 So coronavirus and COVID-19, probably all well known to you now, are that coronavirus is a large family of viruses that cause infections ranging from the common cold to severe acute respiratory syndrome and it's now over a year since the first reports of this new coronavirus came through from China, later named as SARS-CoV-2. That's the virus name and that's the virus that causes COVID-19. As a new virus or a novel virus, SARS-CoV-2 has spread widely because of the lack of immunity in the population and this means that everybody in the population across the world is susceptible and of course we've seen how it's spread widely over this last year and it is now over a year since those first cases were found and we're now dealing with the new variants and viruses as described. The symptoms again, we're probably now very familiar with the key symptoms and they remain the triad of a new continuous cough, high temperature and loss or change in your normal sense of taste or smell, which is a nausea. There are of course other symptoms that people report but the most common symptoms remain these triad of key symptoms. Most people develop the symptoms within five to eleven days of exposure and the symptoms usually last for about five to six days but this phenomenon of deterioration after day seven is certainly a well-known issue and a number of people are admitted to hospital in that second week of symptoms. Presentation may be atypical in the elderly and of course asymptomatic or porcy symptomatic disease is also recognised. So spread of COVID-19, this remains similar to the spread that we're familiar with with other respiratory diseases so it's mainly through respiratory droplets, coughing, sneezing, spread diseases and contact with respiratory secretions so when those respiratory droplets settle out onto surfaces then hands can become contaminated and touching surfaces and then contaminating yourself is a key issue. Aerosol generating procedures is the term that we use for those procedures where aerosols smaller particles are generated which are more effective at spreading the virus with the particles remaining in the air for longer and spreading a wider distance than the two metres and aerosol generating procedures include intubation and those sorts of procedures and there is a list in the IPNC guidance of those procedures. The new variants of virus are more transmissible but to date the mode of spread has not deemed to have changed so they're just more effective at transmitting on to second or third cases rather than it being a change in the mode of spread so respiratory droplets remains the main mode of spread. Very quickly because conscious of time the guidance that you need to refer to in relation to care homes is through the Welsh Government website there on the right and we also have care home guidance linked from the Welsh Government site and also on our own site in Public Health Wales and we have a PHW advisory note on the use of PPE in social care settings available through our main Public Health Wales website for COVID under the information for healthcare professionals in the bottom blue square there and this is the document that you can find in that way. Current UK COVID-19 IPNC guidance as I say Gail and I sit on the UK IPNC cell group and this latest update was published on the 21st of January and is now addressing the need to maintain services within health and care settings as we move into this further phase of the pandemic and this guidance reinforces all the practices and did take into consideration the new evidence on the new variants etc. So that's a very quick run through of the key guidance on COVID all is underpinned by IPNC evidence base and in Wales we've adopted the National Infection Prevention and Control Manual from Scotland which is to be adopted across the UK in due course and you can find that manual at the link there and from our website. So as you heard at the beginning the IPNC checklist template is out and part of the reason why we've put this webinar together to support you with the key elements that are picked up in that IPNC template so you can see here the first page of the template and then the list of the key elements which start with standard infection prevention and control measures at which point I'm hoping that Amanda Daniel is on the call and that she will be able to pick up the next part of the presentation. This is Amanda Daniel who's the community IPNC lead nurse for HAARP. Amanda are you there? Yeah I am I'm sorry I dropped out so I've just thank you very much Ellery and hello everybody. So I'm going to talk to you about standard infection prevention and control precautions and these are basic measures basic interventions to prevent transmission infection and that includes the use of PPE which I think believe Gail is going to talk in a bit more detail about different scenarios and different types of PPE used at different levels. So in order to reduce exposure and transmission we have to look at ways that we can intervene so included in that is cough etiquette to reduce exposure what about contamination of hands when we can look at hand hygiene also to reduce exposure identifying symptomatic residents and isolating them but also decontamination of the environment so cleaning is a really important source of reducing environmental contamination. So when should infection control precautions be implemented well they should apply in all settings for all staff for all residents where there's a risk of contact with body blood and body fluids and sometimes we know that residents will have an infection at other times we won't so these precautions will apply in in all situations. Now the main interventions to prevent and reduce