Introduction: The Importance of IPC in Long-Term Care
As the COVID-19 pandemic has tragically shown, long-term care facilities (LTCFs) are particularly vulnerable to the spread of infectious diseases. Residents in these settings often have underlying health conditions and weakened immune systems, putting them at higher risk for severe illness. Implementing robust infection prevention and control (IPC) measures is crucial to protect this vulnerable population and ensure the safety and well-being of both residents and staff.
The World Health Organization (WHO) has published detailed guidance on IPC in LTCFs, providing a comprehensive framework for facilities to prevent the introduction and transmission of COVID-19 and other respiratory viruses. This article summarizes the key recommendations from the WHO’s “Infection prevention and control guidance for long-term care facilities in the context of COVID-19” to help long-term care providers enhance their IPC practices and better safeguard their communities.
Preventing COVID-19 from Entering the Facility
Screening and Monitoring
The first line of defense is to prevent COVID-19 from entering the LTCF in the first place. This starts with implementing rigorous screening and monitoring protocols:
- Screen all staff, visitors, and new admissions for symptoms of COVID-19 or recent exposure. Use temperature checks and symptom questionnaires.
- Establish a system to actively monitor residents and staff for signs of respiratory illness. Conduct regular health checks and encourage self-reporting of symptoms.
- Restrict entry of any individuals who have symptoms of COVID-19 or have had recent exposure to the virus.
Visitor Management
Managing visitors is another crucial component of IPC in LTCFs. The WHO recommends the following strategies:
- Establish clear visitor policies and communicate them effectively to residents, families, and staff.
- Limit the number of visitors per resident and the duration of visits.
- Require all visitors to wear well-fitting masks, perform hand hygiene, and maintain physical distancing.
- Consider implementing scheduled visiting hours or appointment-based visitation to better control traffic flow.
- Provide dedicated visiting areas, preferably with good ventilation, to minimize interaction with other residents.
- Ensure visitors understand and agree to follow all IPC protocols before entering the facility.
Staff Cohorting
To reduce the risk of COVID-19 transmission, the WHO advises LTCFs to implement staff cohorting practices:
- Assign staff to work with the same group of residents, rather than moving between different units or floors.
- Limit the number of staff providing direct care to residents with suspected or confirmed COVID-19.
- Ensure staff who care for COVID-19 positive residents do not also care for uninfected residents.
- Provide dedicated break areas and change rooms for staff caring for COVID-19 positive residents.
Preventing Transmission Within the Facility
Hand Hygiene and Respiratory Etiquette
Proper hand hygiene and respiratory etiquette are fundamental to IPC in any healthcare setting, including LTCFs. The WHO recommends:
- Provide easy access to hand hygiene facilities (sinks with soap and water or alcohol-based hand rub) throughout the facility.
- Educate and remind residents, staff, and visitors on the importance of frequent hand washing and proper techniques.
- Ensure residents, staff, and visitors cover coughs and sneezes with a tissue or their elbow.
Use of Personal Protective Equipment (PPE)
Appropriate use of PPE is crucial to protect both residents and staff from COVID-19 and other respiratory pathogens. The WHO advises LTCFs to:
- Ensure a reliable supply of high-quality PPE, including medical masks, gloves, gowns, and eye protection.
- Train staff on proper donning, doffing, and disposal of PPE.
- Require staff to wear medical masks at all times when providing direct care to residents.
- Provide residents with medical masks to wear when receiving direct care or when physical distancing cannot be maintained.
- Use respirators (e.g., N95 or FFP2 masks) for aerosol-generating procedures or when caring for residents with suspected or confirmed COVID-19.
Environmental Cleaning and Disinfection
Maintaining a clean and hygienic environment is essential to prevent the spread of COVID-19 and other infectious diseases in LTCFs. The WHO recommends:
- Develop and implement a comprehensive cleaning and disinfection protocol, covering all high-touch surfaces, shared equipment, and common areas.
- Use approved disinfectants effective against SARS-CoV-2 and other respiratory viruses.
- Ensure adequate ventilation throughout the facility, including in resident rooms, common areas, and staff workspaces.
- Regularly review and update cleaning and disinfection practices based on emerging evidence and changes in disease transmission patterns.
Resident Placement and Cohorting
Strategically placing and cohorting residents is a critical IPC measure in LTCFs. The WHO advises facilities to:
- Maintain single-occupancy rooms whenever possible, or ensure adequate physical distancing between beds in shared rooms.
- Cohort residents with suspected or confirmed COVID-19 in a designated unit or wing, with dedicated staff assigned to care for them.
- Avoid placing COVID-19 positive residents in the same room as those who are not infected.
- Ensure appropriate air flow and ventilation in resident rooms and shared spaces.
Testing and Outbreak Management
Testing Protocols
Proactive and widespread testing is essential for early detection and containment of COVID-19 outbreaks in LTCFs. The WHO recommends:
- Establish a regular testing regime for all residents and staff, regardless of symptom status.
- Conduct rapid antigen tests for routine screening and PCR tests for confirmation of positive cases.
- Immediately test any resident or staff member who develops symptoms of COVID-19.
- Expand testing to all residents and staff when a single case is identified, to quickly identify the extent of transmission.
Outbreak Response and Management
When COVID-19 cases are detected in an LTCF, a robust outbreak response is crucial to limit further spread. The WHO advises facilities to:
- Immediately isolate any resident with suspected or confirmed COVID-19 in a single room or cohort them with other infected individuals.
- Implement enhanced IPC measures, including increased frequency of cleaning, use of respirators for staff, and temporary suspension of group activities.
- Collaborate closely with local public health authorities to manage the outbreak, including contact tracing and reporting.
- Regularly monitor the health status of all residents and staff, and continue testing until no new cases are identified for at least 14 days.
Supporting Residents’ Well-Being
While strict IPC measures are necessary to protect vulnerable residents, the WHO acknowledges the significant impact these protocols can have on the mental health and quality of life of LTCF residents. To address this, the guidance recommends:
- Facilitate safe, meaningful visits and interactions with family and loved ones, following visitor management protocols.
- Encourage and support residents to maintain social connections and engage in recreational activities, with appropriate IPC measures in place.
- Provide mental health and psychosocial support services to help residents cope with the challenges of the pandemic.
- Regularly assess the well-being of residents and adjust IPC practices to balance infection prevention and residents’ quality of life.
Conclusion
The WHO’s comprehensive IPC guidance for long-term care facilities provides a crucial roadmap for protecting vulnerable residents and staff from COVID-19 and other respiratory viruses. By implementing robust screening, monitoring, and IPC measures, while also prioritizing residents’ mental health and social well-being, LTCFs can create a safe and supportive environment that enhances the quality of life for all. Adopting these evidence-based practices is essential to ensuring the resilience and preparedness of long-term care communities in the face of future pandemics and infectious disease outbreaks.
