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Infection prevention and control / WASH

Name of documentReference to older peopleLast updated
Infection prevention and control during health care when coronavirus disease (‎COVID-19)‎ is suspected or confirmedNo specific reference to older people29 Jun 2020
Advice on the use of masks in the context of COVID-19Advice to decision makers on the use of masks for healthy people in community settings
- Decisions makers should consider …Vulnerability of the person/population to develop severe disease or be at higher risk of death, e.g. people with comorbidities, such as cardiovascular disease or diabetes mellitus, and older people
Guidance on the use of masks for the general public
- Older people and immunosuppressed patients may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium, and absence of fever. It is important to note that early symptoms for some people infected with COVID-19 may be very mild and unspecific;
WHO advises decision makers to apply a risk-based approach focusing on the following criteria when considering or encouraging the use of masks for the general public:
- Vulnerability of the mask wearer/population: for example, medical masks could be used by older people, immunocompromised patients and people with comorbidities, such as cardiovascular disease or diabetes mellitus, chronic lung disease, cancer and cerebrovascular disease
Use of medical mask recommended for:
- People aged ≥60 years
- People with underlying comorbidities, such as cardiovascular disease or diabetes mellitus, chronic lung disease, cancer, cerebrovascular disease, immunosuppression
5 Jun 2020
Cleaning and disinfection of environmental surfaces in the context of COVID-19No specific reference to older people16 May 2020
Water, sanitation, hygiene, and waste management for the COVID-19 virus: interim guidanceNo specific reference to older people23 Apr 2020
Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortagesNo specific reference to older people6 Apr 2020
Infection prevention and control for the safe management of a dead body in the context of COVID-19: interim guidanceFuneral home/mortuary care
- Adults >60 years and immunosuppressed persons should not directly interact with the body.
24 Mar 2020
Considerations for quarantine of individuals in the context of containment for coronavirus disease (COVID-19)Quarantine of persons
- Persons who are quarantined need to be provided with health care; financial, social and psychosocial support; and basic needs, including food, water, and other essentials. The needs of vulnerable populations should be prioritized.
Ensuring an appropriate setting and adequate provisions
- Older persons and those with comorbid conditions require special attention because of their increased risk for severe COVID-19.
Minimum requirements for monitoring the health of quarantined persons
- Groups of persons at higher risk of infection and severe disease may require additional surveillance owing to chronic conditions or they may require specific medical treatments.
19 Mar 2020
Risk assessment and management of exposure of health care workers in the context of COVID-19: interim guidanceNo specific reference to older people19 Mar 2020
IPC guidance for long-term care facilities in the context of COVID-19Background
- The people living in LTCF are vulnerable populations who are at a higher risk for adverse outcome and for infection due to living in close proximity to others. Thus, LTCFs must take special precautions to protect their residents, employees, and visitors. Note that infection prevention and control (IPC) activities may affect the mental health and wellbeing of residents and staff, especially the use of PPE and restriction of visitors and group activities
System and service coordination
- Facilitate additional support (resources, health care providers) if any older person in LTCFs is confirmed with COVID19.
- [IPC focal point should]: Provide information sessions for residents on COVID-19 to inform them about the virus, the disease it causes and how to protect themselves from infection
- Encourage and support residents and visitors to perform hand hygiene frequently, in particular when hands are soiled, before and after touching other people (although this should be avoided as much as possible), after using the toilet, before eating, and after coughing or sneezing.
- Provide annual influenza vaccination and pneumococcal conjugate vaccines to employees and staff, according to local policies, as these infections are important contributors to respiratory mortality in older people
Physical distancing
- Restrict the number of visitors (access to visitors in the LTCFs should be restricted and avoided as much as possible.)
- For group activities ensure physical distancing, if not feasible cancel group activities
- Stagger meals to ensure physical distance maintained between residents or if not feasible, close dining halls and serve residents individual meals in their rooms
- Enforce a minimum of 1 meter distance between residents
- Require residents and employees to avoid touching (e.g., shaking hands, hugging, or kissing)
- All visitors should be screened for signs and symptoms of acute respiratory infection or significant risk for COVID-19 (see screening, above), and no one with signs or symptoms should be allowed to enter the premises.
- allowed entry to long-term care only on compassionate grounds, specifically if the resident of the facility is gravely ill and the visitor is their next-of-kin or other person required for emotional care.
- Visitors should be limited to one at a time to preserve physical distancing.
- Direct contact by visitors with residents with confirmed or suspected COVID-19 should be prohibited.
- Note that in some settings, complete closure to visitors is under the jurisdiction of local health authorities.
- Surveillance of residents:
• Assess new residents at admission to determine if the resident has signs of a respiratory illness including fever 2 and cough or shortness of breath. (note: Older people, particularly those living with co-morbidities or frailty often present non-specific signs and symptoms in response to infection, including reduced alertness, reduced mobility, or diarrhoea and sometimes do not develop fever: this may be true for COVID-19, so such changes should alert staff to the possibility of new COVID infection.)
• Assess each resident twice daily for the development of a fever (≥38C), cough or shortness of breath
- Source control
• If a resident is suspected to have, or is diagnosed with, COVID-19, the following steps should be taken:
• Notify local authorities about any suspected case and isolate residents with onset of respiratory symptoms.
• Place a medical mask on the resident and on others staying in the room.
• Ensure that the patient is tested for COVID-19 infection according to local surveillance policies and if the facility has the ability to safely collect a biological specimen for testing.
• Promptly notify the patient and appropriate public health authorities if the COVID-19 test is positive
• Assess for potential patient transfer to an acute health facility. If this is not possible or indicated, confirmed patients can be isolated and cared for at the LTCF.
• If possible, move the COVID-19 patient to a single room.
• If no single rooms are available, consider cohorting residents with suspected or confirmed COVID-19. – Residents with suspected COVID-19 should be cohorted only with other residents with suspected COVID-19; they should not be cohorted with residents with confirmed COVID-19. – Do not cohort suspected or confirmed patients next to immunocompromised residents.
• Clearly sign the rooms
• Dedicate specific medical equipment (e.g. thermometers, blood pressure cuff, pulse oximeter, etc.) for the use of medical professionals for resident(s) with suspected or confirmed COVID-19.
• Clean and disinfect equipment before re-use with another patient.
• Restrict sharing of personal devices (mobility devices, books, electronic gadgets) with other residents.
- Restriction of movement
• Confirmed patients should not leave their rooms while ill.
• Restrict movement or transport of residents to essential diagnostic and therapeutic tests only. – Avoid transfer to other facilities (unless medically indicated).
• Isolate COVID-19 patients until they have two negative laboratory tests for COIVID-19 taken at least 24 hours apart after the resident’s symptoms have resolved. Where testing is not possible, WHO recommends that confirmed patients remain isolated for an additional two weeks after symptoms resolve.
• LTCFs should be prepared to accept residents who have been hospitalized with COVID-19, are medically stable and are able to care for the patients in isolated rooms.
Minimizing effect on mental health
- Older people, especially in isolation and those with cognitive decline, dementia, and those who are highly care-dependent, may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak or while in isolation.
- Provide practical and emotional support through informal networks (families) and health care providers.
- Regularly provide updated information about COVID-19 to residents, employees, and staff.
Q&A on infection prevention and control for health care workers caring for patients with suspected or confirmed 2019-nCoVNo specific reference to older people
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