Rates of infectious diseases are seriously high as seasonal influenza burdens many with its annual wicked swoop and the prevalence of ongoing symptoms of Covid-19 continue. Infections such as Group A Streptococcus and scarlet fever continue an ‘out of season’ increase – the latest data from the UK Health Security Agency (UKHSA) shows cases are higher than in a typical year. The rates of these types of infections are expected to rise even higher: children returning to school and social contact reengaging for many following the holiday period will increase the risk of transmission.
Well, when it comes to severe respiratory infections we certainly learnt the type of response promoted by the World Health Organisation (WHO). Despite significant strain on our marvellous NHS service the government has not announced any UK national restrictions to tackle the surge of infectious diseases, but this isn’t surprising given the cost of living crisis.
While there are no publicised restrictions at this time, we know that the government continues to work closely with UKHSA and constantly monitors data in order to determine if any action is necessary to manage these outbreaks.
New data and publications were released on the GOV.UK website on 5 January 2023. Publications included the first of 52 national Influenza and Covid-19 surveillance reports from UKHSA, which will continually survey the national statistics and issue reports on a weekly basis.
The UKHSA reports include a section on community surveillance which collates data on suspected outbreaks of acute respiratory infections in different settings. These are referred to as ‘incidents’. Incidents are reported to UKHSA health protection teams (HPT) which investigate the outbreaks further in liaison with their local partners.
The first report for 2023 delivers data collected for week 52 of the previous year (last week of December 2022). It showed that 458 new incidents were reported throughout the UK (excluding Wales) and 315 of those incidents were from care homes. Granted, the education sector statistics were ‘nil’ as schools were closed; however, care homes not only produced the highest infection rates, but of course the majority of occupants are the most vulnerable people.
Respiratory infection outbreaks in care homes are extremely detrimental for so many reasons; some of the many effects on care home residents include:
If any contagious respiratory infection outbreak occurs in a care home, chances are it will spread quickly so more stringent infection control is paramount. Care home managers should be aware of infections within the home, should follow their local HPT protocols and also make staff and visitors aware.
Care home workforces should refer to guidance provided by the CQC for infections prevention and control in care homes (last updated June 2022), and implement such guidance effectively, reporting outbreaks to their HPT liaison. Care home managers can also keep up to date via the weekly GOV.UK surveillance reports.
If staff are unsure or have concerns in respect of residents’ symptoms out of usual GP hours we recommend consulting NHS 111 unless considered an emergency in which case of course dial 999.
Residents who are subjected to an infection such as flu will possibly need intravenous antibiotics. However, care homes should liaise with the appropriate health care professionals when identifying the treatment required as Ambulance and A&E facilities are experiencing severe delays.
According to The Guardian this week, a senior healthcare official said that as many as 500 people could be dying each week due to the delays in emergency care with December 2022 seeing the highest-ever hospital occupancy levels, so it is vital that appropriate intervention is sought.
Residents who are hospitalised for whatever reason are likely to experience significant delays in their treatment and during that time may be subjected to further risks, compromised care and/or even neglect. Therefore, we urge that care homes make sure that communication is maintained between the home and the resident/hospital if they are unaccompanied by a carer or relative and detailed logs are kept of any updates.
Safeguarding referrals are foreseeable in many cases which may occur during these times. Care homes should understand the importance in making sure paperwork is properly updated to provide as much precise information as possible. Such information will enable a timeline which will identify when the home’s duty of care ceased in the event and what condition the resident was in up until that time.
As an example of why this is so important, the following case study has been created for context:
On 15/12/22, Mrs Keogh (who has mental capacity, but some mobility limitations) had an unwitnessed fall at around 8am when reaching for her walking frame. Registered Nurse/First aider Mr A checked her over and suspected a closed fracture to her right wrist but noted no complaints of pain elsewhere. Paramedics were called at 08:10 and arrived at 08:47. They agreed the suspected injury was to the right wrist only and said Mrs Keogh would need to be transferred to hospital. The home was experiencing an outbreak of flu and with lower staffing levels than usual and so many unwell residents, it wasn’t possible for a carer to accompany Mrs Keogh to the hospital. Her next of kin was notified and agreed to meet her at the hospital. Care home manager Miss B called the hospital for an update at 11:30 and was told Mrs Keogh had yet to be assessed by a doctor and was still in the waiting room. At 16:00 the home called the hospital again to be told she had still not been assessed, but had unfortunately suffered a further fall while in the waiting room. The injury sustained in the subsequent fall was yet to be established, but the hospital reported she had complained of pain to her neck. Fourteen hours after Mrs Keogh’s transfer to hospital the home received a call from a doctor to share Mrs Keogh’s CT scan results. The report showed a closed fracture to her right wrist and a fracture to her cervical spine: due to her comorbidities neither injury qualified her for surgery. After a period of hospitalisation the home was informed that Mrs Keogh had passed away due to complications: following the fracture to her cervical spine she had sustained a respiratory infection due to bed rest and rapidly declined. A safeguarding enquiry was opened with the CQC investigating and the Coroners Court opening an inquest.
Cases like this example stress why infection prevention control, staffing levels and proper housekeeping of resident’s records are fundamental in any complaint, safeguarding enquiry, CQC investigation, and, more importantly, in order to avoid a Prevention of Future Death Report being issued by a coroner. Where a home falls below expected standard in any of the above it becomes difficult to protect the care home’s interests and a civil liability claim is more likely to arise.
We appreciate care home resources are stretched but we ask that care providers continue to do their best to ensure that standards are maintained as far as reasonably possible; to not only prevent infection outbreaks, but to also continually assess other risks of harm to residents such as falls, issues with nutrition and hydration. We also remind homes to frequently check that residents’ care plans are representative of their ever-changing needs, and that staff training is up to date and well documented.
Senior care home management should contact their insurance policy providers for advice if they have any concerns which cannot be resolved by following CQC or government guidance.
Keoghs is happy to assist clients with instructions which may arise during this winter’s surge of infectious diseases and help address any concerns that may follow.
With the help of infection control we hope to see the trend of such infections continually decline and be seen out seasonally by the grace of Mother Nature.
Laurie Harper
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