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Covid and infection control in Community Healthcare West

The 2020 annual report of Community Healthcare West contains valuable insights into how additional infection prevention and control supports were rolled out across the organisation in response to the Covid-19 pandemic. Paul Mulholland reports

A central part of the 2020 annual report of Community Healthcare West, which was recently published by the HSE, concerns the service’s response to the Covid-19 pandemic. The report charts how “expeditious work” occurred to ensure that Covid test centres and assessment hubs were established and that personal protective equipment (PPE) was secured and deployed.

Services were fast tracked to detect cases, to support GPs in managing people at home where appropriate, and to ensure admission pressures were minimised within the Saolta University Healthcare Group. As with elsewhere in the country, facilities and services were developed while existing services were altered and redesigned to ensure that the needs of patients continued to be met in the most challenging of circumstances.

Infection control

The annual report contains important insights into infection control and prevention (IPC) and highlights the lack of IPC resources that existed in the Community Healthcare Organisation (CHO). At the start of the Covid-19 pandemic, Community Healthcare West only employed one IPC Specialist Nurse.

In the initial stages of the pandemic, activities focused on contingency planning and preparedness in a rapidly evolving situation. “Staff and service users’ safety was paramount. Business continuity, in a safe and effective environment, was prioritised,” the report states.

“Preparedness planning involved sourcing emergency accommodation solutions to facilitate staff members who had high risk persons within their household. Some staff left their homes, moved to temporary accommodation, to protect their families and support the continuity of service delivery.”

As the situation evolved and the need for support for IPC increased exponentially, the CHO reached out to the Saolta University Healthcare Group. “The response was prompt and led to a hugely successful joint response across acute and community sectors,” according to the report.

“This ongoing collaboration consolidated relationships and bodes well for the future.”
Specialist IPC support was provided on a seven-day basis throughout 2020.

Interventions included providing Covid-19, PPE and hand hygiene education on site to services. It also included providing education to service users in Direct Provision sites, and Traveller services in residential addiction facilities. Site visits were also undertaken to review current practices and advise on actions required for nursing homes, as well as mental health and disability services. Two self-isolation units for mental health services use were developed in Castlebar and Tuam.

IPC support was also provided to sheltered employment/training centres within the mental health service, and in relation to the launch of the CAMHS [child and adolescent mental health service] e-hub in Castlerea, Co Roscommon.

The gap in IPC knowledge and expertise was acknowledged as a risk across services.

“The emerging IPC team provided innovative systems to build confidence and capacity to address the crisis in the short-term, much of the work included directing service managers to relevant sources of information and explaining the application of same, advice on cleaning resources and advising the management of facilities to enhance/ ensure the safe isolation of persons with possible or confirmed Covid-19 infection,” according to the report.

The IPC team was supported professionally by the nursing team within antimicrobial resistance and infection control (AMRIC) and later from the newly appointed IPC unit within quality and patient safety, community operations.

“Providing advice, support, and education to staff to give them confidence in managing the situation evolving
was critical,” the report states.

There was also the need to respond to the rapid development and release of guidelines by AMRIC/Health Protection Surveillance Centre. These guidelines were disseminated and implementation supported by IPC staff.

IPC membership on the Covid response team and representation on the outbreak control team, chaired by public
health, was pivotal in the management of outbreaks across all sectors, particularly in relation to older people services.

After a brief respite towards the end of summer, the second wave followed in the third quarter of 2020. Again the IPC team was mobilised and worked in a manner similar to how it operated at the beginning of the pandemic. The team worked in a “synergistic way”, according to the report. Some members who had returned to their substantive posts were once again released to respond to the need for IPC staff and specialist support.

“The impact and importance of IPC expertise is recognised and acknowledged and by the end of 2020 an Assistant Director of Nursing and a Clinical Nurse Specialist had been appointed with further posts to follow. This development will ensure our CHO continues to deliver safe and quality services.”

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