COVID-19: Outbreak Response Plan Residential Aged Care Facility

Version 1.0

14 July 2020

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Version Control

Unless the need for an amendment is triggered sooner due to changes in advice, a review of this plan will be coordinated as a minimum every month by the State Health Incident Coordination Centre (SHICC)

Planning Cell. Feedback on the document can be provided at COVIDPlanning@health.wa.gov.au

This Plan should be considered a ‘living document’ that will be regularly reviewed and updated according to changes in advice based on emerging evidence or national guidelines. It will also be modified where either new legislation comes into effect or statutory directions are made which impact the outbreak management response as required.

Learnings from management of outbreaks including lessons learnt from other jurisdictions and internationally, will be incorporated into future plans.

This Plan is due for review one month from the date the most recent version was published.

Version Date Author Approved by Comments

1.0 14 July 2020 SHICC Planning Cell

Dr. Robyn Lawrence, Incident Controller

Nil – original version

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Contents

1. Purpose and context 3

1.1 Purpose 3

1.2 Scope and context 3

1.3 Definition of an outbreak 3

1.4 Objectives 4

1.5 Planning assumptions 4

2. Governance / command and control structure 5

2.1 Legislative and Policy context 5

2.2 Command and control overview 5

2.3 Governance 5

2.4 Roles and responsibilities 5

2.5 Regional governance 6

3. Response 7

3.1 Phase 1: Outbreak prevention and preparedness 7

3.2 Phase 2: Outbreak standby and monitoring 7

3.3 Phase 3 / Phase 4: Outbreak response – rapid escalation from initial to targeted action 8

3.4 Phase 5: Outbreak recovery 19

Appendix A: Legislative and policy framework

Appendix B: Governance and responsibilities for outbreaks in RACFs

Appendix C: Roles and Responsibilities Matrix

Appendix D: Governance protocol to support joint management of a COVID-19 outbreak in a Residential Aged Care Facility (RACF) in WA

Appendix E: DEMC Boundaries and Representations

Appendix F: Integrated outbreak response

Appendix G: Summary of outbreak response phases

Appendix H: RACF Prevention and Preparedness Guidelines

Appendix I: Daily reporting framework / SITREP

Appendix J: Key contacts

Appendix K: Glossary

Appendix L: References

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1. Purpose and context

1.1 Purpose

The COVID-19 Western Australian (WA) Residential Aged Care Facilities (RACF) Outbreak Response Plan (‘Plan’) sets out the tailored response to inform a co-ordinated multi-agency phased response, where required, to an outbreak within a RACF.

This setting specific Plan relates to the overall COVID-19: WA Integrated Outbreak Containment and Response Plan (‘WA Integrated Outbreak Plan’).

1.2 Scope and context

As set out in the WA Integrated Outbreak Plan, this Plan is intended for use by all agencies and responders involved in the system response, as well as those who may be involved in the management of an outbreak in a RACF. RACFs pose a particular risk due to the difficulty in managing or containing the outbreak, a high-risk of rapid spread and a high risk of serious illness if people in the facility are infected by COVID-19.

The Plan does not replace local planning, rather it complements and reflects a hierarchy of local, regional and agency-specific plans which suits the local context and regulatory requirements.

It aims to augment with a description of a comprehensive whole-of-system response which is reflective of collective roles and responsibilities. It also includes and describes ‘trigger points’ for key decisions and escalations from local and regional to a State/system-level response.

The Plan only applies whilst WA is in the ‘response’ phase of the State Hazard Plan for Human Biosecurity and it is active for the purposes of the COVID-19 pandemic response.

1.3 Definition of an outbreak

An outbreak is broadly defined as a localised occurrence of more cases of disease than expected in a given area or among a specific group of people over a particular period of time1.

A more sensitive definition of an outbreak may apply in settings or communities where there is difficulty in managing or containing the outbreak, there is a high-risk of rapid spread or a high risk of serious illness if people in the setting are infected by COVID-19. In these instances, a single suspected case of COVID-19 is sufficient to trigger an outbreak response. Identification of when an “outbreak” is present is determined by Public Health Emergency Operations Centre (PHEOC).

For RACFs a specific outbreak definition has been developed by the Communicable Diseases Network Australia (CDNA): a COVID-19 outbreak is defined as a single confirmed case2 of COVID-19 in a resident, staff member or frequent attendee of a RACF. The definition takes into account surveillance of acute respiratory-like illnesses which can contribute to early detection of possible cases of COVID-19.

1 https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/COVID-19-SoNG-v3.3.pdf

2 CDNA National Guidelines for Public Health Units, version 2.11 published 22 May 2020, section 6, page accessed 29 May 2020.

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1.4 Objectives

The key objectives of this Plan align to the overarching objectives of the WA Integrated Outbreak Plan. This Plan specifically aims to inform a coordinated multi-agency phased response to a COVID-19 outbreak in a RACF (metropolitan and regional) in line with local and State/system-level response.

1.5 Planning assumptions

This Plan aligns to the planning assumptions as set out in the WA Integrated Outbreak Plan. All Plans, as set out in the WA Integrated Outbreak Plan, consider vulnerable populations.

The following groups of people are, or are likely to be at, higher risk of serious illness if infected with COVID-19 noting that a regularly updated list of people who are at greater risk of more serious illness with COVID-19, including those with certain chronic conditions, is available on the Australian Government Department of Health (DoH) website:

• People 70 years and older;

• People 65 years and older with chronic medical conditions;

• People 50 years and older who are Aboriginal with chronic medical conditions;

• Those with compromised immune systems, and obese individuals; and / or

• People who may require additional precautions and support include but are not limited to people with disability who require personal care or healthcare, experiencing homelessness, with drug and alcohol issues and / or with mental health issues.

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2. Governance / command and control structure

2.1 Legislative and Policy context

This Plan has been developed in the context of existing emergency management and WA Health governance arrangements and adheres to the command and control structures and reporting lines of these arrangements through the hierarchy of local and State/system-level response. National and State Legislative and Policy context is included in the WA Integrated Outbreak Plan. Further information on the National, State and setting specific context is provided in Appendix A.

It is the responsibility of a RACF to identify and comply with relevant legislation and regulations. A RACF must fulfil their legal responsibilities in relation to infection control by adopting standard and transmission-based precautions as directed in the Australian guidelines for the Prevention and Control of Infection in Healthcare (2019) and by state/territory public health authorities.

RACF’s are also required to operate under the Aged Care Act 1997 to be accredited and eligible for funding. Accreditation requires adherence to infection prevention and control (IP&C) standards. The Aged Care Quality and Safety Commission expects organisations providing aged care services in Australia to comply with the Aged Care Quality Standards.

2.2 Command and control overview

The Controlling Agency is the agency with responsibility, either through legislation other than the Emergency Management Act 2005 (WA) (‘EM Act’), or by agreement between a Hazard Management Agency (HMA) and one or more agencies, to control the response activities to an incident, as specified in the appropriate State Hazard Plans (Westplans). In most instances, when an incident escalates to become an emergency, the Controlling Agency and the HMA are the same agency.

The State Human Epidemic Controller (SHEC), Department of Health, is the designated HMA responsible for human epidemic.

An Incident Controller has been appointed. Further information on the responsibilities of the Incident Controller can be found in the WA Integrated Outbreak Plan.

The concept of control3 relates to the overall direction of emergency management activities in an emergency situation. Authority for control is established in legislation or in an emergency plan and carries with it the responsibility for tasking and coordinating other organisations in accordance with the needs of the situation. Control relates to situations and operates horizontally across organisations.

The Incident Controller requests other supporting agencies to assist in the outbreak of COVID-19 as required.

2.3 Governance

Governance structures reflects local and regional and State/system-level accountabilities and structures, including Public Health Emergency Operations Centre (PHEOC), State Health Incident Coordination Centre (SHICC) and governance within metropolitan and regional WA.

Governance structures recognise the key role of need for integrated Public Health, clinical, operational and inter-agency responses to inform the overall control of the incident.

2.4 Roles and responsibilities

3 State Emergency Management Glossary May 2016

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The Plan reflects the responsibilities of various agencies as they exist to support a single, integrated response to address an outbreak in a RACF. Appendix B and C provides further information in relation to the roles and responsibilities of key parties or agencies involved in responding to an outbreak in a RACF setting. Further information is contained within the governance protocol, referenced in Appendix D, and as follows:

2.4.1 Commonwealth Department of Health

The Commonwealth Department of Health provides funding for aged care services and supports the RACF’s capacity to manage the outbreak.

2.4.2 Aged Care Quality and Safety Commission (ACQSC)

The ACQSC provides regulatory oversight of RACFs to protect and enhance the safety, health, well-being and quality of life of people residing in the RACF.

2.4.3 WA Government

PHEOC

Leads the public health response and supports the RACF in active surveillance, investigation, contact tracing and confirming swab results.

SHICC Clinical & Logistical Support Team

Establishes a clinical and logistical outreach team to support clinical care in RACF.

2.4.4 Residential Aged Care Facility (RACF)

RACFs lead and manage the response to the outbreak in the RACF as required by legislation, including the Aged Care Act 1997, the CDNA Guidelines and relevant WA legislation (i.e. Public Health Orders) including adequate capacity to manage the outbreak in situ subject to circumstances of the outbreak.

