Covid-19 and acute respiratory infection (ARI) management in care homes

The winter season results in increased pressure across health and social care settings including more respiratory illnesses, such as flu and COVID-19. These can affect both residents and staff which can result in staff shortages and greater care needs when workload is already high. In Bury in 2023-24 the majority of outbreaks in adult social care were related to respiratory infections - 67% related to COVID-19 and 33% to other respiratory organisms. Most hospitalisations (84%) and deaths (76%) reported during outbreaks were associated with respiratory outbreaks. It is therefore very important to be vigilant for symptoms of respiratory illness in your residents.

Respiratory viruses spread mainly through droplets spread via close contact (within coughing or sneezing distance) or touching things or surfaces where viruses have landed where they can live for several hours. Infection control precautions are therefore based on limiting and avoiding spread through contact, aerosol and droplet routes, as well as environmental cleaning.

The following steps can help you and your staff be more prepared to prevent and manage outbreaks of infection within your care setting:

• Encourage staff and resident vaccination uptake – in the event of an outbreak information about uptake rates will be part of the risk assessment. Care home staff can access free COVID-19and flu vaccinations and should let you know if they have had it. Check vaccination status of new residents (flu, COVID-19, pneumococcal and RSV). Remember that vaccinations are not as effective for older people as their bodies don’t convert them so well, therefore encouraging staff to have vaccinations is to help protect the staff themselves, and those close to them, but also your residents.  

• Check your IPC policies are up to date and ensure all staff are aware of what to do in the event of an outbreak and have 24-hour access to them

• Do refresher training on hand hygiene and putting on and removing personal protective equipment, and monitor practice to check it is worn appropriately

• Display respiratory and cough hygiene posters, e.g. ‘Catch it, Bin it, Kill it’ and ‘Respiratory and cough hygiene’, available to download at www.infectionpreventioncontrol.co.uk, and provide hand sanitiser for visitors at the entrance Ensure signs are in place at the entrance to the home asking visitors to stay away if they are ill (which should be in place year round), Flu Poster for visitors to care homes 

• Encourage residents to wash their hands especially before mealtimes; if they can’t get to a sink provide hand wipes

• Make sure you have supplies of COVID=19 tests for residents who are eligible for supportive treatment – see 1 Recommendations  and 5 Recommendations – who should be tested for up to 3 days if symptomatic

• Be alert for symptoms (see ari symptoms) so you can identify infections early and isolate any affected residents (after risk assessment); cohort residents who cannot isolate, and ensure designated toilet facilities are available and robust cleaning of any shared equipment or spaces used by symptomatic residents, and ensure good ventilation of shared areas to reduce the risk of spread.

• Report suspected outbreaks to your local Infection Prevention and Control (IPC) or UK Health Security Agency (UKHSA) Team – also available to discuss any concerns if you’re not sure it’s an outbreak

• Make sure you have supplies of fluid resistant surgical masks (FRSM) and eye protection (goggles or visors) which will be needed if residents have respiratory symptoms. Contact ppe@bury.gov.uk for free disposable visors

• Provide information for safer visiting during outbreaks, see Supporting safer visiting in care homes during infectious illness outbreaks - GOV.UK

• Check supplies of infectious waste bags (orange), appropriate disinfectant product (meets EN14476)

Ensure that all staff are aware how to report outbreaks and can access the guidance for managing respiratory outbreaks:

Management of acute respiratory infection outbreaks in care homes guidance - GOV.UK

Risks From Poor Oral Health

There is strong evidence that oral health and oral hygiene habits are linked to the incidence and outcomes of lung diseases, such as pneumonia and chronic obstructive pulmonary disease. Therefore, improving oral health should reduce the incidence, duration, and mortality from pneumonia in community and hospital patients.

Simple oral hygiene measures such as regular toothbrushing can also help lower the risk of pneumonia, reduce the duration of the illness, and may reduce the chance of dying from pneumonia for community and hospital patients (Evidence summary: the relationship between oral health and pulmonary disease - PubMed (nih.gov) 2017). 

The NICE guideline NG48: Oral health for adults in care homes 2016, recognised the importance of good oral care for people in care homes. Good oral health improves people's quality of life but is also vital for them to be able to eat, drink, take medication and stay healthy. There is also some evidence that poor oral health is associated with increased risk of developing cognitive impairment and dementia (Evidence summary: the relationship between oral health and dementia - PubMed (nih.gov) 2017), and heart disease (Evidence summary: the relationship between oral and cardiovascular disease - PubMed (nih.gov) 2017).