All patients for admission to residential care facilities now have to be tested for Covid-19 beforehand, and to self-isolate for 14 days in the facility, under new infection control guidelines from the Health Service Executive.
The requirement, contained in the newest version of guidelines published by the HSE’s Health Protection Surveillance Centre, marks a reversal of previous policy that did not require testing for patients being moved from hospitals.
At the height of the pandemic, the requirement for testing prior to admission to residential care facilities was removed, though patients did have to self-isolate in the facilities for 14 days after transfer.
This has now been changed to a requirement for prior tests as well as 14 days of self-isolation in a single room after transfer to a residential care facility.
It is “essential” residential care facilities put in place clear processes to facilitate the return of residents from hospitals and to admit new resident “where it is clinically safe to do so”, a newly added appendix to the HPSC guidelines states.
“It is recognised that accepting admission or transfer of residents poses a risk of introducing Covid-19 even where processes to manage the risks are in place.”
At the time testing was abandoned, the State’s testing system was coming under considerable pressure, with backlogs building up across all stages of the process amid equipment shortages and capacity constraints.
Nursing Homes Ireland, which had pressed for the re-introduction of testing, has claimed the lack of testing for transferring patients contributed to the spread of coronavirus in residential settings.
The appendix says “the key point about testing is that interpretation is not straightforward”.
A result that says “not detected” or “negative” does not prove a person is not infectious, while a result that says the virus is detected does not prove the person is still infectious.
“Experience to date indicates that a test may fail to detect the virus a significant proportion of people who have Covid-19 infection.”
A “not-detected” or “negative” test makes infection less likely “but it does not prove the person is not infected”.
Consequently, all patients for admission to residential care facilities should be tested. “This is to help identify most of those who have infection but it will not detect all of those with infection.”
Where a patient is recovering in hospital post-Covid-19, transfer back to a residential setting should be delayed, if there are no other known cases of the disease there, until they are clinically recovered and no longer infectious.
No admissions to a residential care facility where an outbreak is ongoing should take place until it is over.
Separately, the testing criteria for Covid-19 have been widened so that any person experiencing ageusia (loss of taste), dysgeusia (an altered or impaired sense of taste) or anosmia (loss of the sense of smell) is advised to seek a test.