Further responsibilities during an outbreak are described in section 3.3.7 Local RACF response.

2.5 Regional governance

State governance, including governance arrangements for metropolitan and regional WA are set out within the WA Integrated Outbreak Plan. Where regional governance arrangements have a particular consideration or variance to metropolitan arrangements, these have been distinguished within this Plan.

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3. Response

The current and ongoing management of the response to COVID-19, including containment and management of an outbreak, is described using the structure for overall management of a typical phased incident response as set out in the Australian Health Management Plan for Pandemic Influenza and the Infectious Disease Emergency Management Plan (IDEMP).

In this Plan, Phases 3 and 4 are combined to represent the rapid, multi-agency response that would occur from the outset of any outbreak in an RACF.

These phases are:

• Phase 1: Outbreak prevention and preparedness;

• Phase 2: Outbreak standby and monitoring;

• Phase 3 / Phase 4: Outbreak response – rapid escalation from initial to targeted action; and

• Phase 4: Outbreak recovery.

A diagram showing how key plans relate to these phases and a summary table of the phases are provided in Appendices F and G respectively.

3.1 Phase 1: Outbreak prevention and preparedness

Prevention and preparedness of RACFs follow the CDNA Guidelines. SHICC and PHEOC, Agencies and responders have, and will continue to, implement the prevention and preparedness measures as outlined in the IDEMP.

Key to prevention and preparedness has been the development of consistent, comprehensive and coordinated operational plans. Response plans, whether State/system-wide or local responses to COVID-19, have been documented and should be maintained to ensure their currency and quality. All RACFs shall have, and maintain, an outbreak management plan in place to respond to a potential COVID-19 outbreak.

Phase 1 initial activities to prepare for containment and response to outbreaks included:

• Development and testing of local, regional and State/system-wide operational response plans;

• Preparations of supporting agencies to respond and put workforce and supplies management plans in place; and

• Promotion of Public Health and IP&C methods.

Further information in respect of prevention and preparedness measures is provided in Appendix H.

3.2 Phase 2: Outbreak standby and monitoring

A number of Public Health activities and processes are currently in place to respond to COVID-19 which include early identification, isolation and testing of suspect cases and notification of test results.

During Phase 2, the following is ongoing:

• Supporting agencies continued preparedness activities; and

• Ongoing testing and isolation of people with symptoms of COVID-19.

The early identification of COVID-19 symptoms in a resident or staff member, isolation and subsequent prompt testing enables the ability to rapidly provide appropriate IP&C management and prevent further spread of the disease. The recommended methods of testing and sampling for COVID-19 is outlined in the CDNA Guidelines.

Any request by a General Practitioner (GP) or staff member for a resident to be tested would require notification to the RACF Management to be on standby for an outbreak response. RACFs may request

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staff to provide the RACF Management with notification if they are proceeding to be tested for COVID-19 due to having symptoms. On the identification of a suspect case, which is proceeding for testing (either resident of staff member), the RACF Management may decide to provide early notification to PHEOC to provide advice and support at this early stage.

PHEOC and local Public Health Units may advise the facility to implement some actions where an outbreak is suspected (e.g. symptomatic resident being tested), while awaiting test results. Under section 67 of the EM Act, people who have been tested for COVID-19 must isolate until their test results are available. If a person is unable to safely isolate or be cohorted in the RACF as per the CDNA Guidelines, SHICC (WACHS/EOC in regional settings) may arrange temporary accommodation in another available RACF or hospital/ or arrange support services.

COVID-19 is a notifiable condition under the Australian National Notifiable Diseases Surveillance System. This means that medical officers and laboratories in WA, have a legal requirement to notify WA Health of a positive case of COVID-19.

The RACF has responsibility for notifying the Australian Government Department of Health of any suspect or positive case of a staff member or resident to agedcareCOVIDcases@health.gov.au. For emergencies the number for WA is 1800 733 923 which is available 24/7.

Trigger to move to Phase 3: Definition of an outbreak is met.

3.3 Phase 3 / Phase 4: Outbreak response – rapid escalation from initial to targeted action

The Outbreak Response – Initial Action (Phase 3) follows the general principles of outbreak investigation and response traditionally used by Public Health for infectious disease outbreaks.

The public health management of any confirmed COVID-19 case in a resident or staff member of a RACF is coordinated by PHEOC as per the CDNA Guidelines. This includes extensive interviewing of the case (or their next of kin) to confirm details of their illness, investigating the source of infection, identifying close contacts and providing education about isolation. PHEOC will liaise with relevant clinicians, carers, guardians, case workers and RACF staff to assist with this process as required.

The steps outlined below can occur in a different order from which they are listed, or they may occur concurrently. The Initial Action (Phase 3) is defined as the phase in which the outbreak response is conducted within the usual resources that Public Health have available to them for responding, and/or within the parameters of local and regional response plans, after which the response moves to Targeted Action (Phase 4).

In Phase 3, following the definition of an outbreak having been met, the following activities are undertaken/considered:

1. Declaration of outbreak/outbreak notification;

2. Formation of outbreak management team (OMT);

3. Situational analysis (define the setting);

4. Case management;

5. Contact tracing and contact management (downstream contact tracing);

6. Investigation of source of infection (upstream contact tracing);

7. Local RACF response / local and regional response in line with plans;

8. Additional case finding;

9. Public Health control measures;

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10. Standby of Clinical and Logistic Support Team (CLST), Patient Flow Command Centre (PFCC) and other SHICC capacity;

11. Communication and Public Information; and

12. Reporting/monitoring.

Note: An outbreak response may move rapidly through the above activities and into Phase 4 in some cases. In a RACF, additional system-level support and response is anticipated from Day 1 and a senior State-wide governance forum will be mobilised, triggering activation of Phase 4.

3.3.1 Declaration of an outbreak / outbreak notification

After receiving notification of a positive result, and the definition of an outbreak is met, the Deputy Chief Health Officer (D/CHO), Public Health will declare an outbreak and PHEOC will commence the appropriate case management, contact tracing and enhanced surveillance if necessary. If the D/CHO, Public Health determines that the criteria for an outbreak have been met they will immediately notify key parties, including the Incident Controller, Chief Health Officer and Director General, Department of Health.

Note that an outbreak is not declared always if the single case is an infrequent visitor to the RACF. A determination of whether someone is a frequent or infrequent visitor may be based on frequency of visits, time spent at the setting, and number of contacts within the setting.

Notification of the outbreak will be provided directly by the Incident Controller to relevant governance groups and facilities who may be involved in the outbreak response as required. Notification of the outbreak will occur by the Incident Controller and PHEOC Coordinator to relevant local, regional and state governance groups and facilities involved in the outbreak as required.

For an outbreak in a regional facility, WACHS Public Health Team will liaise with Regional Emergency Operations Centres, which coordinates the clinical services and public health response. The D/CHO, Public Health is responsible for notifications and reporting to national bodies on outbreaks occurring in RACFs. The RACFs are responsible for reporting to the Aged Care Quality and Safety Commission.

Briefings to the Minister for Health and Premier and State Emergency Coordinator (SEC) are provided by the CHO and Director General, Department of Health.

Notification to the Department of Premier and Cabinet would be undertaken by the SEC, Chief Health Officer or the Director General, Department of Health.

SHICC Public Information, in consultation with WACHS for regional communications, will coordinate release of the information relating to the outbreak to the public, via the media and RACFs must liaise through the SHICC Public Information team.

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Public Health Emergency Operations Centre(PHEOC)

State Incident Controller (IC)

Receives daily notification of COVID-19 positive case

details

Aged Care Quality and Safety CommissionWA Country Health

Service Regional Emergency Operations

Centre(as required)

Manager of Aged Care Facility

WA Country Health Service as required

Information Notification Process

Parties to confirm key contact points/leads who will coordinate response

during this discussion (and communicate to key parties)

this includes consideration by the (State) IC as to whether a suitable

local/regional Incident Controller for that particular incident is in place or

needs to be identified

Figure 1: Notification process following PHEOC receiving confirmation of COVID-19 outbreak in a RACF.

3.3.2 Formation of an outbreak management team (OMT)

The RACF will have management and governance groups who will be will be required to assist with the response by conducting activities, including but not limited to:

• Activation of the Outbreak Management Plan;

• Providing information to PHEOC to inform contact tracing;

• Implementing control strategies as directed by the PHEOC and the Incident Controller;

• Implementing restrictions on visitors and admissions;

• Assisting with quarantine measures and testing as advised by PHEOC;

• Resident transfer as directed by SHICC/WACHS/EOC;

• Ensuring replacement workforce arrangements are in place;

• Distribution and use of Personal Protective Equipment (PPE) in line with guidelines and/or escalation of risks or issues in respect of ability to provide the required volume and type of PPE;

• Distributing communications to stakeholders and residents with support by PHEOC staff;

• Consulting the SHICC Communications Team on any external media communications;

• Providing daily updates and escalate issues to D/CHO, Public Health or Incident Controller as required;

• Adherence with the CDNA Guidelines for outbreaks in RACFs;

• Mobilise outbreak management team and coordinator at the RACF; and

• Advise agedcareCOVIDcases@health.gov.au of any confirmed cases of COVID-19 among staff or residents.

