Coronavirus and Homelessness – session prepared in collaboration and

partnership with Public Health England

South East Region

Esther Taborn, NHS England and NHS Improvement June 2020

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What is a coronavirus

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• The name for a family of viruses

• Halo or crown around them – hence coronavirus

• Known about since 1930’s

• Mainly cause lung (respiratory) diseases

• The name of the current coronavirus is SARS-COV-2

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Coronavirus diseases

3 COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Mild Severe

Common cold

Bronchitis

COVID-19

SARS

MERS

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COVID-19: symptoms• COVID-19 is the name of the DISEASE

• It is caused by SARS-COV-2 which is the VIRUS

• It causes an infection in the throat (upper respiratory tract) and lungs (lower

respiratory tract)

4 COVID-19 and domiciliary care IPC traiSmening April 2020: PHE London

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Cough

Fatigue

FeverHeadache

Sore throat

Mai

n s

ymp

tom

s Muscle pain

Shortness of breath or chest tightness

Smell loss

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COVID-19: severity

5 COVID-19 and domiciliary care IPC training April 2020: PHE London working

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~80%

~15%

~5%

Mild(Home)

Moderate(Admission)

Severe(ITU)

Source: WHO Coronavirus disease 2019 (COVID-19) situation report – 41

Severity & mortality increase with age

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How do you get it?

6 COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Airborne droplets or infected body fluids

Direct

Indirect via surfaces

Touching of face

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Infected body fluids

7 COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Airborne droplets

Urine & faeces

Blood

Tears

All bodily fluids (except sweat) should be regarded as potentially infectious

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Key messages for everyone

8 COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Hand-washing• Soap kills and removes the virus and other infectious agents • Most effective method for preventing spread• Alcohol gel (>60%) can also be used – must let it dry

Social distancing – 2 metres • Prevents coughs/sneezes from reaching others

Shielding• Protect those who are extremely vulnerable• Keeping them in a safe (home) environment• STAFF who are shielding MUST NOT work

Please remind your clients and their families of these national principles

9 |9 | Presentation title

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Hand washing•As often as possible for at

least 20 seconds:

• Ideally soap and water

• Alcohol gel otherwise (allow todry).

•Definitely:

• Before and after client contact

• After coughing/sneezing

• Before food preparation

• After toileting.

•Correct technique essential

• Link to online video10COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Hand washing: commonly missed areas

11COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Top tips for good hand hygiene.

Presentation title

BARE BELOW THE ELBOWS: SHORT SLEEVES OR LONG SLEEVES ROLLED UP

NO WRIST WATCHES OR BRACELETS (RELIGIOUS,

METAL ONES ARE ALLOWED)

ONE PLAIN WEDDING RING

NO LONG NAILS, NO LONG FALSE NAILS.

COVER CUTS AND ABRASIONS WITH A

WATERPROOF DRESSING

13 |13 | Presentation title

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Cleaning – high touch items

Presentation title

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Who are the vulnerable?

15COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Full list available online

Age 55+Pre-existing

medical conditions

Pregnant women

If your client needs a flu-jab they should be considered vulnerablehttps://www.pathway.org.uk/wp-content/uploads/COVID-19-Clinical-

homeless-sector-plan-160420-1.pdf

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Who are the extremely vulnerable?

16COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Solid organ transplants

Certain cancers and treatments

Severe lung diseases

Weak immune systems(immunosuppressed)

Pregnant with significant heart

disease

Full list available online

SHIELDING NEEDED

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What should you wear?

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Wear your normal work clothes or uniform

Cleaning work clothes/uniform:• Should be laundered after every shift separately from other clothes• If not store separately from other clothes• Use the maximum temperature possible and in a wash cycle of at least 10

minutes.• Do not overload machine• A suitable detergent should always be used.