transmission of coronavirus as we all know includes distancing and this should be measures that are implemented within the care home for everybody so we need to be able to keep at least two metres apart unless you're providing direct care and that involves having a conversation this might also involve during break times the other thing we can do is wash our hands frequently so hand hygiene for at least 20 seconds and you can use either soap and water or alcohol based hand rub and that's generally before and after contact with residents. PPE is also going to be effective measure to prevent transmission but also know this can be difficult and challenging but for staff to report any symptoms or if they are significant contacts of anyone who is confirmed a case. So in order to reduce exposure for coughs and sneezes what we do will catch it but it kill it so the use of single use tissues to be encouraged when sneezing or coughing touching your nose and those to be disposed of promptly afterwards preferably in a closed foot operated waste bin just to avoid touching and contamination of others. After that you should clean your hands with soap and water or use alcohol based hand gel or if you have had any contact with respiratory secretions or contaminated objects so that includes frequently touched surfaces and door handles light switches these kinds of things decontaminate your hands afterwards and the portal of entry is our mucus membrane so we want to avoid touching our eyes mouth and nose and also to give assistance to our residents so that they contain their respiratory secretions so making sure it's always accessible for the hand to have tissues and hand wipes. So we've got two types of hand hygiene that we can use we can either use soap and water liquid soap the type of soap is not important it's really about the technique to ensure that your whole hand has been decontaminated and you can use both types interchangeably what we would say is though if your hands are visibly dirty or there's an outbreak of diarrhea and vomiting you should wash your hands with soap and water but all time other times you can use alcohol gel which contains at least 70% alcohol and that will be effective against the virus. We know that hand hygiene is a single most important measure in reducing the spread of infection and just to note please don't use sinks that you might be using to dispose of other bodily fluids that's really important so top tips for good hand hygiene include making sure in order to wash your hands that you are clear or bare below the elbows so if you've got long sleeves please roll them up if you're wearing watches and bracelets remove them or you can roll up move up any bracelets a wall for religious measures try and avoid any rings that have gems because they tend to harbour organisms and germs likewise long nails chip nails false nails will also harbour organisms underneath the nail and you can't effectively wash them and also we've got bacteria on our skin so please cover cuts and abrasions and use the waterproof dressing and also we want to protect our hands so having amoliants that aren't shared to protect your skin afterwards and just to remind of the five moments the WHO five moments for hand hygiene very good if you want to have posters to remind people when to wash the hands so generally before and after contact with a resident before and after contact with any bodily fluids and when you leave the the resident area or any contact with residents belongings or bed tables that kind of thing just remember to decontaminate your hands so our two modes are include soap and water so you can find how to wash your hands on various videos there's a link there so make sure that you run your hands under warm water that's really for for comfort and to prevent damage to your hands run you run your hands under a tap first then add your liquid soap and then the rest of the steps are about technique to ensure that your whole hand has been decontaminated so frequently missed areas of the palms the tips of the fingers the where the where the hands interlock thumb areas and wrist areas so you take a lot by about 20 seconds and you can sing your favorite tune I understand at the minute it's I will survive by gloria gainer so you can use that to ensure that you're taking the the right amount of time and to dry your hands it's really important that your hands are not wet because they can also harbor germs so paper towels and then try not to recontaminate your hands by using your elbows to turn off taps or using a paper towel so it's exactly the same with hand gel the amount of gel you know you cut your cut the hand gel into the your hands and the amount will depend on how big your hands are but enough to cover the entire surface of your hand and again using the entire using the techniques described here to make sure all parts of your hands are decontaminated again that's 20 to 30 seconds what about residents well they should be encouraged as well to clean the hands after coughing sneezing before eating after going to the toilet and making sure they're available because people are much more able to to decontaminate the hands if they've got wipes that are accessible and that includes visitors as well so when they are able to visit making sure they're available when they enter when they leave the setting and in between also so I think that's that's my section moving on to PPE now and I think Gail's going to take over so thanks a lot for listening thanks Amanda and Gail are you there yes good afternoon everybody I'm Gail Lusardi consultant nurse as part of the harp team involved in healthcare associated infection I'm just going to pick up on specific PPE in relation to COVID-19 PPE forms part