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As outlined within the ‘Governance Protocol to support joint management of a COVID-19 outbreak in a Residential Aged Care Facility (RACF)’ (Appendix D), the following governance structures must be notified within one hour of notification of a COVID-19 outbreak in a RACF and convened within 12 hours. This will automatically trigger the move into Phase 4 and an integrated, system-level response.

Name Membership Functions Meeting Frequency

State Health Incident Coordination Centre/Public Health Emergency Operations Team

CHAIR: Department of Health

• Chief Health Officer, Dr Andrew Robertson

• Incident Controller Dr Robyn Lawrence (SHICC),

• Deputy Chief Health Officer Public Health Dr Paul Armstrong (PHEOC)

• Aged Care Quality and Safety Executive Director (Commonwealth), Ann Wunsch

• Director Aged Care (Comm) Rebecca McIlroy

• Chief Executive Lead CE Liz MacLeod, DOH

• Executive Director Aged Care Stream Gail Milner

• WACHS (Marg Denton, COO)

• Receive and endorse Outbreak Management Plan (OMP) – noting that this will remain dynamic

• Oversee operational responses, including considering expert clinical advice

• Consider issues identified under trigger events for escalation

• Document agreed actions

• Advise relevant Ministers on response to outbreak

• Communicate to peak bodies

Initial meeting at identification of the outbreak and then meeting frequency as required

Outbreak Management Team

CHAIR: RACF provider and

PHOps, or other as agreed by SHICC/PHEOC

• RACF including:

• CEO

• Manager

• Clinical Supervisor

• State Manager, WA, Department of Health

• CLST (SHICC representative), Public Health Emergency Operations Centre (PHOps) representative

• CLST, Clinical Team may include:

• Infectious Disease

• Support the RACF to assume control of the outbreak

• Ensure strong and effective management structures in place to manage the outbreak

• Develop and oversee the implementation of the outbreak management plan – noting that this plan will remain dynamic

• Implement appropriate control measures including restriction of resident movement, restriction of visitor access, rapid audit of infection prevention and control, access to and

Daily

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Name Membership Functions Meeting Frequency

Consultant

• Geriatrician

• Palliative Care

• Hospital in the Home lead

• Infection Prevention and Control Practitioner

• Testing Team

correct usage of PPE

• Assess staff resources and surge staff planning within the RACF preparedness plan. Staffing should include:

o Identification of an infection control lead/champion

o Additional clinical support to meet the increased care needs of COVID-19 positive residents

o Additional allied health staff to avoid deconditioning of quarantined residents, particularly COVID-19 negative residents

o Additional hospitality staff to support changes in practices due to infection control

o Additional lifestyle staff to support enhanced communication with families and changes in activities due to quarantining

• Recommend activating the Commonwealth workforce surge program (if required).

• Ensure resources are adequate, including:

o PPE

o Medical and allied health workforce

o Laboratory and testing

• Identify and investigate all positive COVID-19 cases

• Establish approach to clinical care

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Name Membership Functions Meeting Frequency

including escalation pathway to hospital

• Ensure a communication strategy is in place for each resident and their representative (use external expertise as required

i.e. OPAN)

• Support communication between all stakeholders

• Identify alternate accommodation options, if required

• Document agreed actions

• Report and escalate issues to the SHICC and PHEOC

Standards and Logistical Support Team

• Member of the Outbreak Management Team

• Aged Care Quality and Safety Commission’s Clinical Adviser

• Commonwealth State Manager WA,

• SHICC

• Oversight of outbreak management response

• Identification of and response to regulatory compliance concerns

• Document agreed actions

• Escalation of trigger events/issues

Alternate days – meet with the Outbreak Management Team

3.3.3 Situational analysis (define the setting)

An initial situational analysis may be undertaken to guide the level of response and support needed.

3.3.4 Case management

Daily monitoring is set up for staff who are cases; residents will be monitored through line listings provided by the RACF. Identified staff contacts are interviewed, placed into home quarantine and monitored daily. Contacts among residents are managed in conjunction with the RACF, including quarantine, infection control measures, daily monitoring through facility line listings and testing according to the CDNA Guidelines.

Epidemiology / surveillance will continue during an outbreak. PHEOC will receive daily line listings for all people which will include number of cases, information on new cases, numbers recovered and notification of deaths.

PHEOC also provides information to WA Police Force to support and/or enforce isolation or quarantine measures as required.

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3.3.5 Contact tracing and contact management (downstream contact tracing)

On notification of a positive case, PHEOC will work with the relevant RACF IP&C team to manage the case and undertake contact tracing.

All contact tracing will be conducted by PHEOC in accordance with the PHEOC Standard Operating Procedures (SOP) or by WACHS Public Health in a regional setting. In a regional setting, Public Health teams (WACHS in a regional setting) will conduct all required interviews with contacts and advise on further management, including testing and monitoring.

3.3.6 Investigation of source of an infection

Investigation into the likely source of acquisition of infection in cases is an important element of outbreak investigation. Case interview is used to determine the onset of illness of the case and the contacts during the 14 day period prior to illness onset that could be responsible for infection in the case. This could potentially identify other chains of transmission in the facility or community that may be unrecognised.

3.3.7 Local RACF response / local and regional response in line with plans

Residents of RACF’s are a high-risk population who, when possible, should receive ongoing appropriate COVID-19 medical and nursing therapeutic and supportive care within their own care facility rather than escalation of care to an acute hospital Emergency Department (ED). All efforts should be made to strengthen IP&C practices to minimise the risk of transmission and avoid the need for transfer to acute hospital care, as minimising unnecessary transfers is an integral part of WA Health’s response.

The RACF should continue immediate routine care and medical management directed by their residents regular GP in collaboration with a Geriatrician. The Clinical and Logistics Support Team (CLST) will provide expert clinical advice and support to both the resident’s GP and the RACF.

All visiting GPs should be informed by the RACF at the start of the outbreak and unwell residents must be reviewed by their GP and a Geriatrician. A sample letter for GPs can be found in the CDNA Guidelines.

Care requirements for residents in a RACF include:

Category Care requirements for residents in a RACF

Admission to a facility

• For confirmed cases, the return of an existing resident under security of tenure provisions of the Aged Care Act 1997 or a new admission of a confirmed case can be undertaken, provided appropriate accommodation, care and infection prevention and control requirements can be met. Details on admission during a COVID-19 Outbreak area contained in the CDNA Guidelines for outbreaks in RACFs.

• Hospitals are required to liaise with the facility prior to any transfer being arranged to confirm the readiness of the facility to accept the resident and to confirm their ongoing care needs.

Medical Care

• Treatment in place is preferred over admission to hospital, to ensure better care outcomes for residents. Advance Care Plans and Do Not Resuscitate documentation must be respected. Decisions regarding treatment and/or transfer will be made on a case-by-case basis

• The RACF should arrange review of unwell residents by their GP in collaboration with a Geriatrician and, testing advice should assume possible COVID-19 positivity.

• The RACF must escalate the care of the resident where required by calling 000 for an ambulance and must notify St John Ambulance and the admitting hospital of the resident’s suspected or confirmed COVID-19 state.

• The Residential Care Line will continue to provide clinical (Geriatrician/Nurse) consultation, care coordination and education as required.

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Category Care requirements for residents in a RACF

• The clinical management of a confirmed case who is discharged to a RACF will be determined by the hospital.

• Clinical care of confirmed COVID-19 cases remains the responsibility of the GP in collaboration with a Geriatrician in associated with the RACF or hospital medical team if an inpatient.

• Where additional public health advice is required the facility can speak with Public Health Staff.

Hospital transfer

• Transfer to hospital should be considered for residents whose condition warrants it, in consultation with relatives and taking into account their previous health status and advanced care directive.

• If transfer is required, the ambulance service and hospital must be advised, in advance, that the resident is being transferred from a RACF where COVID-19 is suspected or confirmed.

• Where local capacity is exceeded hospital level support can be accessed from metropolitan health services as requested by the Incident Controller.

• Hospitals are required to liaise with the facility prior to any transfer being arranged at discharge to confirm the readiness of the facility to accept the resident and to confirm their ongoing care needs.

Workforce • The RACF will need to activate local staff deployment plans for replacement staff.

• RACF must provide appropriate regular communications and welfare support to current workforce, who take voluntary absenteeism or who are required to isolate, including support for staff re-entry into the workplace.

• Alternative providers should be identified for cleaning (including decontamination) and food services who are competent in working within a COVID positive environment.

• The CLST will provide additional staff with clinical and infectious disease expertise.

• Where local workforce capacity is exceeded, SHICC can deploy additional health care staff to assist with the management of the outbreak and support of usual resident care.

End of Life care

• Advance care plans and ‘do not resuscitate’ documentation must be respected. Decisions regarding treatment and/or transfer to hospital should made in consultation with the residents next of kin and medical practitioner.

• Existing arrangements for deceased residents apply. All Reportable deaths on admission to the State mortuary are tested for COVID-19.

