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A summary of reported infection prevention and control assessments conducted in long-term care and retirement homes during COVID-19 pandemic in Ontario, Canada

Denich, Tanya ; Richard, Catherine ; CIC Public Health Ontario ; using an assessment tool developed by PHO. Following each assessment ; hand hygiene – 44 (11%) ; cohorting – 26 (6%) ; reening and physical distancing practices ; there was no defined process for cleaning high-touch surfaces or tracking when cleaning had occurred and deficiencies in the auditing process were noted ; reen Shot 2024 04 30 at 1.03.52 PM Conclusion: These findings highlight pre-existing IPAC challenges as well as new issues in LTC/RHs infection prevention and control efforts. The data in this report may be useful in identifying additional actions to support the needs of IPAC leads in these settings. Comprehensive support through coaching/mentorship ; the creation of resources to implement IPAC programs and capacity-building interventions with LTC/RH IPAC leads are needed. ------------ INTRODUCTION The COVID-19 pandemic disproportionately affected residents and staff at long-term care homes (LTCs) and retirement homes (RHs) in Canada. Overall ; 2020 ; 2020). Insufficient infection prevention and control (IPAC) training related to physical distancing ; health and human resources predisposed the system to the devastating COVID-19 outbreaks witnessed in Canadian LTCs and RHs (Gardner ; 2020). Prior to the COVID-19 pandemic ; insufficient data on healthcare-associated infections (HAIs) ; and staffing concerns (Herzig ; 2021). Another American study found that LTCs that followed and implemented the recommended Centers for Disease Control and Prevention (CDC) infection control guidelines had lower COVID-19 infection rates among residents than those that had lesser adherence to recommended guidelines. Also important is that decreasing infection rates of respiratory disease requires compliance with physical distancing and proper use of personal protective equipment (PPE) (Telford et al ; mitigate ; 2021. At the time of the visits ; while three had recently resolved outbreaks. These voluntary assessments used resources developed by PHO to evaluate IPAC measures ; arborough to Deep River to Hawkesbury. The Central Health Region serves communities from Mississauga to Huntsville and Orangeville to Markham. The Northern Heath Region from Parry South to Kenora ; while the Toronto region services 73 urban neighbourhoods across Toronto (Ontario Health ; 2024). The LTC/RHs selected for visits were identified by PHUs as having historical IPAC challenges ; or were currently experiencing outbreaks affecting residents and staff. In most cases ; the purpose of which was to provide PHO IPAC specialists with an overview of the LTC/RH’s preparedness for COVID-19. The pre-visit call using the questionnaire was conducted jointly by the PHU ; PHO IPAC specialist and LTC/RH staff responsible for IPAC. Based on this initial assessment ; not-for-profit ; municipally run homes. The IPAC assessment was conducted using a version of the PHO COVID-19 Infection Prevention and Control Checklist for Long-Term Care and Retirement Homes (PHO ; 2023). A thorough IPAC assessment in all areas included the following: review of entrance ; stations, reening ; visitors policies ; universal masking practices ; PPE use practices ; distancing, physical ; planning and outbreak management ; management of COVID-19 cases ; as well as enivironnmental cleaning and auditing. During the onsite visit ; a public health investigator/public health nurse (PHI/PHN) and the LTC/RH staff responsible for IPAC. For virtual visits ; while 48 (27.9%) ; 37 (21.5%) ; 22 (12.8%) and 5 (2.9%) assessments were completed in the Central ; respectively. The most frequent issues and recommendations made with regards to key IPAC categories and associated practice improvements are de ; ribed in Figure 1. Further analysis was performed on the report content to extract common examples under each category. The following sections outline the main themes of the identified issues (Table 1) and associated recommendations made in the post-visit reports. For each theme ; gown ; mask use and going from room to room without changing gloves ; wearing gloves where use was not indicated ; wearing both a procedure and cloth mask ; reening process and set up of ; reening areas were also documented. Staff were often observed waiting to be ; improper PPE was worn by the ; or had inadequate