Bare below the elbows if involved in personal care

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Personal Protective Equipment (PPE)

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Correct wearing and removal technique is really important

You must still wash your hands even if using PPE

Masks Plastic apron Gloves Eye protection*

Most recent guidance always available online (link here)

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Use videos re donning and doffing

19COVID-19 and domiciliary care IPC training April 2020: PHE London working

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https://www.gov.uk/government/publications/covid-19-personal-protective-equipment-use-for-non-aerosol-generating-procedures

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Do you know how to take gloves off?

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In practice: unwell resident

21COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Has symptoms and you were not aware

Wear appropriate PPEInform NHS 111

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In practice: shopping

22COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Only work if you are well• If you have symptoms follow self-isolation guidance

Maintain 2 metres distancing as much as possible

Don’t enter the room or flat unless you have to - If you do enter the house try to be in a different room to the client where possible

Wash you hands according to the recommendations

Take your shopping bags with you when you leave

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In practice: household cleaning

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Air the room• Ensure temperature doesn’t drop too much

Declutter• Reduces number surfaces exposed to any potential infection• Allows all surfaces to be cleaned effectively• Safer in terms of trip hazards

Cleaning• Use household products – detergents and bleach – as normal• Personal waste (tissues, continence pads) and cleaning cloths

should be securely disposed

Disposal should be by the double bagging method

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Household cleaning guidance

24COVID-19 and domiciliary care IPC training April 2020: PHE London working

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In practice: cleaning equipment

25COVID-19 and domiciliary care IPC training April 2020: PHE London working

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If you must take equipment into a residents home or flat it must be cleaned and decontaminated after each use

Equipment should be cleaned by following your normal practices

Where possible aim to use the residents own equipment for their care

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In practice: laundry

26COVID-19 and domiciliary care IPC training April 2020: PHE London working

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Do not shake dirty laundry - this can release virus into the air

Wash clothes normally as per manufacturers instructions

Heavily soiled clothes• E.g vomit, diarrhoea or those that cannot be washed should be

disposed of with permission from client by double bagging method.

Laundry can still be washed (even if COVID positive)

Wash hands afterwards with soap and water even if you used PPE

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Waste management

• Personal waste of suspected cases (e.g. used tissues, continence pads, other items soiled with bodily fluids), used PPE, and disposable cleaning cloths should be stored securely within disposable rubbish bags.

• These bags should be placed into another bag, tied securely and kept separate from other waste within the room. This should be put aside for at least 72 hrs before being disposed of as normal.

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Advice for staff

Presentation title

If a staff member has a household member who develops symptoms of COVID-19, then the whole household, including the staff member need to self-isolate for 14 days.

Staff who are unwell should self-isolate at home for 7 days and should follow the stay at home guidance

Staff can return to work on day 8 after symptoms if they feel better and they have not been feverish for 2 days

If a cough is the only persistent symptom on day 8 they can return to work (a post-viral cough may persist for several weeks in some cases).

Staff should not attend work if they develop symptoms (continuous cough or fever) at home. If a staff member becomes unwell at work they should go home.

Staff who come into contact with a COVID-19 patient while not wearing PPE can remain at work. This is because in most instances this will be a short-lived exposure, unlike exposure in a household setting.

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More guidance for staff at home

Presentation title

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All in this together..

Presentation title

Homeless Health Outbreak Management / Testing Protocol for the South East Region

This protocol is intended for use with those who have been accommodated as part of the ‘everyone in’ call to action and / or covers those who are / or have been sleeping rough, homeless, ‘hidden homeless,’ placed in temporary accommodation in:

• Hotels• Hostels• B&Bs• Other single / multiple occupancy properties

Monitoring of symptoms

• Advise monitoring of symptoms in residents as part of welfare checks – key symptoms: new dry continuous cough or high temperature (37.8C+) or loss of smell or taste

Symptomatic Residents Identified

• First possible case in the homeless facility or possible outbreak (two or more cases within 14 days) identified (key symptoms: high temperature 37.8c+ or new continuous dry cough or loss of smell or taste) – contact your local Health Protection Team for advice and to arrange testing