Where there is a request for a resident to be removed from the RACF to the care of the family member or guardian, PHEOC must firstly undertake a risk assessment. If the resident is deemed unsuitable for release due to the risk in exposing other community members to COVID-19, the Incident Controller has the authority under the EM Act to refuse the request for transfer.

Where additional clinical advice is required the facility may use the Residential Care Line for specialist clinical management advice (State-wide Service 08 6457 3146). For emergency escalation of care call 000 for ambulance, the RACF must notify St John Ambulance and the admitting hospital of the residents suspected or confirmed COVID-19 state.

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3.3.8 Additional case finding

Enhanced surveillance, isolation and testing of people with symptoms of COVID-19 will be implemented for cohorts associated with the outbreak. PHEOC will consider asymptomatic testing of defined cohorts to assist in additional case finding as needed.

3.3.9 Public Health control measures

The primary responsibility for managing COVID-19 outbreaks lies with the RACF, within their responsibilities for resident care and infection control. All RACF should have existing in-house (or access to) infection prevention, management and control expertise, and outbreak management plans in place.

Control measures will be refined and implemented in accordance with the CDNA. Advice on control measures will be provided by PHEOC according to the CDNA Guidelines, CDNA Guidelines for outbreaks in RACFs and COVID-19 Infection Prevention and Control for Residential Care Facilities. This may include, but is not limited to, isolation, quarantine and cohorting, restriction on visitors, restriction on movement within the facility, suspension of activities, infection control, staff allocation and environmental cleaning. Access to PPE can be requested as per the Australian Government website by sending an email to agedcareCOVIDPPE@health.gov.au.

A daily risk assessment is conducted by the OMT to determine if the control measures are adequate. The control measures will also be regularly reviewed throughout the outbreak by D/CHO, Public Health and the Incident Controller. Escalation will occur if containment issues are identified (including deployment of the CLST).

Further information for four key control measures is set out below:

1. Physical distancing and restrictions: PHEOC will provide advice for the population affected by the outbreak with respect to the need to implement physical distancing measures. Closing or isolating a specific facility or sections of a facility to permit investigation, contact tracing and decontamination will be considered. Broader advice regarding mass gatherings for local and surrounding populations will also be considered as part of the response.

2. Hygiene measures: Measures supporting hand hygiene, cough/sneeze etiquette and physical distancing should be provided. Messaging and information regarding these measures should be made available in various formats, including alternative languages (or pictorial formats) to ensure that all community members understand the information. Consideration should be given to provision of consumables (e.g. soap, alcohol-based hand rub) to specific (high risk) populations if not already available.

3. Additional IP&C measures: The PHEOC IP&C Team will review cleaning and disinfection practices, handling of linen and clothing, food service and utensils, waste management, isolation and cohorting. Infection control measures will be refined and implemented in accordance with the Communicable Diseases Network Australia (CDNA) guidelines. Infection control measures should include, but are not limited to:

• Environmental cleaning and disinfection;

• Use and training of appropriate PPE;

• Exclusion of symptomatic staff from workplaces and venues;

• Consideration of other restrictions such as the prevention of individuals entering or leaving the facility except for medical requirements; and

• Other additional IP&C measures may be implemented as required.

4. Consideration of vulnerable groups: Where relevant, tailored information should be provided to assist the RACF with additional considerations in respect of residents who have additional vulnerabilities to identify their risk and protect themselves from the disease.

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3.3.10 Standby of CLST, PFCC and other SHICC capacity

RACFs have access to CLST who are able to physically enter the facility and provide support in the management of the outbreak in metropolitan areas. The membership of the team can be adjusted according to the requirements of the outbreak and assessment of ability of the RACF to manage components of the outbreak response.

These CLSTs are deployed by the Incident Controller, on advice of the D/CHO, Public Health and will coordinate with PHEOC and SHICC teams. Currently the CLST has only been authorised for the metropolitan areas, however discussions are underway to expand this to service regional RACF.

Members may include:

• Infectious Disease Physician;

• Geriatrician;

• IP&C Nurse;

• Logistics Coordinator;

• Silver Chain Nurses and Palliative Care Services; and

• Residential Care Line nursing workforce.

If required to support patient transfer or transport, the stand-up of the Patient Flow Command Centre (PFCC) can be considered.

The triggers for the PFCC to move from standby to response state to coordination of all inter-facility transfers to and between public hospitals (as well as consideration of private hospital bed capacity) and ambulance and aeromedical distribution to ensure equitable Emergency Department and hospital admissions during periods of increased activity include:

• Health Service Provider – WA Emergency Access Targets & Access Block reporting;

• St Johns Ambulance Service (SJA) notify SHICC of a significant increase or sustained demand pressure that impacts upon their agreed Key Performance Indicators and available resources, including demand for response to influenza like illness/COVID-19 suspected cases;

• Royal Flying Doctor Service (RFDS) notify SHICC of a significant increase in demand in call volume of influenza like illness / COVID-19 suspected cases;

• PFCC identifies from Capacity and Demand Tableau (reporting tool) a significant or sustained increase in self-presentation to EDs;

• Consider escalation/flag if ED presentations are from a family or vulnerable/community group; and

• PFCC notice a significant or sustained mismatch in demand and available capacity cross the system in particular Medical (including Acute Medical Unit), Intensive Care Unit, and ED including ramping.

Note: These transfers may be within the WACHS network or from the WACHS hospital to a Perth metropolitan hospital, also transfers from RACFs. The following issues should be considered:

• Transfer to hospital should be considered for individuals whose condition warrants it. The PFCC will coordinate arrangements for transfers to either regional or metropolitan hospitals;

• If transfer is required, the ambulance service or RFDS and hospital must be advised, in advance, that the individual being transferred is COVID-19 suspected or confirmed; and

• If the case is medically stable or for asymptomatic contacts, evacuation by road or charter plane with appropriate IP&C and PPE use may be considered.

3.3.11 Communication and public information

The RACFs are responsible for undertaking regular communications with staff, residents and family members during and outbreak. Scripts should be used which are consistent with the CDNA Guidelines for RACFs. PHEOC Teams can provide support to review the information being sent to these groups to

Page 18 of 46

ensure it is accurate. Where capacity for communication with family members is exceeded, RACF can request support from the Residential Care Line. PHEOC will liaise with relevant clinicians, carers, guardians, case workers and facility staff to assist with this process as required. PHEOC staff also provides information to WA Police Force to support and/or enforce isolation or quarantine measures as required.

During the response phase, the SHICC Public Information Cell in consultation with PHEOC is responsible for coordinating communication and media activity to, and in conjunction with, Commonwealth Departments, the WA Government (Premier and Cabinet), State agencies, internal staff and the general public. A consistent approach with key messaging and communication activities should be maintained at all times.

During this Phase, the SHICC Public Information Cell is responsible for coordinating communication and media activity to, and in conjunction with, Commonwealth Departments, the WA Government (Premier and Cabinet), State agencies, internal staff and the general public.

Public communications

Under the State Support Plan – Emergency Public Information the State Emergency Public Information Coordinator is responsible for the coordination of whole of government public information across an emergency in WA, including the COVID-19 pandemic. This function is undertaken by the COVID-19 Information Coordination Centre and includes coordination with SHICC Public Information Cell.

SHICC Public Information, in conjunction with relevant parties and Agencies depending on the nature of the outbreak, are responsible for the release of all information to the media. Any public information released to the media must be coordinated via the SHICC Public Information Cell, with relevant approvals in place, with endorsement by the D/CHO, Public Health and approval by the Incident Controller. An RACF should seek advice from the SHICC Public Information Cell who will liaise with the other relevant WA Health staff before speaking with the media or putting out any public communications.

Communications may include:

• Provision of guidance by PHEOC to communities on Public Health;

• Information from the Incident Controller on the status of disease spread and the current response among the health service and emergency management sectors;

• Liaison by the Incident Controller with national and inter-jurisdictional counterparts;

• Briefings to the Minister for Health, Premier and State Minister for Emergency Service are the responsibility of the Chief Health Officer and Director General, Department of Health, with advice from the Incident Controller; and

• Reporting by D/CHO, Public Health as required to national and state bodies.

3.3.12 Reporting / monitoring

The D/CHO, Public Health is responsible for notifications and reporting to national bodies on outbreaks occurring in RACFs. The RACF is responsible for reporting to the Aged Care Quality and Safety Commission.

Daily reporting should continue and include the SITREP and forward risk assessment which will support monitoring to inform early alerting of the need to activate additional aspects of the State/system-level response if required.

Immediately once an outbreak is identified, the Incident Controller will be provided with an assessment of the requirement for either preparing for or triggering a system-level operational response (inclusive of Interagency Response) to support the management of a COVID-19 outbreak on an ongoing basis through the SITREP (see Appendix I for minimum requirements).

This will provide continued consideration of capacity for medical care, workforce, consumable supplies, medical equipment, IP&C capacity, access to testing, infrastructure, logistics and

Page 19 of 46

support services required as the result of the outbreak for current and forecasted needs. Each criterion will be assessed and rated according to the risk categories of:

o GREEN – State/system-level response plan activation standby;

o AMBER – State/system-level response plan activation prepare; and

o RED – State/system-level response plan activation respond.