supplies of alcohol-based hand-rub (ABHR) ; disinfectant wipes and masks. Many LTC/RHs had no formal ; reening questions asked ; signage at the main entrance to alert visitors with potential symptoms was absent in many LTC/RHs. Physical distancing Challenges with physical distancing in common areas ; activity rooms and dining rooms were observed. Barriers to practicing effective physical distancing included limited space in break areas and meeting rooms. Gaps in education of staff regarding physical distancing was another issue identified. Environmental cleaning Most of the assessed homes did not have a formal auditing process to monitor environmental cleaning (EC) practices. In many LTC/RHs ; including ; one wipe or cloth being used on multiple surfaces ; inadequate product contact time when disinfecting surfaces and/or equipment. Some cleaning products used were not healthcare-grade cleaner/disinfectants with a Drug Identification Number (DIN) ; and LTC/RHs were lacking processes to check disinfectant concentration with test strips. Many of the LTC/RHs assessed did not have documented processes for cleaning high-touch surfaces ; barriers to implementing those plans included a lack of understanding on the part of LTC/RH staff on how to provide care to cohorts ; lack of clear guidance to inform this measure ; room cleaning delays impacting the movement of residents (in most instances ; environmental services staff were not dedicated to outbreak units). Hand hygiene In most of the assessed LTC/RHs ; ABHR was not available or contained an insufficient alcohol concentration ; such as common areas. DI ; USSION In response to the IPAC practice gaps observed during these visits ; 200 participants. The analysis of data from the LTC/RH assessment reports informed the content for these webinar sessions. Particularly important in decreasing respiratory infection rates is compliance with physical distancing and proper use of PPE (Telford et al ; reening processes included how to set up the ; improvements to the process ; clarification of PPE needed by the ; reener. In response to this finding ; items related to PPE usage ; reeners was added to the PHO COVID-19 IPAC Checklist for LTC/RHs (PHO ; 2023). Further guidance on environmental cleaning best practices seemed to be a common need observed at many LTC/RHs. Recommendations included developing processes on cleaning practices and procedures ; as well as regular review of EC processes ; including on-the-spot training. In many of the LTC/RHs ; there was no defined process for cleaning high-touch surfaces or tracking when cleaning had occurred. Many of the LTC/RH environmental services departments did not have a formal process in place to audit environmental services staff on room cleaning and work practices ; however ; help to maintain their environmental services programs. Many homes would benefit from the use of at least one measure that directly assesses cleaning (e.g. ; there was a lack of process to monitor or audit hand hygiene compliance and homes may benefit from assistance with establishing hand hygiene auditing programs. Hand hygiene is an important prevention measure ; Such, AS ; audit results need to be shared with observed staff ; 2021 ; 2021). Actions such as reconfiguring common resident and staff areas in order to meet distance requirements ; adequate staffing complements ; limiting staff from working in multiple sites ; proper ; on site management ; IPAC policies and setting specific guidance (Lavoie-Tremblay ; 2022 ; Baumann et al ; Rebmann et al ; early implementation of IPAC policy ; but also observing community prevalence rates of COVID-19 ; Abrams et al ; 2022). In an American study ; 2020). The data collected through these assessment reports informed PHO’s response to support during the COVID-19 pandemic and can be useful for designing future IPAC supports for outbreak control. IPAC considerations should be tailored in consideration of national guidance (CSA ; 2022) and ethical framework for LTC/RHs to provide balance between IPAC measures and the need for a home-like atmosphere. Additionally ; urinary tract infections (UTIs) ; capacity-building interventions with LTC/RH IPAC leads at the center. Targeted interventions should include adequate resourcing to support the role of ICP-designated staff to lead the implementation of best practices and evidence-based decision-making in the LTC/RH sector. REFERENCES

Winnipeg: Infection Prevention and Control Canada

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