of standard infection controlled precautions as Amanda's already outlined but to address the transmission route specifically of this organism there is specific PPE that needs to be worn so in line with the UK IPNC guidance and this this information is contained on the advisory note on public health Wales website for direct resident care within two metres there's a requirement to wear single use gloves single use aprons a fluid repellent surgical mask and eye protection if you're looking after somebody suspected unknown of being infected with COVID-19 and as you will see as you go down the line when performing a task when you're not in direct contact you've got surgical face mask and eye protection if there's a risk of splash and if you're just circulating in the home and not having any contact not within two metres then the surgical mask is still required so one of the key items to prevent infection to your cells is the surgical fluid repellent face mask and we'll go on to describe some of the elements as we go on along now so it's it's it's good to have good PPE but unless it's worn correctly unless it's changed at the right time unless it's accompanied by the other standard infection control precautions is not going to be protective of of you or your residents and I've just put down there that you you have to make sure that everybody is trained to put on which is called donning and to remove which is called doffing the PPE you know correctly otherwise you risk contaminating yourself or your residents in the use of PPE and as outline PPE is just one element of the hierarchy of controls for IPNC just to note that while you've got PPE on you have to be aware of what you might be touching so you're all very familiar walking around with the phones in our pockets et cetera but you really should not be touching anything once you've got your PPE on which isn't related to the tasks that you're performing and we have got some guidance on mobile devices and how to clean and what on the good practice points which you can also find on our website so a little thing about gloves okay they are single use they need to be changed after different tasks with the same patient so the example's given you helping somebody to toilet and mouth care well one is is more or less a clean procedure the other one is more or less a dirty procedure so you need to be changing your gloves and your aprons between different tasks with each patient and between patients as well so always remove your gloves and wash hands after handling body fluids always wash your hands or use alcohol gel after removing your PPE gloves are like nice warm moist environments that bacteria and viruses can multiply quite quickly in there and just to say that it is not acceptable to be using alcohol gel on top of gloves it actually changes the properties of them and can allow organisms to go through the product so it's about changing them and hand hygiene each time you really need to be careful not to touch your nose and your face once you've got your gloves on because they will be contaminated and so if you touch those key areas nose mouth face then you are risking contaminating yourself disposable plastic age prints are intended to just cover that area of your uniform which is most likely to become contaminated in the UK we have always advocated bare below the elbow because it's it's very effective to wash up to your forearms to remove any contamination rather than wearing additional a PPE on top of that so wear your apron for contact with your resident for providing care and again change after each task and with after each patient okay so we come to masks so there's a lot of discussion in the media about what is a surgical mask what is what is a face covering the fluid repellent surgical mask has got a fluid repellent layer within them to stop the droplets soaking through and they also offer some filter capacity as well to the air that you're actually breathing in so FRSM masks are intended as PPE to protect you as the worker whereas face coverings are intended to protect others around you in case you are actually infected so that's why members of the public are expected to wear face coverings in public places you are expected to wear a fluid repellent surgical mask as PPE to protect yourself from the risks of COVID-19 so you can wear your mask sessionally and we'll bring up a description of that but once your mask is on you need to make sure it's worn correctly and what we see is on the news lots of pictures of staff in care homes in acute settings and also remember the public wearing their masks incorrectly so with it you know down below their nose with it not fitting correctly around the neck with it being drawn down being hanging off one year any of those incorrect placements of the mask are going to put you at significant risk so you know you see people pulling the mask down to talk to their colleagues well you're removing your protection every time you do that if you touch your mask to readjust it um then your hands are going to get contaminated whatever's on the outside of the mask if you do have to touch your mask you need to make sure that you are uh cleaning your hands once again and when you put your mask on you need to make sure that it's fitting correctly so that it's ready to go and you won't have to keep adjusting it so if you have a small face and it is it's keep sliding you need to make adjustments and there are ways of doing that by tying the loops at the side or twisting the loops and there are devices that can stretch between the loops to get you a better fit but it's important that you fit it correctly in the first place eye protection um most of you will either be using safety goggles or be using visors