3.3.13 Escalation to the Australian Government

The Australian Government Department of Health have made available through a case management approach a range of support measures to assist aged care providers as part of the response to COVID-19. This includes a temporary surge workforce support through Mable, and Aspen Medical for an intensive emergency response team deployed by the Commonwealth Government This workforce includes clinical and support workers and is available to assist in rural areas. RACFs can activate this response by communication with the Commonwealth Department of Health.

Upon completion of stand-down and recovery, if the State Hazard Plan for Human Biosecurity remains active for the purposes of the COVID-19 pandemic response, the response will return to Phase 2 of this plan (standby and monitoring). However, recovery efforts and hospital surge activities may continue

3.4 Phase 5: Outbreak recovery

The response phase concludes when the outbreak is determined to be over by the D/CHO, Public Health. This occurs when 14 days have passed with no new cases identified. A longer period to declare the outbreak over may be recommended by PHEOC in some circumstances, for example particularly vulnerable population groups are involved.

During Phase 5, a recovery response for the particular outbreak will be considered. Activities in this phase may reflect the commencement of activities which will be ongoing post completion of the recovery phase when a response will be return to Phase 2 and may include:

• Response teams and supporting agencies are stood down;

• RACF returns to Business as Usual activity;

• In consultation with SHICC Logistics Cell, ensure adequate replacement supplies are available;

• Ongoing monitoring of COVID-19 through laboratory notification of cases and the notifiable infectious disease system by PHEOC staff;

• Contribute to a debrief or investigation of the outbreak if deemed necessary by the Incident Controller;

• Review and evaluate management protocols;

• Incorporate lesson learnt into Business Continuity Plans;

• Funds recovered, where applicable;

• Clearance of cases by PHEOC and release of contacts from quarantine should proceed as normal as per the CDNA Guidelines;

• Ongoing monitoring of COVID-19 through laboratory notification of cases and the notifiable infectious disease system by Public Health. Facilities, PHEOC and WACHS staff should continue monitoring in event that further cases are identified;

• Ongoing public communications to reassure the public and thank responders;

• In consultation with SHICC Logistics Cell, ensure adequate replacement supplies are available;

• Debriefing and evaluation of the response / review and evaluate management protocols; and / or

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• Incorporate lesson learnt into Business Continuity Plans.

3.4.1 Stand-down

In most cases, stand-down for an outbreak can be determined to be over 14 days post isolation of the last case, that local health service capacity is no longer being exceeded and the Public Health threat can be managed within normal arrangements with ongoing monitoring for changes. A longer period of time to declare the outbreak over may be recommended by the D/CHO, Public Health in some circumstances, for example where particularly vulnerable population groups such as Aboriginal people are involved.

3.4.2 Recovery activities

PHEOC Public Health and RACF staff will continue to monitor residents for a second wave of infection.

Appendix A: Legislative and policy framework

This Plan should be read in conjunction with the following national and state legislation and guidelines.

Legislation National Biosecurity Act 2015 (Australia)

Public Health Act (WA) 2016

Emergency Management Act (WA) 2005

Health Services Act (WA) 2016

National Policy

and Guidance

Australian Health Sector Emergency Response Plan for Novel Coronavirus

(COVID-19)

Coronavirus Disease 2019 (COVID-19) Communicable Disease Network

Australia National guidelines for public health units (CDNA Guidelines)

Australian guidelines for the prevention and control of infection in

healthcare (2019)

State Policy

and Guidance

State Emergency Management Plan (State EM Plan)

State Emergency Management Policy

State Hazard Plan for Human Biosecurity

Infectious Disease Emergency Management Plan (IDEMP), WA Health

System, 2017

WACHS COVID-19 Emergency Management Framework (draft)

WA Department of Health Coronavirus Disease – 19 Infection Prevention

and Control in Western Australian Healthcare Facilities

WACHS COVID-19 Critical Care Patients Guideline

Western Australia Government Pandemic Plan

WA Interim Respiratory Infectious Diseases Emergency Response

(RIDER) Plan 2020

# due to the vast number and variety of local guidelines this Plan does not included a list. These can be accessed from local agencies as required.

There are significant resources available to assist RACF to develop local plans:

Resource Link

WA DoH COVID-19 Guidelines for Western Australian Residential Aged Care Facilities

https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Infectious%20diseases/PDF/Coronavirus/COVID-19-Guidelines-for-the-Western-Australian-Residential-Aged-Care-Sector.pdf

Access to PPE Aged care providers that require Personal Protective Equipment (PPE) must email agedcarecovidppe@health.gov.au

Australian Government – Coronavirus (COVID-19) resources for health professionals, including aged care providers, pathology providers and healthcare managers

https://www.health.gov.au/resources/collections/coronavirus-covid-19-resources-for-health-professionals-including-aged-care-providers-pathology-providers-and-healthcare-managers

Australian Government – COVID19 Guide for Home Care Providers

https://www.health.gov.au/resources/publications/coronavirus-covid-19-guide-for-home-care-providers

Australian Government – COVID-19 outbreak management in residential care facilities

https://www.health.gov.au/resources/publications/coronavirus-covid-19-outbreak-management-in-residential-care-facilities

Australian Government Coronavirus (COVID-19) – Restrictions on entry into and visitors to aged care facilities

https://www.health.gov.au/resources/publications/coronavirus-covid-19-restrictions-on-entry-into-and-visitors-to-aged-care-facilities

Australian Government - (COVID-19) information for health care and residential care workers

https://www.health.gov.au/resources/publications/coronavirus-covid-19-information-for-health-care-and-residential-care-workers

CDNA National guidelines https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/COVID-19-SoNG-v3.1.pdf

Australian Government CDNA Infection Control Expert Group guidelines COVID-19 Infection Prevention and Control for Residential Care Facilities

https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdf

Appendix B: Governance and responsibilities for outbreaks in RACFs

Daily Communications Meetings

WA Department of Health

Dr Robyn Lawrence SHICC Incident Controller

Ms Liz Macleod Health Operations Lead CE

Dr Paul Armstrong Deputy Chief Health Officer, Public Health

COMMONWEALTH

Residential Aged Care Facility (RACF)

Roles and responsibilities

• Develop RACF specific outbreak management plan consistent with interagency outbreak management plan;

• Manage the outbreak in consultation with PHU and according to:

• Standard 3: Personal care and clinical care of the Aged Care Quality Standards ;

• Communicable Diseases Network Australia’s (CDNA) Guidelines for the Prevention, Control and Public Health Management of Influenza Outbreaks in Residential Care Facilities in Australia;

• Work with PHU, Clinical Logistical Support Team to manage outbreak and provide care for residents;

• Engage surge workforce: consider additional staff to avoid deconditioning of COVID-19 -ve residents, and for specialist infection control support;

• Facilitate access to surge workforce (Mable, Aspen Medical), PPE;

• Act as primary communication contact for residents and families; and

• Ensure ongoing care needs are maintained, including liaison with GP and allied health personnel.

Aged Care Quality and Safety Commission (ACQSC)

• Monitor compliance with the Aged Care Quality Standards under the Aged Care Act 1997 or funding agreement.

• Take regulatory action and management where compliance issues are identified.

• Respond to complaints received about the service.

State Health Incident Coordination Centre (SHICC)

Roles and responsibilities

• Provide operational leadership for the impact of an outbreak on the WA Health system;

• Support operational aspects e.g. facilitate PPE supply if required;

• Assist in sourcing clinical and inflection prevention and control expertise; and

• Facilitate relocation of cohorts where appropriate,

Public Health Emergency Operations Centre (PHEOC)

Roles and responsibilities

• Lead the public health response, including monitoring and supporting the RACF with Outbreak and Cluster Teams (to identify and manage cases, contact tracing) and advising on infection control;

• Support RACF in communicating with residents & families; and

• Notify ACQSC: cases, deaths and when outbreak is closed.

Clinical & Logistical Support Team

Roles and responsibilities

• Lead and provide clinical & logistical support through ID Team, Geriatrician, RCL, SCNA HITH/ model;

• Provide clinical support & information to treating ;

• Support GP and RACF staff to develop advance care planning for residents; and

• Determine processes for clinical deterioration: care in RACF/transfer to hospital.

Appendix C: Roles and Responsibilities Matrix

GP

RA

CF

Pat

ho

logy

PH

EOC

SHIC

C

Phase 1 – Prevention and Preparedness

Develop Outbreak Plan for RACF X X X

Develop a Staff Contingency Plan X X

Undertake Staff Education and Training X

Acquire Contingency stocks X X

Develop Communication Tools X X X

Phase 2 – Standby and Monitoring

Initial Notification of Potential COVID-19 Case to RACF X

Organise Testing of Potential COVID-19 Case X x

Initial Notification of Potential COVID-19 Case to PHEOC X

Isolation of Suspected Case X

Phase 3 – Response

Confirmation of COVID-19 Case to PHEOC X

Confirmation of COVID-19 Case to SHICC X

Confirmation of COVID-19 Case to RACF and other authorities X

Case Management and Contact Tracing X

Isolation and Quarantine Arrangements X

Ongoing Medical Care X

Hospital transfer for clinical care X

Control strategies- visitor restrictions, IP&C X

Maintaining Workforce X

Mental Health Support X

Public Communication of the Outbreak X

Information to Staff, Residents and Family X X

Provision of Surge Response X

Phase 4 – Recovery

Determine Outbreak Over X

Ongoing Monitoring X X

Debriefing and Close Out X X X X

Incorporate lessons into Plans and Procedures X X X

Appendix D: Governance protocol to support joint management of a COVID-19 outbreak in a Residential Aged Care Facility (RACF) in WA

Parties

The Commonwealth Government (Department of Health and Aged Care Quality and

Safety Commission) and the WA Government (Department of Health) and RACFs.

