Under the Aged Care Quality Standards (Quality Standards) in the Aged Care Act 1997, every aged care provider is responsible for ensuring that they have sufficient staff with the necessary knowledge and skills to provide safe, respectful and quality care and services. Providers are also responsible for ensuring that staff have the necessary training, including in infection control practices and procedures, and in the appropriate use of personal protective equipment (PPE) including gloves, face masks, face shields and gowns.
The Commission is currently working with state and territory governments, and local health authorities across the nation to monitor and test preparedness of aged care services to respond to a COVID-19 outbreak.
The Commission is undertaking unannounced monitoring visits with residential aged care services nationally to observe infection control defences at the service to prevent transmission and to recognise and respond to symptoms of COVID-19; this is to ensure that everyone is adhering to infection control arrangements including safe PPE protocols.
Officers conducting the visits use a range of tools including a review against best practice based on the Communicable Diseases Network Australia (CDNA) guidelines for COVID-19 Outbreaks in Aged Care Facilities and in some instances, an infection control monitoring checklist to guide the visit.
Additional questions are also asked to understand how the provider is applying the public health directives relating to infection control applicable in their state or territory.
The site visit is a monitoring visit, not a performance assessment. Where issues or concerns are identified, such as staff not applying correct PPE or adhering to other infection control practices, the Commission will consider further regulatory action to ensure that the provider is meeting their quality and safety obligations. This may include a performance assessment against the Quality Standards or imposing sanctions.
The Commission will not undertake these infection control site visits with services that have known positive cases of COVID-19.
The infection control site visits will be made by officers authorised by the Commissioner. The officers:
- have authority to enter services, with consent, under Part 8 of the Commission Act; and officers will show relevant identification when seeking consent
- in visiting residential aged care facilities, are exercising functions and powers of the Commission under Commonwealth legislation that are recognised by State and Territory Health Authorities
- have undertaken PPE training to meet best practice and state-based requirements
- have completed a declaration to confirm their participation and understanding of the PPE training; agreement to use PPE as instructed; and their influenza vaccination in 2020
- will undergo daily screening by the Commission regarding any fever or symptoms of acute respiratory infection; contact with a confirmed case of COVID-19 or persons awaiting test results; and a temperature check based on expert medical advice
- will comply with the infection control processes and screening required of workers of the service on entry to the service such as complying with any entry requirements consistent with public health directions, infection control requirements. Officers will confirm that they have not been to sites with confirmed cases of COVID-19 or had any known contact with COVID-19. (Please note: in doing so, the officers are not able to disclose the names of any services visited as this is protected information under the Aged Care Quality and Safety Commission Act 2018)
- will comply with the PPE required at the service in accordance with the public health direction of the relevant state; required PPE have been supplied to the officers.
- will comply with current inter-state travel restrictions, and quarantine requirements and with the current restriction levels in place in any restricted areas
- will follow Commission notification and response protocols if a service has any COVID-19 positive cases after the officers have left the service.
A record of the regulatory official’s observations of the service environment, consumers and staff practices will be emailed to the provider of the service following the site visit.
Queries in relation to these site visits can be made to the relevant Regional office of the Commission or by phoning 1800 951 822 (free call).
Early findings from infection control monitoring activities
The Aged Care Quality and Safety Commission has recently started infection control spot checks at residential aged care facilities. The checks are conducted to observe infection control defences to ensure that services are adhering to infection control arrangements, including safe PPE protocols.
What providers are doing well
Generally, the visits have found that Outbreak Management Plans (OMP) are in place, are reviewed regularly and, importantly, contain all relevant information in an easy-to-read format. A large proportion of providers have floor plans showing room configurations, highlighted alternative access points, don/doff stations and clearly marked command centres and staff break rooms.
Some providers had laminated floor plans so they could be used as a living document that could be updated as required and one had printed a table-sized floorplan with Velcro tabs with photographs of consumers for easy identification of placement within the service. Some providers demonstrated a high level of preparedness by undertaking drills using the OMP including the allocation of staff to various lead roles and testing staff in their roles and responsibilities.
What could be improved
Our officers noted that several providers did not have sufficient PPE for the first 48 hours in the event of an outbreak.
While providers exhibited a good level of awareness about the COVID-19 status of staff and consumers and have strategies to use while waiting for test results, in some instances this was not well tested, with our regulatory officials identifying some consumers waiting for test results who were not isolated adequately.
While many providers had OMPs in place, there were some common issues identified. For example, some services had an organisational OMP template that did not have service-specific information. Not all plans had clearly identified service cohorting zones/rooms where PPE donning and doffing stations are, or should be, located.
Additionally, some services did not have clear documentation of clinical handover or lockdown processes, or a centralised listing of consumer Medicare numbers readily available. Further it was noted that some services lacked prepared signage that could be used immediately to identify areas that are active COVID-19 zones.
In locations where PPE is a requirement (in accordance with state/territory directions), our officials observed some occasions where aged care staff were wearing masks incorrectly and/or frequently touching their face/mask, and donning and doffing stations were not always clearly identified.
In terms of infection control, hand washing/alcohol-based hand sanitiser stations and disinfectant wipes are readily available in most, but not all, services. Shared equipment, such as phones or computers were not always wiped down between users, and although social distancing measures were in evidence in many services, some did not have clear signage to identify the permissible number of staff in common areas such as offices, break and changing rooms.
Good ideas and initiatives noted during our visits
- Laundering of staff uniforms so the service can be assured that each staff member has a clean uniform every day.
- Picking up staff who don’t drive and taking them to/from work in the service’s bus so they don’t have to take public transport.
- Investing in staff tracking devices for the purposes of contact tracing. The device tracks when a staff member is in a room for >10 or 15 minutes and registers it on a database. In the event of an outbreak, the service is able to run a report about which staff members and residents may be impacted.
- Investing in face scanner technology that recognises the forehead and scans faces for temperatures.
- Relocating upper and middle managers out of the main aged care service into different buildings so that in the event of an outbreak, there are senior staff available who can step in and help if their senior onsite staff have to isolate.
- Creating a song about the donning/doffing process so staff remember what to do.
- Preparing and keeping handy an ID wristband for every resident that can be placed on their wrist in the event of an outbreak, to help incoming staff who are unfamiliar with the residents to identify them if a large number of the rostered staff have to go into isolation.