Acute respiratory infection (potential or confirmed COVID-19 or Influenza)

NOTE: facilities should institute active surveillance for symptoms / signs to facilitate early detection
Consider COVID-19 or influenza if there is recent or new onset of:

A. Clinical features:

1. Acute respiratory symptoms – including new or worsening shortness of breath or cough (dry or productive), sore throat, runny nose or nasal congestion, increased respiratory rate or drop in oxygen saturation
2. Fever >/=37.5 degrees Celsius or history of fever including night sweats or chills, can occur, however fever is less common in older persons
3. Older people may also present with atypical symptoms - these may include:
   • Nausea, vomiting, diarrhoea, loss of smell, loss of taste or acute loss of appetite
   • Increased confusion or delirium or change in baseline behaviour
   • Falls
   • New fatigue, headache, myalgia (muscle aches), arthralgia (joint pain)
   • Worsening of chronic disease of lungs

B. Close contact of a confirmed COVID-19 case: refer to National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Care Facilities

1. Use appropriate personal protective equipment (PPE) when caring for residents with potential or confirmed respiratory infection: see Queensland Health Pandemic Response Guidance Personal Protective Equipment (PPE) in Residential Aged Care and Disability accommodation services for specific advice on PPE in the RACF setting
   NOTE: all staff should be trained and deemed competent in the proper use of PPE including donning and doffing procedures; RACF clinical staff should further receive training in collection of nasopharyngeal swabs in regions where timely access to pathology providers is not available. Follow National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Care Facilities
2. Isolate resident with potential infection in a room with the ability to close the door and with a separate toilet, where they should remain and have meals delivered until the test result is known. Where a single room is not available - follow National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Care Facilities
3. Place standard and transmission-based precaution signs, PPE and alcohol-based hand rub (ABHR) outside the  residents room making it easy to perform hand hygiene, along with a hands free waste receptacle for immediate waste disposal
4. Ensure all hand wash areas have adequate amounts of liquid hand soap, disposable paper towels and a hands free waste receptacle for immediate waste disposal. ABHR products should also be placed throughout the facility for staff, residents and visitors to perform hand hygiene. Using hand hygiene signage around the facility may assist with educating anyone entering the facility on the importance of clean hands
5. Implement enhanced environmental cleaning and disinfection of the resident’s environment and all shared equipment (for example monitors, BP cuffs, thermometers, glucometers) - clean frequently with neutral detergent followed by a disinfection solution or use detergent and disinfectant impregnated wipes (TGA-registered hospital grade disinfectant). More information on environmental cleaning and disinfection principles is available in Environmental cleaning and disinfection principles for COVID-19 and in Australian Guidelines for the Prevention and Control of Infection in Healthcare.
   It is imperative to ensure that resident environments are frequently cleaned, decluttered and that particular attention is paid to appropriate cleaning of soft furnishings and appropriate waste management
6. Respiratory hygiene and cough etiquette - encourage residents to cover their nose and mouth with the elbow when they cough or sneeze or use tissues and dispose of them into a rubbish bin and perform hand hygiene
7. Monitor staff and ALL residents for symptoms of fever or acute respiratory infection - refer to national guidelines in relation to staff management if symptoms or exposures National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Care Facilities
8. Comply with Commonwealth and State directions and advice
9. Communicate clearly and frequently (particularly as changes arise during outbreak) with the resident and / or the resident’s substitute health decision maker including:
   • The symptom and signs of concern
   • The immediate required response
   • A senior clinician (RACF clinical manager / GP) should undertake shared decision making with the resident and / or their substitute health decision maker to determine the planned course of action including testing and required infection control procedures including isolation and use of PPE by staff and the proposed site of care (based on clinical need / stability, resident’s goals of care and ability to achieve effective isolation
   • Communicate and update predicted time-line to receiving results and the likely management in the event of either a positive or negative result
   • Communicate results of testing and together with the resident plan the ongoing course of management
10. Where residents are isolated in the RACF, there is increased risk of psychological distress and physical deterioration - ensure that there is attention to:
    • Increased access to usual primary care provider and frequent review by RACF clinical staff
    • Continuity of support of family and care providers - facilitate phone calls or use of technologies such as video-conferencing to allow ongoing support throughout all phases of pandemic response, and visiting windows where clinically feasible
    • Allow access to usual primary care provider and frequent review by RACF clinical staff
    • Enable use of technology (e.g. videoconferencing) where appropriate and only allow staff trained in correct use of PPE to enter the room
    • Ensure regular communication with resident and families to update on current situation and provide cultural, emotional and spiritual support; where indicated ensure an interpreter is used - the Older Persons Advocacy Network (OPAN) offers guidance and assistance for providers in communicating with both residents and families during an outbreak. For further information, refer to National COVID-19 Residential Aged Care Emergency Communication guide
    • Provision of cognition appropriate activities
    • Maintenance of oral intake and addressing of nutritional needs
    • Delirium prevention strategies including orientation prompts (verbal or signed), particularly where changes to environment are required
    • Prevention of falls and maintenance of mobility
    • Continuity of disability support services, where relevant