Purpose

The purpose of this protocol is to formalise the coordination of government support to an aged care provider in their management of a COVID-19 outbreak in a Commonwealth funded residential aged care facility (RACF) in WA.

This protocol outlines the roles and responsibilities of relevant parties, governance structures,

escalation procedures and expectations around information sharing and timeframes. The

agencies identified in this protocol are informed by, and provide advice to, the State Health

Incident Coordination Centre (SHICC) and Public Health Emergency Operations Centre

(PHEOC).

Objectives

The primary objectives of this protocol are to optimise care for all residents and staff

impacted RACFs (irrespective of their COVID-19 status) and to contain and control the

outbreak to bring it to an end as quickly and safely as possible.

When to implement this protocol

A single positive COVID-19 case within a RACF (resident or staff member) will trigger the use

of this protocol. Each outbreak will differ according to the circumstances of the RACF,

therefore, the application of the protocol will be applied based on identifying and

understanding the features of the outbreak.

Principles

The key principles underpinning this protocol are:

• Consumer-centred care

o The clinical and welfare needs of residents are paramount. Decisions on the most

appropriate clinical care, including location of the care and whether transfer to hospital

is required, are regularly reviewed and made on an individual basis but cognisant of

the welfare needs of the all residents in the facility.

o Risks to individuals, and the service, are balanced with decisions informed by the

circumstances and preferences of each resident and their representative (including

through advanced care plans), and the circumstances of the RACF at which they

reside.

o Communication to residents and their representatives is coordinated and occurs

frequently.

• Rapid response and decision making

o Support for providers will consider the assessed capability and capacity of the

provider and surrounding health services to respond to the outbreak and informed by

the provider’s outbreak management plan.

o All parties should mobilise and implement actions within their remit rapidly and in

coordination with other parties.

o Parties escalate issues according to clear governance processes with agreed criteria

on when new decisions might need to be made, or existing ones revised.

o Parties work collaboratively and are focussed on finding solutions.

• Timely information sharing

o The early days of an outbreak will be particularly challenging therefore it will be vital

that mechanisms are rapidly agreed, appropriate to the circumstances of the outbreak,

to ensure information is shared between the Commonwealth and WA Governments in

a timely manner to coordinate an approach.

o Limitations, or perceived limitations, of parties involved in the response are raised

early.

• Accountability of aged care provider

o Aged care providers are expected to comply with their responsibilities under relevant

Commonwealth legislation, including preparation of up- to-date outbreak management

plans.

o Providers will be given guidance to support their compliance and their compliance will

be monitored, with detected non-compliance actioned quickly.

Roles and responsibilities

Commonwealth Government

Commonwealth Department of Health

Role

• Provides funding for aged care services and supports the RACF’s capacity to manage the outbreak.

Tasks

• Support viability and capacity of service provider to manage outbreak.

• Allocate state-based 24/7 case manager.

• Facilitates adequate access to primary care for residents of the RACF.

• Facilitate access to resources, including surge workforce (where required) and personal protective equipment (PPE)

• Provide funding to assist management of the outbreak, where appropriate.

• Facilitate relocation of cohorts, where appropriate. Provides rapid response COVID-19 in-reach pathology testing services, if required.

• Assist with access to aged care advocacy services for residents and their representatives.

• Responds to media requests directed to the Department.

Aged Care Quality and Safety Commission

Role

• Provide regulatory oversight of RACFs—to protect and enhance the safety, health, well-being and quality of life of people residing in the RACF.

Tasks

• Provides guidance and advice to support the provider’s compliance with relevant Commonwealth legislation.

• Monitors compliance with the Aged Care Act 1997 and Aged Care Quality and Safety Commission Act 2018.

• Respond to identified compliance issues, including escalating concerns immediately to the SHICC and PHEOC Groups.

• Acts to work with the provider to resolve complaints received about the service.

Residential Aged Care Facility (RACF)

Role

• Lead and manage the response to the outbreak in the RACF as required by legislation,

including the Aged Care Act 1997, the CDNA Guidelines and relevant WA legislation (i.e.

Public Health Orders) including adequate capacity to manage the outbreak in situ subject to

circumstances of the outbreak.

• Regularly communicate with residents and their representatives — updating

them on the outbreak response, including each resident’s circumstances and

preferences.

• Develop an outbreak management plan to ensure preparedness in the event of the outbreak including engagement with Public Health Unit (PHU).

Tasks

• Notify and liaise with the PHU, and the Commonwealth Department of Health.

• Establish an Outbreak Management Team in conjunction with PHU (immediately) and co-

chair daily meetings of the Outbreak Management Team until the outbreak is closed.

• Update the outbreak management plan (OMP).

• Assess staff resources, detailed in the OMP:

o Contingency planning in the event of significant staff loss (30-40 per cent)

• Surge staff planning – including identifying staff through usual recruitment agencies, staff

from within the broader organisation, and other aged care provider

• Lead, direct, monitors and oversee outbreak response in the RACF.

• Identifies an Infection Control Local Lead

• Implements infection prevention and control measures, including:

o Isolating and cohorting residents and staff

o Instructing on PPE, hand hygiene, and environmental cleaning

o Instituting contact and droplet precautions

o Assessing the RACF for potential breaches (e.g. food trolleys, medication trolleys)

o Displaying visible signage throughout the RACF

o Designating an infection control practitioner role to support adherence to PPE\

o Certifying that all staff entering the facility are orientated and trained in the use of PPE.

• Restrict visitor and community (including health workers) to minimal essential

requirements. Non-essential visitors will be precluded from face to face visits with

residents [detailed in CDNA Guidelines]. Keep a log of all visitors entering the facility,

including areas and residents visited.

• Manage staff, including rostering and isolation measures for exposed staff.

• Implement a timely and responsive communication policy with residents and their families.

• Engage surge workforce where critical staff are not able to be sourced through other avenues, if required.

• Monitor resident welfare and well-being, and regularly communicates with residents and their families.

• Work with GPs to review/develop advance care plans for residents.

• Enable access to aged care advocates.

• Facilitates pathology requisition orders and timely specimen collection.

• In coordination with SHICC and PHEOC, liaise with GP and allied health personnel to

ensure approach to acute and chronic disease is addressed, and de-conditioning, grief

and psychiatric sequelae of isolation and loss are addressed.

WA Department of Health

PHEOC (Public Health Emergency Operation Centre)

Role

• Lead the public health response and support the RACF in executing its role.

Tasks

• Establish Outbreak Management Team immediately with RACF, and co-chair subsequent daily meetings until outbreak is closed.

• Notify PHEOC/SHICC WA Department of Health of any further confirmed cases,

deaths and recovered cases associated with an RACF.

• Active surveillance, investigation and management of cases in staff and residents.

• Contact tracing and management.

• Support and instil confidence in the RACF manager to respond to the outbreak response.

• Ensure that public health and initial infection control measures are implemented to

control the outbreak. If barriers are identified, escalate to State Health Incident

Command Centre (SHICC) Group to ensure appropriate resourcing and outcomes.

• Interview the case(s), with case questionnaire, and confirm swab results

(PHOps) Public Health Operations

Role

• Oversee the public health response, supporting PHEOC.

• PHOps operations team are the key liaison point for public health response.

Tasks

• Support the RACF in a) convening Outbreak Management Team, and b) effectively managing the public health aspects of the incident.

• Liaison will encompass:

o Sharing information with SHICC, and other stakeholders, in support of PHEOC.

o Clarity and accuracy of messaging to government and external media requests.

• Notify the Aged Care Quality and Safety Commission of all cases, deaths, and when the outbreak is closed.

SHICC Clinical & Logistical Support Team (CLST)

Role

• Establish clinical and logistical outreach team and infection control support.

• Support clinical governance within RACF.

Tasks

• Determine clinical lead and outreach model (Hospital in the Home /geriatric outreach model) with specialist clinician support (e.g. geriatrics, infectious diseases, palliative care) to maximise clinical care of residents both COVID-19 positive and negative.

• In partnership with the CEC, advise on infection prevention and control measures, including isolating and cohorting residents (for both COVID-19 positive and negative residents), with support for monitoring as needed.

• Determine, through RACF, the level and type of specialist and support care required (for example, infectious disease, palliative care, geriatrics, allied health).

• Assist the RACF in testing of all residents and staff.

• Support staff/GPs to provide appropriate patient-centred care and review/develop advance care plans for residents.

• Liaise regularly and provides clinical information and support to GPs.

• Determine the processes for clinical deterioration, including care in RACF and/or support to transfer to hospital as clinically determined and consistent with the wishes of the resident.

