Why you can’t rely on PPE alone for your infection prevention

While COVID-19 pandemic restrictions have eased, the threat of new variants is still very real. Maintaining a high standard of infection prevention and control within your facility will be essential as Australia braces for the next wave.

Health experts have warned that November and December will be testing times as COVID-19 Omicron subvariants BQ.1 and XBB take hold in Australia. They are both expected to overtake BA.5 as the dominant variant by early 2023.

Consistent case numbers and deaths within residential aged care highlight the importance of ongoing infection prevention and control measures as there is still a risk of a virus slipping through.

But there are barriers, and many providers are stepping up to enforce them. Vaccination numbers are strong as 82% of eligible aged care residents have received their fourth dose. The use of antiviral treatments is rising, too, providing vulnerable residents with medicinal support if they do become COVID-19 positive.

Meanwhile, new training opportunities for enhanced infection prevention and control knowledge mean more staff can be better prepared.

Hello Leaders spoke to Professor Alison McMillan, the Australian Government’s Chief Nursing and Midwifery Officer for her advice about how to ensure your facility remains ready for the next COVID-19 wave.

PPE as part of the hierarchy of controls

Preventing and managing viral outbreaks has always been a key focus in aged care settings. It’s an essential part of providing care for residents. Publicly, however, that same focus was not present until the COVID-19 pandemic. 

Mask-wearing, hand hygiene and safety measures, like social distancing, have become the norm. Masks, as one form of personal protective equipment (PPE), essentially became the face of the pandemic.

Ms McMillan said a facility has to remind staff that PPE, including masks, gloves and gowns, is only one part of the hierarchy of control in infection prevention and control.

“COVID-19 has polarised thinking to some extent, and absolutely PPE is important, but without knowing, understanding and endearing to all of the hierarchy of controls, PPE is not sufficient enough to protect the residents in aged care on its own,” Ms McMillan said.

“It’s a part of what we call standard and transmission-based precautions. Caregivers should and would have been using PPE against a whole set of guidelines in everyday practice.”

The hierarchy of control is the recognised system for controlling risks in the workplace, including infectious risks. It’s a step-by-step approach that eliminates or reduces risks through six levels of protection, which are:

• Eliminate risks – for example, restrict the entry of potentially infectious staff or visitors
• Substitute the hazard with a safer alternative – use spacers instead of nebulisers for aerosolised medication
• Isolate the hazard from people – safely isolate a sick resident in a single room
• Reduce the risks through engineering controls – have heating and cooling options that do not rely on recirculated air to minimise particle spread
• Reduce exposure to the hazard using administrative control – provide a vaccination program to staff and residents to ensure they are up to date
• Use personal protective equipment – provide easy accessibility to PPE for staff, residents and visitors throughout the facility

The use of PPE sits at the lowest rung of protection and reliability on the hierarchy of control. Other preventative measures, such as outbreak management plans, vaccinations and antiviral treatments, offer better protection and should be supported by PPE.

Oral antiviral treatments, such as Lagevrio and Paxlovid, are accessible through the Pharmaceutical Benefits Scheme (PBS). They are proven to reduce the chance of hospitalisation and severe COVID side effects when used within 3-5 days of symptoms appearing.

Antivirals are recommended for people aged over 70 as they are at the highest risk of complications, and should be recommended to any resident who tests positive in your facility.

As case numbers look set to rise over the summer, Ms McMillan said facilities need to encourage staff and residents to remain up to date with their boosters.

Education and training for staff

The ongoing education of aged care staff has been an essential part of implementing infection prevention and control measures. The wider effects of COVID-19 have highlighted the real-world implications of poor infection management.

In a facility, a uniform understanding of infection prevention and control allows you to take collective action against any outbreak. Therefore, ensure all staff are aware of their responsibilities to minimise the risk of transmission, both at work and in public. 

This can be helped by providing staff with the latest resources – which are featured below – and refresher training courses. 

As part of the pandemic response, new regulations were introduced requiring an infection prevention and control (IPC) nurse on site in every Government-funded residential aged care facility.

The IPC nurse, or IPC lead, can be an existing staff member that takes on the additional role of observing, assessing and assisting with improving infection prevention and control within your facility.

There are long-term investment options available as the Government announced a new grant opportunity to support Registered and Enrolled Nurses in aged care who want to complete the training.  

Announced in early November, this is one way to provide enticing career growth opportunities for existing staff. Relevant courses are also available through the Australasian College for Infection Prevention and Control or leading universities like Griffith University and Charles Darwin University.

Where to find information and resources

The COVID-19 pandemic accelerated a move to online training and education, as the need to be protected against an unknown virus created a “real appetite for information”, according to Ms McMillan.

“We want to give everyone the confidence to go to work knowing they will be safe if they follow the advice online,” Ms McMillan said.

“We continue to do that by providing information that can be understood by a range of people and be applied at the bedside or in the care facility to protect the most vulnerable residents and the staff.”

Resources are available to ensure each facility remains prepared for a potential viral outbreak. Leading reference points include:

• The Department of Health and Aged Care 
• The Aged Care Safety and Quality Commission
• Australian Commission on Safety and Quality in Health Care 
• Relevant State and Territory health departments
• Online health care and aged care training and e-learning platforms

Recent advice on isolation requirements in high-risk settings and the new National COVID-19 Community Protection Framework are two important resources highlighted by Ms McMillan.

“The pandemic and COVID-19 have not gone away and we need to remain vigilant and prepared for outbreaks or an increase in community transmission,” Ms McMillan said.

She said the Government will continue to provide updated information for aged care facilities and staff to help maintain a sense of preparedness and readiness for any outbreak.

Do you believe existing infection control resources provide the right information for future protection? Let us know your thoughts in the comments below.