and these are mainly supplied as single use and they will be marked as such with a circle with a two and a cross in it uh and if you are using reusable items every time you take it off make to make sure that you are disinfecting those items thoroughly and you should not be sharing your eye protection with somebody else so um online you will find the advisory note with the guidance and so just to clarify when when providing personal care which requires you to be in direct contact with a resident then you will need to wear a fluid repellent surgical mask a disposable apron and gloves and eye protection if the patient if the resident is actually known to be positive or suspected of having covid in two metres um you would need to wear a surgical mask again no aprons and gloves required if you are outside that two metres and you're not having any contact and you will find a further guidance in the short animation link here which will show you how to don and doff your pp correctly and is specifically aimed at mk homes for you to review and there's also some very useful posters that you can use as well which shows the steps for donning and doffing to make sure that you are doing that safely and effectively. Sessional use so the only items that can be used sessionally are your mask and your eye protection okay the other items as described aprons and gloves must be single use only single patient single resident use only so as you will see from the the bottom to the items that can be used on session a bit of the ones that protect the health care worker from the resident and we talked about that being PPE and the items that protect both resident and the health care worker can cannot be used in this way so gloves and aprons have to be changed so a session might include a couple of hours while you're caring for a patient helping the wash helping them address um it might be before you go to break uh and but if you do then have to go on your break if to go to a different area of the home then you need to change your PPE okay so there's some do's and don'ts there um and just to say that before you actually don your PPE just make sure that you're ready to wear it for a period of time so you may want to take a comfort and break have you had enough to eat before you start your shift and put your PPE on so that um you don't have to keep going back and changing those items on a regular basis um and just to say with masks after after wearing for about two hours you'll usually find that they become quite moist on the inside then that will prompt you to go in and change change them okay so if they do get splashed or sprayed if they do get very moist then you do need to go and replace your PPE take extra care when removing and it's a good idea to if you're practising on donning and doffing is to get one of your colleagues as a buddy and uh after looking at some of the videos and the posters etc you can review each other's practice and pick up the good points and the bad points and it's still a good idea in practice if you see one of your colleagues is not wearing their PPE correctly there should be an open and honest culture the way you can challenge each other so that you are all because everybody's human and we all make mistakes um and you know lapses of of concentration etc so if you've got somebody there who's watching you and supporting you and they and you are watching them is is much more likely that the PPE will be worn correctly so there will be some residents that you will be looking after will require aerosol generating procedures so this is a procedure which is usually involved in the lower part of the respiratory tract which will generate aerosols or tiny particles which are more of a risk for inhalation and can actually more or less contaminate the area around the room the air around that person and for this we will require additional PPE so be a long sleeve gown um eye protection must be worn and you will need to be fit tested to wear a it should say ffp3 respirator and um that needs to be fitted correctly again donning and doffing is going to be very important so you may have patients who may be on non-invasive ventilation they may have a tracheostomy and they may be on high flow nasal oxygen will require aerosol generating procedures PPE so use a good visual guide of the levels of PPE so it's just to make sure you're wearing the correct level at the correct time and hasn't changed greatly since the beginning of phase one of the pandemic just because we've got variants it doesn't mean that we need to know step up with extra PPE because the transmission route is exactly the same so Larry I'll hand over to you thanks Gail um so hopefully that gives you an overview of the PPE and we'll just move on quickly to the admission to care and residential homes which is covered um in the ipnc checklist um but just to flag that the um admission discharge criteria has been updated since december of 2020 and the link is provided there for you and the health boards and local authorities should now be following that to try and support effective and timely admissions from health boards and care facilities into care and residential homes and between um so there's quite a useful flowchart and information within that guidance when you have admitted individuals into care homes for the first time then um you you may need to consider isolation of um residents either because they are new into the environment stepping down from um a health board or or community hospital environment or because they've developed symptoms and you're suspecting that they might be developing uh COVID-19 and isolation within a care home um means that you should be considering isolating the resident in their own room ideally