Health Protection Teams

•Thames Valley HPT (covering Berkshire West, Berkshire East, Oxfordshire and Buckinghamshire):

•Tel: 0344 225 3861

•Out of Hours: 0844 967 0083

•Email: tvphe@phe.gov.uk (not patient identifiable information)

•Hampshire Isle of Wight HPT (covering, Hampshire, Isle of Wight, Portsmouth and Southampton):

•Tel: : 0344 225 3861

•Out of Hours: 0844 967 0082

•Email: HIOW@phe.gov.uk (not patient identifiable information)

•Surrey and Sussex HPT (covering Surrey, West Sussex, East Sussex and Brighton & Hove):

•Tel: : 0344 225 3861

•Out of Hours: 0844 967 0069

•Email: PHE.sshpu@phe.gov.uk (not patient identifiable information)

•Kent HPT (covering Kent and Medway):

•Tel: : 0344 225 3861

•Out of Hours: 0844 967 0085

•Email: HPU-Kent@phe.gov.uk (not patient identifiable information)

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Thames Valley HPT Area:

Hampshire Isle of Wight HPT Area:

Surrey and Sussex HPT Area:

Kent and Medway HPT Area:

For West Berkshire; Oxfordshire; Buckinghamshire:• Contact your local Health Protection Team to discuss next steps

Contact your local HPT to discuss next steps

Contact your local HPT to discuss next steps

Contact your local HPT to discuss next steps

For East Berkshire:- Contact the Community Swabbing Team directly via emailebpc.covid19@nhs.netor by phone on:03000 770 007The email address and phone line are staffed 7 days a week from 0900hrs to 1700hrs

If you have further individuals displaying symptoms after the initial call has been made to HPTs, there will be slightly different arrangements / contacts depending on

where the accommodation is located. Please see below:

Results:Depending on local arrangements, results will normally be communicated to the individual by the GP practice where they are registered or the community swabbing team. Where no GP practice registration is in place, prior consent for results to be communicated by the service lead / provider may need to be arranged (with the service user), as a means of providing results to individuals.

Staff testing: Staff can access testing if they are symptomatic through the .gov.uk testing portal for essential workers:https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested

Other test options for clients, staff and volunteersThe government announced that testing is available for everyone over the age of 5 years that has symptoms and have indicated that those who are homeless / rough sleepers / living in temporary accommodation etc. would be able to access testing like anyone else. See here: https://www.nhs.uk/conditions/coronavirus-covid-19/testing-for-coronavirus/ask-for-a-test-to-check-if-you-have-coronavirus/There will be another route to testing for those you are supporting. We will update this with details, once portal inks are updated.Members of staff /volunteers working with homeless populations are key workers and therefore can access prioritised testing through the essential worker route: https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested .

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Infection Prevention and Control and Personal Protective Equipment (PPE) Advice:Please see below for advise around what PPE should be worn when.

Link to the full PPE / infection control guidance, can be found here:https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

*What is ‘Sessional Use’ of PPE?• Sessional use of PPE is when you can use the same PPE, without changing it, between residents/clients or

activities• Masks and eye protection can be used for sessions because they do not come into contact with

residents/clients• If they become moist, damaged, soiled, compromised or uncomfortable they should be changed immediately• You should avoid touching your facemask or lowering it on your face as this increases the risk of

contamination• Gloves and aprons cannot be used for sessional use. These are single use and should be changed and hand

hygiene completed between every resident/client• Whilst most PPE items are for once-only use, certain PPE items are manufactured to be re-usable. This most

commonly applies to eye/face protection items i.e. goggles or visors. Speak to your line manager about this.• Risk assess refers to utilising PPE when there is an anticipated/likely risk of contamination with splashes,

droplets of blood or body fluids. Where staff consider there is a risk to themselves or the individuals they are caring for they should wear a fluid repellent surgical mask with or without eye protection as determined by the individual staff member for that episode of care

