Coronavirus (COVID-19): care home outbreaks - root cause analysis

Table of Recommendations

No. 1

Relates to:

Care Home risk factors

Recommendation

• It is important to recognise that any care home, irrespective of size or number of residents, is vulnerable to outbreaks, and prevention strategies at care home level and HSCP level should take account of this
• A campaign of awareness-raising amongst Care Home staff of the particular symptoms in older people should be undertaken 

No. 2

Relates to:

First wave

Recommendation

• Board level and national-level lessons learned for care homes are required to be continuously reported and shared in the pandemic with the care homes and the wider system. 
• All long-term care facilities (care homes, residential settings and community hospitals) need to implement active measures to prevent introduction of COVID-19 and be kept up to date with the emerging epidemiology and IPC issues.
• Additional factors found for consideration of further guidance and support include: travel associated risks in care workers, on-going variation in care homes with respect to glove use, hand hygiene, and cleaning
• IPC, inclusive of its application to visiting, is critical to the sector. Care homes should have access to expert IPC advice to support local risk assessment and a mechanism should be developed to enable sharing of what works well, in terms of applying the national guidance in a local context 

No. 3

Relates to:

Data landscape and digital infrastructure

Recommendation

• IMT systems need connected within and between boards to enable outbreak management and network analysis to be further enabled
• Intelligence sharing across the system of national organisations supporting the pandemic needs strengthened to inform national action planning in support of local needs. 
• The TURAS safety huddle system should consider wider winter preparedness and broader IPC needs as part of planned future developments and how the system might move to be used for local improvement 
• Support in building capacity and capability for data systems to be used by care home staff for quality improvement is required
• Care homes should ensure preparedness for any potential outbreak by maintaining a current register of all required staff and resident data  

No. 4

Relates to:

Early Warning Systems

Recommendation

• TURAS, and supporting processes for its use in the HSCP and care homes, should continue to be further developed to ensure it can be used as effectively as possible as an early warning system 
• Care homes should be supported to use the TURAS data for local improvement
• A further detailed review of staffing rosters and workforce capacity should be considered based on the findings from the TURAS indicator data, it may be helpful for care home oversight groups to work collectively with care homes in the use of workforce tools to enable system level planning and mutual support

No. 5

Relates to:

Testing

Recommendation

• Urgent action should be taken to ensure parity of access to testing and speed of response for care home and wider NHS and agency staff deployed there 
• Urgent action to ensure suspected outbreaks in care homes result in all staff and residents being quickly tested and there are no delays to total turnaround time from sample being taken, to results being reported back

No. 6

Relates to:

IPC knowledge and expertise

Recommendation

• Local IPC capacity requires to be developed at H&SCP level and with HPTs to support care homes with expert IPC advice which is risk based, proportionate and supports compassionate care in a homely setting 

No. 7

Relates to:

IPC indicators

Recommendation

• IPC indicators (such as hand hygiene compliance) should be routinely monitored in care homes and comparative reporting over time developed – TURAS should be considered for further development to encompass this
• Monitoring systems for IPC compliance in care homes should be further developed 
• Further work is required to develop SICPS as part of day to day practice in care homes settings
• The TURAS dashboard needs to be used by care home managers and by HSCP in order to provide assurance in relation to safe staffing, escalation and IPC 

No. 8

Relates to:

Leadership

Recommendation

• Organisations should take steps to ensure the emotional wellbeing of all staff, with a particular focus on care home managers, through providing access to support and signposting to the range of resources currently available
• Consider access to enhanced leadership training, mentoring and leadership networks 
• A national information campaign should be considered for care home staff to ensure information is well understood in relation to how personal behaviour can impact on their role whilst at work, to include social distancing, cigarette breaks, car sharing, and remaining vigilant to risks at all times  

No. 9

Relates to:

Training and education

Recommendation

• Development of a mandatory induction module for IPC, in partnership between SSSC and NES, should be undertaken as soon as is practicably possible
• Consider a supportive education model where care homes educators roles are developed to support every care home in Scotland 
• Workforce development needs for IPC requires to be considered for all staff in care homes and those providing IPC support to this sector

No. 11

Relates to:

Guidance and local adoption

Recommendation

• HSCP planning using a multimodal approach to IPC is required; this may be supported by national IPC lead organisations such as ARHAI Scotland
• The new national care home manual for IPC planned for completion in December 2020 should be produced with a multimodal strategy plan for dissemination and implementation
• National organisations should be mindful of the impact of publication of guidance on days towards the end of the week or over weekends, and the availability of senior managers to support interpretation, dissemination planning should be considered as part of the guidance development process
• Most recent versions of guidelines should clearly highlight the additional information or changes from the previous version   

No. 12

Relates to:

Inspection arrangements

Recommendation

• Undertake a thorough review of the joint inspection process to ensure a truly integrated approach to inspection in care homes is in place 
• Ensure that relevant professional national IPC expertise is at the centre of the process, to provide a consistent level of expertise and support 
• At present the operation of the wider company structure is outwith the scope of Care Inspectorate scrutiny, and consideration should be given to extending its remit to corporate entities    

No. 13

Relates to:

Carer perspectives

Recommendation

• Context specific care home level guidance is required locally, in line with national guidance, for visiting and care practices within the individual home that makes it easy for consistency in application of IPC needs in a risk based and proportionate way to enable compassionate care in a homely setting
• Provision of a 'Visiting champion' or other similar arrangement is desirable in ensuring that advice and guidance relevant to specific contexts is readily available and consistently applied

No. 14

Relates to:

Built environment

Recommendation

• Infection prevention and control specialist support for individual care homes is required when considering the built environment and risk assessment
• Risk assessment inclusive of advice relating to the built environment covering areas such as fire and falls is required, to ensure that no unintended consequences of changes in the built environment due to IPC measures, are present.
• Ventilation guidance should be considered nationally to share general principles to mitigate transmission risks re aerosols over the winter months in care homes

No. 15

Relates to:

Raising Concerns

Recommendation

• Consider extension of the whistleblowing service to all staff across the health and care sectors.