with en suite facilities although commodes might be an option um or if not possible to have their own single room with en suite that you might want to dedicate a bathroom near to the person's bedroom for their identified use only or if you've got more than one case you may then have to consider uh zoning etc um the PPE has already been described and obviously um should be adhered to carefully and also be very careful in terms of um the signage to prevent a necessary entry into areas or bedrooms of the care home if you're dealing with a possible case room doors should be kept closed where possible and where it's safe to do so although obviously you know we are in the real world and we know that people may need to have the the doors open um in order to keep an overview um but then this needs to be risk assessed and considered in terms of how you manage the general area that the individual is in. When you're isolating an individual then all necessary procedures for care um and personal care should be carried out within the resident's room and PPE of all staff appropriate with appropriate area for removing that um and where possible you need to dedicate the specific equipment as well medical equipment so thermometers blood pressure cuffs etc for that resident's use only increasing the cleaning and disinfecting in the area would be important and restricting the sharing of personal devices so it's not about removing devices from the individual because obviously these can be the one mode of communicating with others but making sure that the guidance on cleaning of these devices is followed and that they're not shared with other residents so it's about trying to ensure that the the possible cases is isolated as far as possible and I'll hand back to Gail. Okay so just picking up on the decontamination theme there is specific guidance which is supported by the World Health Organization and also the UK IMP and guidance which actually states what sort of disinfectants should be used and a thousand parts per million of chlorine um is with a general detergent is recommended for removing and destroying this virus so you should only be using cleaning and detergent products which have been supplied by your employer and they need to be make sure that they are mixed accordingly and used accordingly with regards to contact time etc we are aware of a number of companies approaching care homes but also other institutions claiming all sorts of advantages of their product when in fact they don't they don't meet the biocidal regulations as required for viruses and bacteria so if you are concerned you can speak to your EHO or local health board if you are considering using an alternative to those recommended within the the UK guidance it's really important alongside standard infection control precautions and pp that the environment is decontaminated adequately as you know the virus will spread quite widely and contaminate all sorts of areas of of the home and so it's it's really important that all shared equipment is clean so there are items that maybe have to be shared between residents which making sure that they are clean between use where possible use single use or designate key bits of kit to a resident or a group of residents some things which may cause a risk such as sharing magazines and software and things which are more difficult to decontaminate so the the the the the real I think what I'm trying to say now really what we should be ensuring is that everything that we've got we can decontaminate we know guidance came out a year ago about the role of fans in circulating air which potentially can actually spread infection as well so it's it's having control of those and risk assessing if you do need to use them last year with a very hot summer we're now in the winter if we're still in the position we are we're in last year and the weather gets hot again we may need to revisit the risk assessment around any additional ventilation or circulation of air so additional procedures for cleaning rooms you know we need to make sure that the staff that we're doing the cleaning etc are trained in the appropriate use of pp and standard infection control precautions if you've got a mix of residents who are positive and negative to covid then you should always prioritise doing the the areas which are have negative residents then doing the clean rooms of residents of residents who are covid positive last using disposable clothes and mop heads unless you've got good systems in place to lawn down mop heads etc in line with the health technical memorandum on decontamination of linen laundry and cleaning equipment so it should be routinely cleaning order from high points to low points from furthest to closest point and making sure you discard in any cleaning solution at a designated disposal point and not for instance as Amanda's raised down any point where you might be washing hands etc and remove waste and linen for disposal and reprocessing in a timely manner so under waste management there has been specific guidance released by national resource Wales on waste management in care homes namely on waste from routine care but also now from waste from lateral flow device use okay so you probably will be familiar with this so the waste that has to go into clinical waste will be that generated from those residents who are known to be covid positive and this has been issued across the whole of Wales and you should be working with your waste manager to make sure that you are adhering to this closely so if you've got PPE routine care performing meal rounds you can see some examples there then that will go into the tiger stripe or offensive waste stream also if you've got waste contaminate with blood or body