1. Notify GP, resident and substitute health decision maker of results of tests
2. Continue to isolate and use standard and transmission based precautions - for residents with PCR positive for COVID-19 or influenza, continue isolation until, in consultation with Public Health Unit resident meets criteria for release from isolation. For residents who test negative to COVID-19 and influenza, continue isolation until all symptoms and fever have resolved
3. Monitor for complications of febrile illness and seek review by GP at any time if condition worsens or fails to resolve or at 24 hours after resolution of symptoms; contact HHS RaSS for additional support at GP discretion
4. With GP and resident or substitute health decision maker, review and document goals of care and update / confirm Advance Care Plan
5. If resident tests positive for COVID-19:
   1. Continue appropriate infection control and refer to National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Care Facilities
   2. Where positive result is a rapid antigen test (RAT), register result here
   3. For all positive COVID-19 results (PCR or RAT), notify:
      1. Public Health Unit
      2. Commonwealth Department of Health via the COVID-19 Support Portal accessible via My Aged Care service provider portal
   4. GP to assess resident diagnosed with COVID-19, guided by QH COVID-19 treatment guidelines for mild-moderate disease (adults), for illness severity, risk for deterioration and indications for:
      1. Disease-modifying treatments including antiviral therapy - ensure each resident is assessed for eligibility for antiviral therapies and other disease-modifying therapies
      2. Symptomatic and supportive treatments
      3. Antibiotics where secondary bacterial infection is suspected
6. If tests positive for influenza A or B:
   1. GP to assess resident diagnosed with influenza for illness severity, risk for deterioration and indications for:
      1. Antiviral therapy - Where not commenced on syndromic grounds, GP to consider commencement of oseltamivir
      2. Symptomatic and supportive treatments
      3. Antibiotics where secondary bacterial infection is suspected
   2. Notify Public Health Unit who will consider the use of oseltamivir for post-exposure prophylaxis in an outbreak setting and will co-ordinate the response with the RACF and GP

Note: Co-infection with COVID-19 and influenza is uncommon - management should be guided by Public Health Unit. Where additional support required, at GP discretion refer to HHS RaSS

1. Communicable Diseases Network of Australia. CDNA National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection in Residential Care Facilities 2022. version 1.0. https://www.health.gov.au/resources/publications/national-guidelines-fortheprevention-control-and-public-health-management-of-outbreaks-of-acute-espiratory-infectionincludingcovid-19-and-influenza-in-residential-care-facilities
2. Public Health Laboratory Network (PHLN) guidance on laboratory testing for SARS-CoV-2 (the virus
   that causes COVID-19). 2022. version 2.2 accessed 16/02/2022.
3. Australian Government Department of Health. First 24 hours - managing COVID-19 in a residential
   aged care facility. 2022. https://www.health.gov.au/sites/default/files/documents/2022/02/first-24-hoursmanaging-covid-19-in-a-residential-aged-care-facility-first-24-hours-managing-covid-19-in-a-residentialaged-care-facility_0.pdf accessed 16/02/2022.
4. Burkett E, Carpenter CR, Hullick C, Arendts G, Ouslander JG. It’s time: Delivering optimal emergency care of residents of aged care facilities in the era of COVID-19. Emerg Med Australas. 2021;33(1):131-7.
5. Graham NSN, Junghans C, Downes R, Sendall C, Lai H, McKirdy A, et al. SARS-CoV-2 infection, clinical features and outcome of COVID-19 in United Kingdom nursing homes. J Infect.2020;81(3):411-9.
6. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARSCoV-2
   Infections and Transmission in a Skilled Nursing Facility. N Engl J Med. 2020;382(22):2081-90.
7. Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility - King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):377-81.
8. Kittang BR, Hofacker SV, Solheim SP, Kruger K, Loland KK, Jansen K. Outbreak of COVID-19 at three
   nursing homes in Bergen. Tidsskr Nor Laegeforen. 2020;140(11).
9. Stall NM, Farquharson C, Fan-Lun C, Wiesenfeld L, Loftus CA, Kain D, et al. A Hospital Partnership with a Nursing Home Experiencing a COVID-19 Outbreak: Description of a Multiphase Emergency Response in Toronto Canada. J Am Geriatr Soc. 2020;68(7):1376-81.
10. Infection Control Expert Group. Coronavirus (COVID-19) guidelines for infection prevention and
    control in residential care facilities. 16/06/2021. https://www.health.gov.au/resources/publications/
    coronaviruscovid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities accessed 16/02/2021