Critical Analysis of Corona Virus (Covid-19) Prevention - Nursing Assignment Help

Assignment Task

Critical analysis of Corona Virus (Covid-19) Prevention and Management in rural residential aged care facilities (RACF)
The organisations policy on Corona Virus prevention and management seeks to minimise the impact of Corona Virus outbreak by the effective use of infection control measures and Public Health Unit directives. Recommended Prevention measures, standard and transmission-based precautions, infection control procedures are utilised to prevent and reduce the transmission of coronavirus to residents, clients, staff, and the wider community. Planned procedures such a visitor/staff screening and communication, aids in reducing anxiety related to a coronavirus outbreak and ensures the wellbeing of resident, clients, visitors, and staff.
Identified in the policy is the lack of a business support officer to ensure a thorough visitor screening process at the single point of entry. The organisation supports residential aged care workers in addition to their duties on a day-to-day basis to screen all visitors and themselves into the residential aged care facility. As a result of this practice screening questions may be rushed and or missed due to heavy workload, and a possibly infectious person may enter the facility causing an outbreak at rapid speed.
The screening process in place follows the public health guidelines to mitigate the risk of infection of Covid-19 in residential aged care facilities. Restrictions regarding the access of visitors into aged care facilities are important for protecting residents and staff to reduce the risk of transmission of COVID-19. The facility is required to stay up to date with the visitor access directions in state of New South Wales and ensure that restrictions to visitor access are applied as ordered in a timely manner. CITATION Aged20 \l 3081 (Aged Care Quality and Safety Commission, 2020).
The screening process will be evaluated to assess how the public health orders are implemented when changes occur if staffing levels are adequate to facilitate a thorough screening of visitors and if the review process is sufficient. This analysis will assess if the process presently in place adequately breaks the chain of infection thus preventing and outbreak of Covid-19 in a residential aged care facility.
The residential aged care facility is home to twenty-one residents and approximately 30 staff members. On a business day the facility is staff with three care service employee’s, one registered nurse, one cleaner, one care manager, one team leader, one cook and one lifestyle officer. Weekends and public holidays are staffed with one three care service employees, one cook and one endorsed enrolled nurse.
The policy states all staff are aware of visitor conditions including on weekends and legislative requirements, specifically vaccination status which is mandatory for flu vaccinations after June 1st 2021. If they are not vaccinated for influenza or refuse to be vaccinated the staff member is to advise the visitor that their visit cannot be supported as the current Public Health Order stated that this is a mandatory requirement, except where the person has a medical exemption. Staff then escort the visitor via the most direct route to designated area i.e., resident room/ meeting room.
As outlined in the policy a data base is kept of all staff, volunteers, families and contractor’s vaccinations. At staff meetings the location of the data base and requirements of entry is discussed to remind staff of their responsibilities. To access in a timely fashion the database containing vaccination statuses can be accessed on the G drive and in a folder location in the report room. If staff have any doubt about status or entry requirements, they can seek advice from more senior staff either directly or indirectly after hours. The facility utilises toolbox meetings to educate staff of frequent changes and to provide support ensuring they feel confident enough to explain refused entry to those who do not meet the requirements when more senior staff are not on duty to do so.
Screening takes place using a QR code and IPAD at the front entrance. There is a digital thermal screening device and an infrared thermometer in the event of IT failure for temperature recording. It can be expected that not all staff and visitors will be tech savvy so the option of both is forward thinking. In the event of an IT fault a paper base method can be utilised by all staff and visitors. This is to be kept onsite for a minimum of three weeks according to the policy. In the event paper-based forms run out, the policy states the form number and location in the G drive so an updated form can be printed for use.
If a staff member is present in the administration area of the building it is their responsibility to screen the visitor into the facility. Should the office be unattended there is a bell on the reception desk which visitors are to ring so a staff member on the floor can be alerted to their presence and screen them in.
It can be assumed that given the screening area is not always supervised and staff may be attending to other duties that some visitors may not complete the screening process adequately if at all. To break the chain of infection it is important staff are screening in all visitors. Hand hygiene is one of the most effective ways of preventing the transmission of contaminants and breaking the chain. CITATION Tra20 \l 3081 (Williams, 2020). Alcohol based hand rub is provided at the point of entry and is a part of the screening process which all visitors are required to adhere to and staff to enforce.
What would I do differently.
Hire a BSO for screening during 8-430 and 430-830 to facilitate screening.
Educated the screenings with clear guidelines.