fluids sort of incontinence pads et cetera stoma bags that can go into offensive waste and then lastly so where the resident is suspected or confirmed of covid then that would need to be held in a clinical waste bag and if you haven't you could need to store it securely for 72 hours if you are to then put it in the correct stream. For lateral flow devices information has been circulated on the waste from that as well so all the packaging is non-hazardous and can go to landfill and the swabs should be going ideally into a yellow sharps container but it's not hazardous waste so that would be offensive waste if you didn't have the appropriate packaging. Test cartridges is non-hazardous of the same as swabs and PPE that you use to do the sampling and the testing is also in the offensive waste stream so linen and laundry those that are suspected or confirmed of covid 19 they should be managed as infectious linen and you should have processes in place for managing infectious linen now anyway but key things it shouldn't be handled inside you know all in there should be handled inside the room of the resident you need to be putting it into a laundry receptacle rather than carrying it to a disposal point and never rinse or shake or sort any linen it needs to be put straight into a bag or receptacle for removal. So staff uniform so we get a lot of questions about the role of staff uniform you know your uniform is not PPE the PPE I've described is there to protect you but there are some good practice points about the use and wearing of uniform so changing to an out of uniform at work where possible or if if you were working out in the social care in people's homes as well we would expect it to change uniform except when you've got got home if you're transporting put it in a disposable bag which could be thrown away and just put your uniform into the into the washing machine wash on the hottest temperature for the fabric tumble and iron and dry so most just routine laundering through your own domestic washing machine will is enough more than enough to remove this virus there are other other pathogens which cause infections like Cdiff which are much more likely to be remain on your uniform than COVID-19 so we just need to make sure that you're handling your uniform as you should be anyway aside of COVID-19 so hand over to Ellary. Thank you and I'm conscious that we want time for questions so I'll run through this very quickly to finish off so resident testing a single symptomatic resident I'm sure that you all know now you should be informing the EHO or Public Health Wales and when there is a confirmed case we will move to whole home testing and a new testing strategy was released in earlier earlier this year so last month now January which you can find on that link there and I'll skip over that the sampling and so when when you're in certain circumstances in Wales our key diagnostic sample is a throat swab we use dry swab testing to go through the NHS Wales laboratories but there will you will be familiar with certain other settings where nose and throat samples are acquired because those samples go through the lighthouse laboratories so that so there will be slight differences but essentially all of these tests are validated for use for COVID-19 detection and you will come across these two systems of testing or sampling depending on where you're being sampled. Care home visiting again to flag to you that the care home guidance has been updated and the link is there for you and obviously as we've indicated you know visiting is subject to change depending on the levels of the alerts that we're at and also visitors should be complying with IPNC guidance within the care homes and then the hot topics to finish off question we get asked a lot now is that now that the vaccination programme is rolling out can we all throw our masks away which would be lovely but that isn't the advice at the moment so even though the vaccine rollout is going very well and we know that a number of the care homes now are have received their vaccines we are still working through how well the vaccination does in terms of protection and so for the moment all IPNC controls must continue to be adhered to whether or not the individual patients or visitors have been vaccinated so we're not clear yet whether the immune response differs between people how long it takes to gain immunity will vary between people and the immune responses may also vary according to the underlying risk factors that any individual may have and at the moment we're not entirely sure whether or not the vaccination will prevent transmission. Early evidence suggests it will but while we're working this through we need to be super cautious and therefore IPNC measures need to continue the other hot topic of course is the new variants of COVID-19 that have been described and there are thousands of new variants the virus is mutating and changing all the time but occasionally we get more concerned about certain variants which have acquired the ability to be more transmissible or to change particular key parts of the virus. The UK variant which was first described in London and the south east is deemed to be 50 to 70 percent more transmissible by means of this mutation. The mode of transmission as I said however has not changed therefore a spirtory droplets is still the the considered mode of transmission there is some evidence though not strong and data still uncertain with regard to increased mortality related to the new variants but at present current measures are effective in reducing spread the lockdown that we're currently in we are seeing the figures coming down and the vaccines that we have in use are effective. This week we have had lots