COVID-19 Desktop Exercise at PresCare Alexandra Gardens

This year has been focused on being prepared to prevent and manage COVID 19 outbreaks and we have seen a wealth of resources, guidelines and requirements across the aged care sector. The huge amount of work being done is important to ensure we are taking all the necessary precautions and putting plans in place to maintain the wellbeing and safety of our residents, their loved ones, employee’s and our community.

Our Outbreak Management Team and key personnel at Prescare have been working closely and meeting fortnightly via teleconferencing with CQ Public Health Unit (PHU) representatives for updates on COVID-19 and to share information regarding infection prevention and management. 

PHU representatives offered to conduct exercises at RACFs to test preparations for, and the ability to respond effectively to a COVID-19 outbreak. This was considered an opportunity for the Outbreak Management Team at PresCare Alexandra Gardens to gain a deeper understanding of a COVID-19 outbreak response in an aged care facility and to test PresCare’s Outbreak Management Planning at organisational and local levels.

In preparation for this exercise, the full staff roster for one week before and after, as well as a full list of residents (by wing/unit) was provided to the CQ PHU on 16 September. A ‘case’ was selected from this information and a scenario around this case was developed by the Registrar, Public Health Unit.

Scenario:

The scenario as follows was received at 1200 on 23.09.2020 following a phone call from the Public Health Nurse:

"Unfortunately, the Central Queensland Public Health Unit has been notified that one of your staff members, an enrolled nurse has tested positive for COVID-19. (specimen collected 12:30 pm Sunday 20.09.20)".

The illness onset date and time had to be established, and identified to be Wednesday 16 September at around 11.00am with mild symptoms, but gradually worsened until Sunday when the enrolled nurse decided to leave work early at midday to be tested. The staff member worked normal shifts as per the roster up until this time.

It was of the upmost importance that we established movements of this staff member in the facility from the commencement of their infectious period (Monday 14/9/2020 – 11.00am) until notification and identify all close contacts as a matter of urgency.

To assist in the public health investigation, we had to also gather the following information and share via email as well as providing a printed copy:

• An electronic copy of the staffing roster that includes all the staff on the shifts where the enrolled nurse had worked (including those shifts before and after to incorporate handover) during these times.  We had to include; Operational Staff / Kitchen Staff / Students / Maintenance / administration support *

• An electronic list of all visitors to the centre during the enrolled nurses shift times (including MO's, external allied health, contractors, etc).
• The PHU needed to go through this list and define those that were Close Contacts based on the CDNA Guidelines and  contact them and arrange quarantine and follow up testing.

• A complete list of Residents that the enrolled nurse would have had contact with during these shifts:
• On medication rounds,
• Dressings,
• Reviews.
• The PHU assessed each of these Residents separately.  They would be identified as Close Contacts if they have had >15 minutes face to face or 2hrs in a confined area cumulative over 7 days. Therefore, if the staff member was the RN who did the medication round for the whole facility over multiple days it is likely that all the Residents based on the F2F for 15min would be classed as close contacts.

• A full list of staff who work in the facility which includes:
• Full Name & DOB,
• Phone Number and alternate contact number,
• Email address,
• Identifies Staff that also work at other facilities.

• A list of any unwell Residents or Staff (Temp >37.5 or ARI symptoms);
• A list of staff who have taken Sick Leave during this time frame.

• A full Resident list by Wing/Unit that includes:
• Full Name and DOB,
• Wing and Bed Number.

• Resident accommodation and facility site map that includes:
• Type of room (single, shared, 4 bed bay),
• Bathroom (shared or individual).

• The Name and Contact number for the facilities Outbreak Management Team (specifically the Operations Controller) that the PHU could contact as a central point.  This list had to also included after hours contact numbers.

• The Name and Contact number for the facilities Infection Control Officer (if different from the Operations Controller) that is responsible for the Infection Control & PPE within the facility.

• List of GP’s who provide services to the Residents in the facility including which residents are under their care.

• A plan of how all residents will be swabbed for COVID-19 and who will undertake this task. (Approximately 4-5 staff who will be collecting swabs)

Response:

We placed the whole facility in lock down as the enrolled nurse had contact with the RN who works across the facility. Signage was placed at the Facility entry point and the entry to each Court/House.

The OMT, including the Crisis Coordinator, convened and responsibilities were settled, and the PresCare COVID-19 Outbreak Response was activated.

A PPE starter trolley was placed at the donning station in each Court/House and a folding table, pedal bins and hand sanitizer were paced at the doffing stations in each Court/House.

The Crisis Coordinator activated the Emergency Response and Communication Plan for COVID-19 to support outbreak management at the Facility. 

The following documents were provided to CQ PHU:

ONE - Alexandra Gardens staff list with second contact and email address. The list included Allied Health staff. No external contractors had been on site at that time, all maintenance works were performed by internal maintenance staff person.