• Provide expert advice to RACF for initial infection prevention and control, with support for monitoring as needed.

• Facilitate testing through provision of staff and laboratory processing.

Governance

The following governance structures must be notified within one hour of notification of a COVID-

19 outbreak in an aged care facility and convened within 12 hours.

Name Membership Functions Meeting Frequency

State Health Incident Coordination Centre/Public Health Emergency Operations Team

CHAIR: Department of Health

• Chief Health Officer, Dr Andrew Robertson

• Incident Controller Dr Robyn Lawrence (SHICC),

• Deputy Chief Health Officer Public Health Dr Paul Armstrong (PHEOC)

• Aged Care Quality and Safety Executive Director (Commonwealth), Ann Wunsch

• Director Aged Care (Comm) Rebecca McIlroy

• Chief Executive Lead CE Liz MacLeod, DOH

• Executive Director Aged Care Stream Gail Milner

• WACHS (Marg Denton,

COO)

• Receive and endorse Outbreak Management Plan (OMP) – noting that this will remain dynamic

• Oversee operational responses, including considering expert clinical advice

• Consider issues identified

under trigger events for

escalation

• Document agreed actions

• Advise relevant Ministers on response to outbreak

• Communicate to peak bodies

Initial meeting at identification of the outbreak and then meeting frequency as required

Outbreak Management Team

CHAIR: RACF provider and

PHOps, or other as agreed by SHICC/ PHEOC

• RACF including:

• CEO

• Manager

• Clinical Supervisor

• State Manager, WA, Department of Health

• CLST (SHICC representative), Public Health Emergency Operations Centre (PHOps) representative

• CLST, Clinical Team may include: • Infectious

Disease Consultant

• Geriatrician

• Palliative Care

• Hospital in the Home

lead • Infection Prevention

• Support the RACF to assume control of the outbreak

• Ensure strong and effective management structures in place to manage the outbreak

• Develop and oversee the implementation of the outbreak management plan – noting that this plan will remain dynamic

• Implement appropriate control measures including restriction of resident movement, restriction of visitor access, rapid audit of infection prevention and control, access to and correct usage of PPE

• Assess staff resources and surge staff planning within the

Daily

and Control Practitioner

• Testing Team

RACF preparedness plan. Staffing should include:

o Identification of an

infection control

lead/champion o Additional clinical

support to meet the increased care needs of COVID-19 positive residents

o Additional allied health staff to avoid deconditioning of quarantined residents, particularly COVID-19 negative residents

o Additional hospitality staff to support changes in practices due to infection control

o Additional lifestyle staff to support enhanced communication with families and changes in activities due to quarantining

• Recommend activating the Commonwealth workforce surge program (if required).

• Ensure resources are

adequate, including:

o PPE

o Medical and

allied health

workforce

o Laboratory and

testing

• Identify and investigate all

positive COVID-19 cases

• Establish approach to clinical care including escalation pathway to hospital

• Ensure a communication strategy is in place for each resident and their representative (use external expertise as required

i.e. OPAN)

• Support communication

between all stakeholders

• Identify alternate

accommodation options, if

required

• Document agreed actions • Report and escalate issues

to the SHICC and PHEOC

Standards and Logistical Support Team

• Member of the Outbreak Management Team

• Aged Care Quality and Safety Commission’s Clinical Adviser

• Commonwealth State Manager WA,

• SHICC

• Oversight of outbreak

management response

• Identification of and response to regulatory compliance concerns

• Document agreed actions

• Escalation of trigger events/issues

Alternate days – meet with the Outbreak Management Team

Appendix E: WACHS Network map

Appendix F: Integrated outbreak response

Appendix G: Summary of outbreak response phases

Appendix H: RACF Prevention and Preparedness Guidelines

Prepare an outbreak management Standard Operation Procedure

At a minimum, facilities must identify a dedicated staff member to plan, co-ordinate and manage logistics in an outbreak setting as well as communicate and liaise with WA Health. Further information is contained in section 2 and 3 of the coronavirus-covid-19-outbreak-management-in-residential-care-facilities .

Workforce management

Facilities should have a staff contingency plan in the event of an outbreak where unwell staff members need to be excluded from work for a prolonged period until cleared to return to work. Health care workers may also require exclusion from the workplace if they have returned from international travel. Workforce management is discussed in depth in section 3 of the coronavirus-covid-19-outbreak-management-in-residential-care-facilities .

Staff should be informed, and supported (e.g. leave policies), to exclude themselves from work when they have any kind of respiratory illness and to notify the facility if they were confirmed to have COVID-19. Staff exclusion during an outbreak is discussed further in section 5 of the coronavirus-covid-19-outbreak-management-in-residential-care-facilities

Staff education and training

Each RACF is responsible for ensuring their staff are adequately trained and competent in all aspects of outbreak management prior to an outbreak. Staff should know the signs and symptoms of COVID-19 to identify and respond quickly to a potential outbreak. Additionally, all staff need to understand the RACF infection control guidelines and be competent in implementing these measures during an outbreak.

Residents, staff and visitors should be encouraged to practice good respiratory etiquette, which includes coughing or sneezing into the elbow or a tissue and disposing of the tissue then cleansing the hands. Useful educational and promotional material can be found in the CDNA Guidelines.

Online hand hygiene courses are available and staff should be encouraged to do refresher training. PPE requirements for caring with residents with suspected or confirmed COVID-19 are outlined in the ICEG IPC guideline.

Consumable stocks

Facilities should ensure that they hold adequate stock levels of all consumable materials required during an outbreak, including:

• Personal protective equipment (PPE) e.g. gloves, gowns, masks, and eyewear.

• Hand hygiene products (alcohol-based hand rub, liquid soap, hand towel)

• Diagnostic materials (swabs)

• Cleaning supplies (detergent and disinfectant products)

• Staff Health Plan – closely monitor the health of staff, including fever screening, where appropriate

• Staff should be informed, and supported (e.g. leave policies), to exclude themselves from work when they have any kind of respiratory illness and to notify the facility if they were confirmed to have COVID-19. Casual staff should also notify their agency if they become unwell and be supported to exclude themselves from work with all elderly people.

o Staff sick leave policies must enable employees to stay home, if they have any even very mild symptoms of respiratory infection.

o Staff must be educated to the early signs and symptoms of COVID-19.

o The policy must describe the process for staff to report their symptoms to the residential aged care facility and who is responsible for sourcing additional resources to match agreed roster profiles.

• Consider how to leverage the relaxation in the international student visa work conditions for aged care facilities and home care providers. This will allow international student nurses and other aged care workers to work more than 40 hours a fortnight.

• Develop a Communications Plan that clearly identifies how and who is responsible for communicating with residents, their families, their staff members and service providers. This plan must articulate with the communication strategy outlined in the WA DoH Public Health Emergency Operations Centre COVID-19 Public Health Outbreak Management Response Plan to ensure that communication responsibilities are maintained.

• The principle underlying staff and visitors staying away from the facility if they are unwell should be reinforced by placing signage at all entry points to the facility.

Exposure prevention

There is currently no vaccination to prevent COVID-19. Avoidance of exposure is the single most important measure for preventing COVID-19 in RACF. During a COVID-19 pandemic, or when local community transmission of the disease is identified, RACF should focus on preventing introduction of the disease into the facility or spread within or between facilities, if infection has been identified within the RACF.

Exposure prevention actions that RACFs can undertake are detailed in the coronavirus-covid-19-outbreak-management-in-residential-care-facilities

Prevention of introduction into the facility/setting

• RACFs should comply with all Commonwealth, and State or Territory direction on restrictions to visitors to RACF when they are unwell or when there is significant community transmission occurring.

• RACF should advise all regular visitors to be vigilant with hygiene measures including social distancing, and to monitor for symptoms of COVID-19.

• RACF must ensure that adequate hand washing facilities and alcohol-based hand rub, as well as tissues and lined disposal receptacles are available for visitors to use; at the entrance of the facility and in each resident’s room.

• Visitors will be restricted from entering a RACF unless they are unwell, an outbreak is occurring, or when advised by health authorities during periods of significant community transmission. Protracted restrictions on visitors is likely to have detrimental impacts for resident’s wellbeing.

• Prevention of spread within and between facilities/setting.

• Identify dedicated employees to care for residents with COVID-19.

• Provide the correct supplies to ensure easy and correct use of PPE.

• Notify facilities and transport service providers prior to transferring a resident with an acute respiratory illness, including suspected or confirmed COVID-19; or transferring to a higher level of care.

Notify any confirmed COVID-19 cases in residents and employees to the Incident Controller.

Audit and Compliance

The Aged Care Quality and Safety Commission continues to undertake audit checks across all RACF across the state to ensure compliance with the requirements for prevention and preparation for an outbreak.

Appendix I: Daily reporting framework / SITREP

Minimum requirements for a daily SITREP have been outlined below which should be provided, through governance, to the Incident Controller.

This information does not replace existing information flows via the Regional Emergency Operation Centres / Patient Flow Command Centre.