of attention on the South Africa variant and we have a few cases in Wales which we're following up very carefully. Most are certainly so far identified as being associated with travel contacts to South Africa. Again this variant is more transmissible but current measures effective at reducing spread and the current vaccines are still believed to be effective although perhaps with some reduced protection but still effective so new variants will continue to be found and we will continue to work alongside our partners to detect these and take action as soon as needed. As I say there's many thousands of variants we expect the virus to mutate and we have got an excellent genomic program in Wales which is working with our partners and inputting data into the UK and the world on all these sequences so we are in a very good place in Wales to pick these up at an early point and to take action on them. So diolch yn fawr iawn am wrando. Thank you for listening. We're happy to take questions. Can I just say there are a few questions in the chat that I've picked up. The first one's from Helen asking can we clarify the difference between type 2 FRSM and type 2R FRSM? Yes I've picked that one up then Amanda. So they are both surgical face masks they are both type 2 that means they filter the same amount of air through them and give you the same but the difference between the FRSM which is the type 2R and the type 2 is the type 2R has that fluid repellent layer within the mask to stop droplets going through it. And there's another question from Helen which is asking could you clarify the controls that need to be in place during staff to staff interactions and the use of break areas and travelling to and from work? Well I can pick that up as well it's really important as emphasised that the social distancing is maintained throughout the home so it's not just when you're dealing with residents the staff need to maintain two metres distance even if they've between each other unless they're providing care even if they've got PPE on should avoid sharing lifts in cars because we know that has been a transmission point between staff and therefore if it's essential because there is no other way that the other member staff can get to work then there are some key things that you can do as in you need to wear a face mask so ideally the person the passenger would sit in the back the window should be kept slightly ajar and both all occupants should be wearing a fluid repellent surgical mask otherwise if there is a transmission risk you will be classed as a contact. Could I ask whether decision to retest staff after 13 weeks is to be reviewed as I'm getting half staff still testing positive weekly after having contracted COVID and then having to isolate again and change our status at the home. So didn't quite catch the time frame 13 weeks was it? Retest staff after 13 weeks is to be reviewed as I'm getting half staff still testing positive weekly after having contracted COVID. Yeah so the the time is 90 days that we recommend not retesting so that possibly does translate into 13 weeks but it's 90 days that is the deemed point at the minute. I'm not party to any particular discussions about extending that but I am aware that it does cause some difficulties so certainly will take that point away for further discussion but the 90 days was chosen because we knew that that was a point that certainly in general terms you were less likely to find a positive related to a previous positive but we are aware that particularly in with masses of asymptomatic testing going on that we are still finding after this time. When having visitors within a children's home we can't stop to meter distance but we need to use AGPs regularly how can we do this safely? I'm not quite sure with this question whether you're talking about the visitors safety or the staff I'm not quite sure clearly if you're doing AGPs and the patient or the children are deemed to be COVID-19 suspected or positive cases then the AGP requirement would be for the full PPE as per the guidance if you are in a position where you do not have COVID in the home and everybody is being regularly tested and no symptoms then the level of PPE can potentially be stepped down on a risk assessed basis and the visitors ideally would not be encouraged to visit when AGPs are being done but obviously if the AGPs are of such regularity that this is a challenge then it would be a case of risk assessing that in terms of whether or not you've got suspected cases or not at the time and I would suggest that visitors are not visiting when when you've got cases but again without knowing the absolute situation that you're in then it would you know you'd probably have to manage that on a case by case basis. Miss the information for the vaccine for the people we support when will this be starting the health boards and arrangements that way so I think you'd have to direct your question to two colleagues in your local health board. The local GPs that will be facilitating the rollout of the vaccines for residents so I would contact the GP if I was you. I did that and they've reassured me and given me some some dates. I'm the manager at Chirk Court Care Home. I wanted to ask a question about the value of the VLT fogging whether we think that that's productive to manage some of the COVID and infection control as an additional protocol. Okay shall I shall I pick at that up? I'm not exactly sure what devices you're using. You know the smoke you know where it's like a smoke a fogging VLT system. Okay so there's two issues and Health and Safety Executive have released a safety information sheet on misting and that refers to not using any misting devices for staff or visitors or anybody