MASKS:• Direct patient/resident care or assessing an individual within 2 metres (regardless of

symptoms)–single or sessional use*• Direct care or visit to any individuals in the extremely vulnerable group or where a

member of the household is within the extremely vulnerable group undergoing shielding – single use Working in reception/communal area and unable to maintain 2 metres social distance - sessional use*

• Surgical mask can be used except for direct hands-on care of any resident or if less than 2m from a resident who is coughing, where sessional use of a fluid resistant surgical mask (type IIR mask) must be used

APRONS and GLOVES :• Direct patient/resident care regardless of whether they have symptoms.• Cleaning• These must be single use.

EYE GOGGLES / VISORS • Direct patient/resident care or assessing an individual (within 2 metres) where there is

risk of droplets or secretions from the client’s mouth, nose, lungs or from body fluids reaching the eyes – risk assess sessional use*

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Key infection control messages

Handwashing:• Soap and warm water removes virus and other infectious agents and is the most effective method of

preventing spread• Alcohol gel (>60% alcohol) can also be used – must let it dry• Wash hands as often as possible and definitely before and after client contact; after sneezing /

coughing; before / after food preparation / serving; after toileting

Social distancing – 2+ metres:• Prevents droplets from coughs / sneezes from reaching others

Shielding:• Protect those who are extremely vulnerable by keeping them in a safe (home) environment• Note PPE requirements when supporting someone who is shielding – minimise transmission

Work clothes – what to wear?:• Wear your normal work clothes or uniform• These should be cleaned (laundered) after every shift• Incorporate ‘bare below the elbows’ practices if involved in personal care with clients (preferably no

watches, only a single wedding band and keep nails short / no long false nails)

Laundry (including washing work clothes):• Laundry can be washed (even if worn by someone who is COVID positive)• Do not shake dirty laundry – this can release virus in to the air• Wash clothes normally as per manufacturers instructions and to the highest temperature this allows• Heavily soiled clothes e.g. those contaminated with vomit, diarrhoea or those that cannot be washed

should be disposed of with permissions from the client by double bagging method (see waste management)

• Wash hands afterwards, even if you used PPE

General cleaning:• Wherever possible wear disposable or washing up gloves and aprons for cleaning. These should be

discarded after use following the doubling bagging waste management procedures.• Using a disposable cloth, first clean hard surfaces with warm, soapy water, then disinfect these

surfaces with your usual cleaning products• Pay particular attention to frequently touched areas – bathrooms, grab-rails in corridors and stairwells

and door handles• The amount of virus living on surfaces reduces significantly after 72 hours – if an area can be kept

closed and secure, wait until this time has passed before cleaning• If an areas has been heavily contaminated, such as visible bodily fluids, consider using protection for

the eyes, mouth and nose as well as gloves and apron

Waste management:• Personal waste from possible or confirmed COVID cases (e.g. used tissues, other items soiled with

bodily fluids should be put into a plastic rubbish bag and tied when full, then placed in a second bin bag and tied

• The same should be done with used PPE and disposable cleaning cloths, cleaning gloves, heavily soiled clothes etc.

• The bags should then be placed in a suitable secure place, marked appropriately (noting the date / time) and stored there for at least 72 hours, or until test results re known

• If the individual is tested and results are negative the wastes can be put in the normal waste straight away

• If the individual is tested and results are positive, then continue to store for at least 72 hours before putting in the normal waste

Questions?

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Acknowledgements•All staff working in the London Health Protection Teams particularly Dr B Patel

•North West London Collaborative Clinical Commissioning Group

•Karen Shaw – DIPC – UCLH London

•Based on a webinar training model developed by PHE London, including

presentation preparation, delivery, Q&A forum and evaluation. The PHE London

webinar training team are Sarah Lang, Bharat Patel, Youssof Oskrochi, Karen

Hawker and Rebecca Cordery

• Icons from the thenounproject used under the creative commons license.

36PHE London – coronavirus and care homes