Add to the plan that all updated information is sent out via memo to all staff including BSO every time there is a chane. Daily review of the data by management to ensure there was no breacg.
Residential aged care facilities must follow the advice of the aged care quality and safety commission for screening advice. CITATION Aus201 \l 1033 (Australian Government, 2020).
Cleaning Decontamination/Disinfection and Sterilisation
Coronaviruses like COVID-19 can survive on surfaces for many hours however the length of time viruses survive on surfaces varies. Cleaning and disinfection is well documented to be effective in killing the viruses. The amount of contaminated body fluid (for example respiratory droplets), the type of surface, the temperature and the humidity all affect how long the virus survives. As well as regular cleaning schedules, during the COVID-19 pandemic staff should clean and disinfect surfaces often touched with detergent solution or detergent/disinfectant wipes. General surfaces and fittings must be cleaned straight away when visibly dirty and after spills. CITATION Aus20 \l 1033 (Australian Government, 2020).
Enhanced environmental cleaning during an outbreak includes but is not limited to; enhanced cleaning of communal areas and residents’ rooms and frequently touched surfaces. All resident care equipment should be cleaned and disinfected between each use or used exclusively for individual residents where required/available. CITATION Dep21 \l 1033 (Department of Health, 2021).
Surveillance and EpidemiologyThe cornerstone of any prevention and control measures is the epidemiological surveillance. Surveillance is “the ongoing systematic collection, analysis, interpretation and dissemination of data regarding a health-related event; for doing actions”. Surveillance is a critical part of public health practice. Real-time analyses of epidemiological data are urgently required for increasing the awareness about the problem and for prompt interventions. Identification of the newly suspected or confirmed Covid-19 cases is an essential element for effective public health interventions, and for prevention of future pandemic. CITATION Aus20 \l 1033 (Australian Government, 2020).
Covid-19 surveillance involves monitoring the spread of the disease in order to identify the patterns of progression, and for application of preventive and control measures. Despite the efforts for enhancing epidemiological surveillance, developing nations still have difficulty in accurate identification, diagnose, and reporting such communicable diseases. CITATION Nah20 \l 3081 (Ibrahim, 2020)The policy does not state who documents the cases but does state it has been documented. This could be made clearer for new staff (possibly agency staff coming to replace unwell staff or those unable to work) such as how and where this
Staff in direct contact with ill residents should observe contact and droplet precautions. In addition, staff should not move between the cohorts of those with the disease (in isolation) and those in quarantine. They should only work within one of the cohorts and undertake regular testing during the outbreak. The public health unit will assist the outbreak management team to coordinate testing in the facility every 72 hours: All positive cases will be isolated as mentioned previously. Repeat testing will identify those who are pre-symptomatic to enable rapid removal from the environment. Staff should also be regularly screened for symptoms. CITATION Age20 \l 1033 (Aged Care Quality and Safety Commission , 2020).
Once cases are isolated, to further reduce the risk of transmission specific staff should be allocated to the care of residents with COVID-19 who are in isolation. Staff members must not move between their allocated room/section and other areas of the facility or provide care for other residents. Considerations in choosing dedicated staff should be made by the care manager. Staff should not be assigned who are at risk of having more severe disease if they are infected. As per policy and WHS the care manager is to ensure staff have recently completed infection control training and updating the register accordingly. CITATION Dep20 \l 1033 (Department of Health, 2020).
Raise awareness around the facility by placing signage to identify the need for droplet precautions in addition to standard precautions for infection control. Preventing COVID-19 from spreading to outside the facility is done by suspending all group activities, particularly those that involve visitors for example music groups/performers and exercise classes. Visits from non-essential external providers such as audiologist, hairdressers and podiatrist are also to be rescheduled. Regular visitors including families and pastoral care workers must be informed of the outbreak of COVID-19 and request only essential visits (palliative care) take place. Children under 16 should not attend unless there are extenuating circumstances such as palliative care. CITATION Dep20 \l 1033 (Department of Health, 2020).
Enhanced environmental cleaning during an outbreak is a key part of management; enhanced cleaning of communal areas such a dining rooms/lounge rooms and residents’ rooms is required. High touch surfaces should be cleaned frequently throughout the day and all resident care equipment such as lifters should be cleaned and disinfected between each use or used exclusively for individual residents where available. CITATION Aus211 \l 3081 (Australian Government DHA, n.d.)Monitoring the progress of the outbreak should occur daily by management. This includes closely monitoring all residents and staff for signs of infection. Ideally repeated testing should occur for those isolating with the line listing updated daily. Repeating testing of individuals allows management to closely monitor the outbreak and sooner hopefully sooner declare it over. Typically, the outbreak can be deemed as over 14 days after isolation of the final case. The leader of the outbreak team is responsible for deciding the outbreak is over and announcing it in consultation with the PHU. CITATION Aus21 \l 3081 (Australian Government Department of Health, 2021).