TWO - Front office visitor and screening list with phone numbers: Highlighted name of visiting GP’s and Nurse Practitioner.  Visitors list from 14th September to 23rd September.

THREE - Resident list, names, DOB and Medicare number.

FOUR - Staff sick during this period: (see below examples of details required)

• [AIN]: new staff member onboarding who did not present with any symptoms but was tested due to her roommate being tested for COVID-19.

• [AIN]: presented with sinus symptoms and went to GP; currently on sick leave.

• [AIN]: is on carer’s leave due to her daughter unwell.

FIVE - Resident were closely monitored, such as temperature check twice daily, COVID-19 screening tool used daily to detect any resident presenting unwell or with suspected symptoms.

SIX - Site Map showing shared rooms and shared en-suites, entry and exit to each Court/House, PPE Store, donning stations and doffing stations.

• Outbreak management team list provided to include Crisis Coordinator

SEVEN - GP list with contact details

EIGHT - The COVID- 19 Swab plan, including a list of the staff responsible for undertaking the swabs, GP and pathology involved.  

Desktop Exercise:

The Public Health Team added another complexity advising that the enrolled nurse (who had tested positive) had a birthday party on Sunday evening attended by an RN, 2 EENs, 2 AINs, 1 SSW and the FM. This increased the number of staff to be removed by the workforce.

• Close contacts were confirmed and included 3RNs, 3EENs, 1CCC, 1 FM, 12 AINs, 1 PT, 1 OT, 1 Chaplain, 1 Lifestyle, 1 maintenance, 12 SSWs. The central laundry and kitchen are located in Jasmine Court increasing contact with Support Services staff.

• It was noted that the QFES came to Jasmine Court on Saturday morning (19.09.2020) due to a smoke detector activated in the Jasmine Court Dining Room. A resident in Jasmine Court attended Haematology Clinic at the local Hospital on 21.09.2020, another resident attended a private dental clinic and a resident was at private hospital today for day surgery.

• Communication Plan, including diverting the main phone line to CO, informing residents, family representatives and staff, all well received and PHU staff advised that they maintain contact with staff every day from the first to last day of quarantine.

• Swabbing arrangements need to be revised due to potential difficulties accessing in-reach staff. PHU assisted with pathology forms.

• Infection Control expertise required on-site; FM or CCC (in quarantine) advising on-site RN will not meet requirements.

• We identified, introduction of 12-hour Outbreak shift allocation would not be sustainable due to >60% of Support Services staff in quarantine. Surge Workforce would take up to 4 days to deploy.

• Access to PPE supplies considered adequate.

• Environmental cleaning process discussed and use of Contain 5000 considered effective.

• Planned catering and laundry arrangements during an outbreak considered appropriate.

• Resident identification considered appropriate.

• On-site GP Medical lead, agreed and confirmed her acceptance to take on the role responsibilities.

• The need for single rooms with an en-suite for each resident discussed. The use of commodes not acceptable. Transferring residents out of the Facility may be required.

Learnings:

• PHU recommend that all RNs and ENs be trained to swab for COVID-19 instead of using in-reach services. As well as baseline swabbing there is a requirement to swab on day 4, 8 & 12.

• All resident information needs to be provided to PHU in one spreadsheet; include, by Court/House, residents name, DOB, room number, photo, family representative/s and contact details, GP and contact details, and Medicare number.

• Need a supply of N95 masks for staff taking COVID-19 swabs. Set up a swabbing station.

• Availability and access to a surge workforce needs to be clarified and confirmed.

• Include a contingency plan for deep cleaning, particularly with >60% of Support Services staff in quarantine.

• If deploying staff from other facilities recognise the impact of these staff being away from their place of employment for 4 weeks.

• Infection Control Coordinator (ICC) needs to be on-site and for prolonged time.

• Infection Control Champions with training are a critical success factor to support the ICC.

• A GP/medical lead is required on-site.

• Tension/anxiety increases quickly, and the tension experienced by some staff is almost palpable.

• Identify work that staff in quarantine can do to decrease the pressure on staff on-site.

• Process required for the transfer of information to staff deployed to site.

• Do not underestimated the importance of the way information is conveyed to families and significant others.

• Cohorting staff and residents at all times will pay dividends.

Conclusion:

Staff responded appropriately and demonstrated commitment to effective infection prevention and keeping resident who live and people who work at PresCare Alexandra Gardens safe from the COVID-19 Pandemic.

The PHU Team, Public Health Registrar, Public Health Nurse, Senior Project Officer and Project Support Officer COVID-19, were pleased with preparations at PresCare Alexandra Gardens and with the Communications Plan.

The desktop exercise was intense and time consuming but beneficial in gaining understanding of COVID-19.

By Sandra Thomson, Manager PresCare Alexandra Gardens