This Briefing Note was completed by the Research, Analysis, and Evaluation Branch (Ministry of Health) based on information provided by members of the COVID-19 Evidence Synthesis Network. Please refer to the methods section for further information.
Purpose
This briefing note provides a summary on infection prevention and control (IPC) measures in long-term care homes (LTCHs) and Retirement Homes (RHs) following COVID-19 vaccination of residents.
*The full version of the Briefing Note including the Appendix can be accessed in the PDF file at the top of the page*
Key Findings and Implications
- Jurisdictions (Canada [Ontario, British Columbia, Prince Edward Island, Yukon], Netherlands, Republic of Ireland, the United Kingdom, and the United States [Washington State, Arizona]) report that LTCHs should have a range of protections against COVID-19 following vaccination such as:
- Continuing to follow IPC measures (i.e., masking, physical distancing, and hand washing for residents and visitors),
- Testing and screening(i.e., testing of visitors, staff, and residents where available),
- Encouraging COVID-19 vaccinations for residents and visitors; prioritizing outdoor visits over indoor visits; increasing the number of visitors per day for residents who are fully vaccinated (e.g., two instead of one), and
- Permitting communal and group dining in conjunction with public health measures (e.g., sitting six feet apart, masking unless eating).
- Guidance from the United States focuses on two factors: the quality of IPC measures in LTCHs, and the community spread in the area based on percent positivity. For example:
- Indoor visitation is permitted when there is <10% positivity in the area and >70% vaccine rate of residents in the LTCH. Fully vaccinated residents can choose to have close contact (including touch) with their visitor while wearing a well-fitting source control (i.e., mask or respirator) and performing hand-hygiene.
- Absences from LTCHs for non-medical reasons, communal dining, and social activities can occur with appropriate IPC measures (e.g., physical distancing, hand hygiene, and masking), where there is minimal to moderate community spread and >70% vaccine rate of residents.
Implications for Ontario
- In addition to routine practices for COVID-19 immunization clinics, IPC measures should be implemented in accordance to the LTCH outbreak status. Resident and staff cohorting should remain in place, including LTCH staff cohorting for those providing the vaccine to residents. As of January 18, 2021, there is no change to case, contact, and outbreak management if a new confirmed infection is identified in a previously vaccinated
Supporting Evidence
The section below describes jurisdictional experiences on IPC measures used in LTCHs and RHs following the COVID-19 vaccination of residents. In terms of jurisdictional experience, information is presented on Canada (Ontario, British Columbia, Prince Edward Island, Yukon), Netherlands, Republic of Ireland, the United Kingdom, and the United States (US) (Washington State, Arizona). No updated guidance for LTCHs or RHs following vaccinations were identified in Alberta, Israel, Manitoba, New Brunswick, Northern Ireland, Northwest Territories, Nova Scotia, Nunavut, Quebec, Saskatchewan, Wales, or Wyoming. Most guidance was identified on LTCHs and not all jurisdictions reported guidance specifically for post-COVID-19 vaccination.
International Scan
Allowances of Visitors
- The following are IPC changes permitting visitation in LTCHs: active screening and testing for residents, staff, and visitors (WHO; US: Center for Disease Control and Prevention [CDC], Arizona; Scotland); practicing IPC measures (PPE, physical distancing, hand hygiene) (WHO; US: Centers for Medicare & Medicaid Services [CMS], Arizona; UK; Scotland; Republic of Ireland); using a monitoring system to verify visitors’ compliance with IPC measures (WHO); having a visiting space that is well ventilated (WHO); limiting the number of screened visitors (WHO); visitation occurring outdoors or in open space (WHO, US: CMS; UK); permitting indoor visits if COVID-19 risk is low (US, CMS; US, CDC); not permitting indoor visitation until residents have been fully vaccinated (US: CDC, Washington); and specifying an identified number of visitors (i.e., Netherlands: two visitors per day and expanded bubble; Scotland: two visits per week; Republic of Ireland: increasing the duration of visit).
Congregate Dining and Social Activities
- The following are IPC changes permitting congregate dining and social activities in LTCHs: group activities carried out using virtual/video modalities (WHO); social activities undertaken outdoors (WHO; UK); dining and meals staggered to ensure physical distancing (WHO); residents dining in their rooms (WHO); and adhering to IPC measures (PPE, physical distancing, hand hygiene) (US: CMS, CDC, Washington).
Absences From the Home
The following are IPC changes permitting residents to leave their LTCHs: absence permitted if a resident does not have suspected or confirmed SARS-CoV-2 (US, CDC); IPC measures should be followed when off the LTCH grounds (PPE, physical distancing, hand hygiene) (US: CDC; Scotland); if fully vaccinated, residents do not have to quarantine when they leave and return to the LTCH (US, Washington; Republic of Ireland); avoiding public indoor spaces (Scotland); and residents being advised against leaving their home if unvaccinated (Republic of Ireland).
Other Relevant Recommendations
- Facilities should continue to regularly vaccinate new admissions (US, CDC).
Canadian Scan
Allowances of Visitors
- The following are IPC changes permitting visitation in LTCHs: active screening and testing for residents, staff, and visitors at every visit (Canada; British Columbia; Yukon); practicing IPC measures (PPE, physical distancing, hand hygiene); limiting movement within LTCHs (Canada; Yukon); removing visitors from LTCHS if non- compliance with IPC measures is identified (Canada); limiting the number of screened visitors (British Columbia); and implementing visitor management systems (i.e., scheduled visits, predetermined visit locations in LTCHs) (British Columbia; Prince Edward Island; Yukon).
Congregate Dining and Social Activities
- The following are IPC changes permitting congregate dining and social activities in LTCHs: residents remaining in their room the during visits and social activities (Yukon).
Absences From the Home
- The following are IPC changes permitting residents to leave their LTCHs: movement or transfer within and between facilities of residents who are suspected to be infectious (Canada); residents permitted to travel only in the company of caregivers, or for exceptional circumstances (Prince Edward Island); and residents not leaving the LTCH unless necessary (Yukon).
Ontario Scan
Allowances of Visitors
- In addition to routine practices for COVID-19 immunization clinics, the Ministry of Health recommends that IPC practices be implemented in accordance to the LTCH outbreak status. Resident and staff cohorting should remain in place, including LTCH staff cohorting those providing the vaccine to residents. As of January 18, 2021, there is no change to case, contact, and outbreak management if a new confirmed infection is identified in a previously vaccinated individual. There is also no change to contact management if a contact has been vaccinated.
Methods
The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following member of the Network provided evidence that was used to develop this Evidence Synthesis Briefing Note:
- Ontario Health (Quality). (April 1, 2021). Infection Control and Public Health Measures in Long- Term Care and Retirement Homes Following COVID-19 Vaccination of Residents: A Jurisdictional Scan.