homes following hospital discharge

We would encourage health boards to work with care home providers on discharge testing arrangements. Routine pre-admission testing is not recommended. Yet it can be clinically advised based on assessment of risk and/or to support infection prevention and control measures.

Admissions to care settings from elsewhere

You can delay placement or admission for 10 days where people show signs of respiratory infection and come from:

• their own home
• the home of a relative
• another care setting

It can be 14 days for people who are clinically or extremely clinically vulnerable.

Alternatively, the care home could consider admitting them into isolation if they have the facilities.