Daily Report

1. Public Health

o Any information as relevant related to identification of outbreak and early notification of high risk of outbreak following case identification

Relevant commentary here

o Daily case counts (inclusive of confirmed / awaiting test results / admitted / admitted ICU) Relevant commentary here

o Details of any control measures introduced or proposed (information as relevant related to any request to Incident Controller to issue lockdown directive or other public health control measures)

Relevant commentary here

o Confirmation that adequate laboratory testing capacity in place Relevant commentary here

2. Situation Assessment

o Information as relevant related to any situational assessment to determine capabilities and capacity for a local/regional response. Where relevant (in particular in respect of any outbreak in a remote Aboriginal community), this should include an overview of:

- Local health clinic capability

- Testing capability

- Isolation capability

- Population size & vulnerability

- Road distance to a hospital and access to an airstrip

- Other considerations.

Relevant commentary here

o Is there a requirement for onsite Clinical and Logistics support teams to be activated Relevant commentary here

o Details of media or briefing requests Relevant commentary here

3. Current State and Forward Risk Assessment to support preparation for, and activation of, a State or System-level response

Key criteria should be forward assessed and provided to the Incident Controller as part of daily reporting. This assessment will provide early visibility, wherever possible, of the emerging need to commence preparation to use system-level plans.

The system-level response includes the mobilisation of supporting agencies through the State Health Incident Coordination Centre (SHICC) who can assist in the response by providing, for example, additional transport, supplies, isolation facilities, welfare, security and emergency management support. Where no information is available, the assessment should be considered as a minimum to be an amber assessment and preparations for a potential system-level response commenced until such time as information advised otherwise that satisfies the Incident Controller that contingency planning can be stood down.

Criterion to address current and future need

Related

system-level Plans

Ris

k C

ate

go

ries

SYSTEM-LEVEL RESPONSE

STAND-BY

No action – low risk:

response can be managed fully within local resources within next 72 hours and/or, where

required, system-level resources can be accessed

within 12 hours and/or forecast resources beyond 72 hours

meet demand

SYSTEM-LEVEL RESPONSE

PREPARE

Contingency plan – moderate risk: response cannot be managed fully within local resources next 48 hours and/or, where required,

system-level resources can be accessed within 12-24 hours

and/or forecast resources beyond 72 hours may not meet

demand

SYSTEM-LEVEL RESPONSE

RESPOND

Enact plan – high / extreme risk:

response cannot be managed fully within local resources

within next 24-48 hours and/or, where required, system-level

resources require > 24 hours to access and/or forecast

resources beyond 72 hours will not meet demand

Adequate and appropriate capacity is available to care for COVID+ patients and/or non-COVID related essential services, including but not limited to:

- Areas for isolation of suspected or positive cases / accommodation

- Road or aeromedical transport

- Treatment spaces e.g. clinics

- Accommodation

(Note: Includes admitted & symptomatic isolated incl. of physical and clinical Mental Health needs)

• System surge plans

• Aeromedical Transport plans

• SWICC Plans

• Inter-Agency Plans as relevant

Syste

m-l

eve

l S

trate

gie

s

Capacity is available through localised surge plan & nil anticipated requirement for use system surge plan and/or aeromedical or other transportation organised through the PFCC

Capacity may exceed localised surge plan & anticipated potential requirement for use system surge plan and/or aeromedical or other transportation organised through the PFCC

Capacity predicted to exceed localised surge plan & requirement for use system surge plan and/or aeromedical or other transportation organised through the PFCC

Appropriate workforce (health and/or other agencies) is available at the required level to maintain normal activity – including but not limited to:

- Medical

- Nursing

- Other clinical or support staff

Workforce required to continue business as usual if the outbreak has occurred in a facility

• System-level workforce plan

• Inter-Agency Plans as relevant

Workforce personnel available locally or can be sourced from local pools / using localised surge measures & nil anticipated requirement for use system resourcing surge plan and/or transportation by air or road of additional staff resources organised through the PFCC

Workforce personnel may not be available locally or from local pools / using localised surge measures & potential requirement for use system resourcing surge plan and/or transportation by air or road of additional staff resources organised through the PFCC

Workforce personnel predicted to not be available locally / cannot be sourced from local pools / using localised surge measures & will require system resourcing surge plan and/or transportation by air or road of additional staff resources organised through the PFCC

Criterion to address current and future need

Related

system-level Plans

SYSTEM-LEVEL RESPONSE

STAND-BY

No action – low risk:

response can be managed fully within local resources within next 72 hours and/or, where

required, system-level resources can be accessed

within 12 hours and/or forecast resources beyond 72 hours

meet demand

SYSTEM-LEVEL RESPONSE

PREPARE

Contingency plan – moderate risk: response cannot be managed fully within local resources next 48 hours and/or, where required,

system-level resources can be accessed within 12-24 hours

and/or forecast resources beyond 72 hours may not meet

demand

SYSTEM-LEVEL RESPONSE

RESPOND

Enact plan – high / extreme risk:

response cannot be managed fully within local resources

within next 24-48 hours and/or, where required, system-level

resources require > 24 hours to access and/or forecast

resources beyond 72 hours will not meet demand

Supplies (individual supplies lines or multiple lines for health and/or other agencies) are available – including but not limited to:

- PPE

- Medical supplies

- Food or other welfare supplies

- Pharmaceutical supplies.

• System-level supplies plan

• Inter-Agency Plans as relevant

Syste

m-l

eve

l S

trate

gie

s

Supplies lines are available in volumes to meet demand in required locations or local stores & nil anticipated requirement to access supplies from elsewhere in the system and/or access DPMU / arrange additional supplies delivery through appropriate mechanisms

Supplies lines may not be available locally in volumes in required locations or local stores & anticipated potential requirement to access supplies from elsewhere in the system and/or access DPMU / arrange additional supplies delivery through appropriate mechanisms (or consideration alternative strategies for management)

Supplies lines predicted to not be available locally in volumes in required locations or local stores and/or will require access supplies from elsewhere in the system and/or access DPMU / arrange additional supplies delivery through appropriate mechanisms PFCC

(or consideration alternative strategies for management)

Medical Equipment to support COVID-19 requirements is available

• System-level equipment plan

Items of medical equipment are available in volumes to meet

demand in required locations or alternative local proximity & nil

anticipated requirement to reallocate equipment from

elsewhere in the system and/or arrange additional medical

equipment through the logistics team and PFCC

Items of medical equipment may not be available in volumes to meet demand in required locations or alternative local proximity & anticipated potential requirement to reallocate equipment from elsewhere in the system and/or arrange additional medical equipment through the logistics team and PFCC (or address through alternative redirection of patient flow to alternative locations with equipment)

Items of medical equipment predicted not be available locally in volumes to meet demand in required locations or alternative local proximity & will require reallocate equipment from elsewhere in the system and/or arrange additional medical equipment through the logistics team and PFCC (or address through alternative redirection of patient flow to alternative locations with equipment)

Appendix J: Key contacts

Agency / Team Contact Email

WA Residential Care Line

08 6457 3146

Care of the Older Person Workstream, WA Department of Health

0419 944 301

0438 912 728

PHEOC 08 9222 0221 pheoc@health.wa.gov.au

SHICC On call duty officer

9328 0553

Watch -desk

08 9222 2017

Duty.OnCall@health.wa.gov.au (first point of contact)

shicc@health.wa.gov.au

St John Ambulance

08 9344 1226 stateambulancedutyofficer@stjohnambulance.com.au

WA Police Force 0411 709 153 emergency.operations.unit@police.wa.gov.au

Department of Communities (SWICC)

13COVID (1326843)

Appendix K: Glossary

Acronym Definition

ARI Acute respiratory illness

CDNA Communication Diseases Network Australia

CLST Clinical and Logistic Support Team

COVID-19 Coronavirus disease 2019. The name of the disease caused by the virus SARS-CoV-2, as agreed by the World Health Organization, the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations.

GP General Practitioner

HSP Health Service Provider

IDEMP Infectious Disease Emergency Management Plan

IP&C Infection Prevention and Control

PHEOC Public Health Emergency Operations Centre

PPE Personal Protective Equipment

RACF Residential Aged Care Facility

RIDER (Interim) Respiratory Infectious Diseases Emergency Response Plan (endorsed)

RRT Rapid Response Teams

SHICC State Health Incident Coordination Centre

WA Western Australia (State of)

WA Health Incorporates Department of Health and Health Service Providers.

WAPF WA Police Force

Appendix L: References

• Communicable Disease Network Australia (CDNA) Coronavirus Disease 2019 National Guidelines for Public Health Units

• State Hazard Plan – Human Biosecurity

• State Health Emergency Response Plan

• (Interim) Respiratory Infectious Diseases Emergency Response Plan (endorsed)

• IDEMP (Infectious Disease Emergency Management Plan)

• WADoH COVID-19 Guidelines for Western Australian Residential Aged Care Facilities

• Australian Government - Coronavirus (COVID-19) resources for health professionals, including aged care providers, pathology providers and healthcare managers

• Australian Government - COVID19 Guide for Home Care Providers

• Australian Government - COVID-19 outbreak management in residential care facilities

• Australian Government Coronavirus (COVID-19) – Restrictions on entry into and visitors to aged care facilities

• Australian Government - (COVID-19) information for health care and residential care workers

This document can be made available in alternative formats on request for a person with a disability.

© Department of Health 2020

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.