to walk through so there's a safety issue there and also the WHO have got some specific guidelines on what should be used for cleaning and decontamination and only last week HSC have released their latest safety bulletin with a paper on using fogging devices and if you are using them they would have to be as an adjunct to the other cleaning methods not instead of. The effectiveness of a lot of them have not been proven for COVID-19 so unless I got further information I think you should discuss it with the WHO or the local health board because as I said a number of these devices are not actually effective against COVID but we are aware of companies offering trials, pilots of them when they don't actually comply with the biocidal regulate that helps Lisa but if you want to contact us outside I can I can pick that up with you. Ted can I also ask whilst I'm on our medication rooms and I've got five dedicated medication rooms each allocated to a single household usage but we do actually use air conditioning to manage the temperatures are we advocating the use of air conditioning at the moment? The guidance is that the air conditioning can be left running as as it is and obviously you should hopefully have that regularly serviced if there's any filters in there should have been changed as per schedule so just to make sure that it is running correctly it has been serviced and maintained but otherwise you do not need to switch it off. That's fantastic thank you. I just to say there's a link to the HSE document that Gail was referring to about fogging as well in the chat. Oh that's wonderful thank you thanks very much. I just wanted to highlight as well on the cleaning is that we did issue some cleaning standards for hospitals for COVID-19 and Amanda's been working busily to make the same document available for care homes but specific to your area so we're just working on that document it gives you some better information the standard you should be trying to achieve for cleaning and hopefully you will see that in the near future. Can you confirm how we dispose of lateral flow testing equipment so after we've carried out the lateral flow test and it's negative? There is a slide in the slide set and there is specific guidelines from national resources ways on lateral flow testing so the PPE would go into the offensive waste stream the actual slide and swab would go into a yellow sharps box for disposal that's within because it's within a care setting there are different arrangements out in the community where lateral flow is being spread out for schools etc so we can share that information with you as well. Yes yeah that would be helpful and I'll pick up there because there's a related question from Kerry I'm just wondering with the lateral flow device tests I've been informed by my environmental health officer that they're actually quite unreliable so if and when we start visitors again how can we rely on the results when using on visitors so in in relation to the lateral flow device tests they in all tests diagnostic tests have a sensitivity and specificity and so you know there will always be a certain level of false positives and false negatives whatever test you do so it's not a case that the lateral flow device tests are unreliable they they just are perhaps a bit less sensitive than some of the other tests that we use but in the context of the the way they're being used they should be used as an adjunct to all your other measures in the sense that they give you added information you know you should still be ensuring that visitors have not been in contact with a case that they shouldn't be visiting if they you know have have symptoms they shouldn't be visiting if they've recently travelled from somewhere that's on a band list etc etc but that the lateral flow device test is an adjunct then to assist people with testing and so that you know they are very good a positive is very very definitely a positive and obviously a positive would mean that the individual should not be visiting and it should be used to assist with the process of feeling a bit more comfortable with visit visiting when we are allowed to to go back to that can you please send the link for disposing lateral flow testing please well we will share the slide set we're happy to do that and we're do and we've got a member of staff who's the face mask he's struggling to fit his face because it's too small is there a larger mass unfortunately there is only one universal size for an FRSM so it's it's looking to see how it's actually you can make the fit better are you saying that he's got his face yes he has a very long face a lot but he also has a beard as well okay so that's not that's not going to help the situation but it is a revisit in the training to see if you can try to get to make it a fit more closely and there are slightly different manufacturers of the FRSM masks and it may be worth trying a different manufacturer because they are slightly different shapes and sizes but it's just making sure he's got all the training points for fitting it and seeing if if you can get a different make which might be a slightly different shape and sometimes if they're not in wide supply but sometimes if they have got ties on them they are able to actually tie them much more securely but most of the supply that we've got for covid are looped yeah they're all looped yeah just to say it is something that Welsh Government and across the UK they're looking forward about as well about the face fit of the universal mask because it's not just that you know in this country it is only one size universal across the whole of the world at the moment and so those are one of the innovations they need to look out to get that good fit