Multi-resistant Organisms/Antimicrobial StewardshipAntimicrobials have enabled medical advancements over several decades. However, the continuous emergence of resistance to antimicrobials restricts our ability to treat diseases and curbs efforts to achieve universal health coverage and the health-related sustainable development goal. Antimicrobial resistance is a neglected global crisis that requires urgent attention and action.
Appropriate prescription and optimized use of antimicrobials guide the principles of antimicrobial stewardship activities, together with quality diagnosis and treatment, and reduction and prevention of infections.2 During the current coronavirus disease 2019 (COVID-19) pandemic there are potential threats that could affect antimicrobial stewardship activities and drive antimicrobial resistance. CITATION Hai21 \l 1033 (Haileyesus Getahun, 2021).
Aseptic Technique and Invasive DevicesA risk mitigation approach should be taken to reduce the risk of transmission of infection. The most effective strategy is to eliminate the risk; however, this is often not possible in healthcare. Substitution follows, by means such as providing tele-health appointments, however, this itself has limitations for example it is not application of vaccinations. Thirdly, engineering controls; this includes having adequate ventilation and physical barriers. Fourthly administrative controls can be implemented, and this includes hand hygiene and staggering work schedules to minimise overlap. The final stage is the wearing of personal protective equipment includes masks, gloves, gowns and face shields etc. (Australian Health Protection Principal Committee [AHPPC], 2020).
International and Australian oversight of IPC Strategies
The policy does not refer to the clinical governance team nor their responsibilities/role. Clinical governance ensures that the organisation can be confident that systems are in place to deliver safe and high-quality health care, and continuously improve services. Suggest the policy be reviewed to incorporate this important section. It is clear from prior Covid-19 outbreaks both nationally and internationally that clinical governance is key is outbreak management of Covid-19 in residential aged care facilities. CITATION Age20 \l 1033 (Aged Care Quality and Safety Commission , 2020).
Employee HealthAccording to the policy transmission of vaccine preventable diseases in aged care settings has the potential to cause serious illness and the potential of grave consequences for consumers as well as those living in the community. Under s17 of the Work Health and Safety ACT 2011, a duty is imposed to organisations which requires risks to be eliminated and if it is not reasonable to do so, risks should be minimised through controls. The organisation therefore has a duty of care and a responsibility under work health and safety legislation to control risks. The policy provides a framework for the assessment, screening and vaccination of healthcare workers, other clinical personnel, and students to minimise the risk of transmission of vaccine preventable disease.
Vaccination is the most important measure to prevent the spread of communicable diseases. As stated in the policy the organisation is responsible for meeting the cost of the vaccination/screening program and clear documentation will be maintained for each employee in their employee records. Documentation must include results of all screening tests and vaccinations administered. This documentation will be maintained in staff files. Consent must be obtained from all staff to participate in the program and the organisation must ensure that employees that refuse to particpate
Practice specific settings
Risk of experiencing more severe and fatal disease is cumulative and on a sliding scale. As a person ages, their risk will gradually increase until we quantify this as a high risk at 70 years old. Even though adults under 70 years old are not technically classified as a high risk, it is important to remember that the actual risk does not suddenly escalate when turning 70. Age is the strongest independent COVID-19 risk factor for severe outcomes, followed by chronic disease (Australian Government, 2020a; CDNA, 2021).

Conclusion
The Corona virus prevention and management policy from my organisation leaves little room for error. As the virus evolves throughout the pandemic it makes sense that policies and procedures should evolve as well to protect our staff and residents. Annual review of such a policy is not adequate given how fast the virus is changing. Suggest a review every three months or sooner if required. While the policy is rather solid it was noted to need updating with specific focus on expanding the prevention strategies to support staff through their wellbeing, communication and education. In addition to the above clear clinical framework is required in the policy to best manage a potential outbreak. Updating the clinical governance team and providing training to those team members in their roles/responsibilities would strengthen a potential outbreak response. The fight for aged care and the rest of the world against Covid-19 is far from over.

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