Novel Coronavirus COVID-19
 

Manitoba Families Townhalls with Dr. Roussin

Manitoba Group Home Sector and Manitoba Child Protection Sector


Introduction

The following questions and answers (Q&As) are provided in follow-up to webinars held on April 14 and April 15 with Dr. Roussin, Manitoba’s Chief Provincial Public Health Officer. The April 14 webinar was for residential care and group care providers in the Community Living disABILITY and Child and Family Services sectors. The April 15 webinar was for the broader CFS sector.

When reviewing the Q&As, please note that some may not apply to your particular role. For example, PPE use is different for care providers who work in home or residential settings for their entire shift than for care providers who provide in-home visits. Responses may also differ for services provided to vulnerable adults, than those provided to children.

Remember: Social distancing is not possible in many of these care situations. As such, please follow the PPE guidance that has been provided to your sector. Public health guidelines are subject to change. Information will be provided when required. Department and agency staff have a responsibility to ensure that they review all information shared by the department related to PPE use and health management.

PPE must be used responsibly and as per directives to ensure that provincial supplies are available to meet needs. We all have a duty to take care of our own health, however we also must do everything we can to support and protect the health of the vulnerable populations that we serve.




Common Questions and Answers


How do we know when staff or residents need to self-isolate? How do we isolate them?

Public health officials will advise and provide detailed instructions to anyone needing to self-isolate. Public health will follow up with anyone who is a close contact of someone who has tested positive for COVI19 and will advise on the appropriateness of isolation and when the discontinuance of isolation protocols can be considered.


If we get a case, and the person cannot be well isolated from group home housemates, or if we are dealing with vulnerable people who would not understand the need to self-isolate, where do they go?

Public health officials will provide direction on the appropriateness of isolation. They will provide advice on what isolation looks like and work with individuals and agencies on a case-by-case basis to assess each circumstance. For example, isolation may take place in a home-based setting, within a community or residential care setting or within provincial isolation units. Hospitalization will be determined by health professionals.


I work in a staffed residential care setting. What PPE is required and when?

If you work in a staffed residential care setting:

  • Eye shields and masks are worn continuously to keep residents safe.
  • Gowns are only worn if a resident in a home is presumed to have COVID-19, is COVID-19 positive or has cold/flu symptoms.
  • Gloves are worn only if a resident is COVID-19 presumed or positive or has cold/flu symptoms or when providing intimate personal care (contact with bodily fluid).

I provide unit-based services (in-home visits). What PPE is required and when?

If you provide unit-based services (in-home visits):

  • Ask screening questions to identify risk before entering the home.
  • If you can confirm through criteria questions that no one in the home is ill and that social distancing (two metres or six feet) can be maintained – you do not need to wear PPE.
  • If you cannot confirm the screening questions, if someone is ill or if social distancing cannot be maintained, PPE should be worn as outlined above.

Do we have to wear N95 masks?

N95 masks will not be required. These are used for aerosol-generating medical procedures only. A standard procedure mask will suffice.


If we run out of procedure masks, can staff wear cloth masks?

Cloth masks likely will not provide much protection to the person wearing them but it can be an effective way to protect the people around you. Health Canada sees this as an option when physical distancing is not possible. This is not a strong recommendation. However, as the situation evolves, this direction could change if the supply of masks is low.


Residents in the home are healthy, why do I need to wear PPE?

Wearing PPE continuously throughout shifts ensures that our clients are protected from germs that staff potentially bring into the home.


Can PPE be reused?

Reuse of masks depends on the job setting. In a staffed residential care setting, use the same mask for the duration of the shift, unless the mask becomes wet, damaged or soiled. Masks can be taken off when eating for example, but staff need to do so in a way that prevents contamination.

When providing unit-based services (in-home visits), masks can be worn between multiple client visits. However if a mask is removed from the face, it must be discarded and a new one used. If you are a child protection worker, your mask can be discarded after each home visit and a new mask used.

Eye shields can be worn for all client visits/interactions for an entire shift. Eye shields and frames can be washed with soap and water and reused.

Gloves cannot be reused.

Disposable gowns cannot be reused. Cloth gowns can be laundered and reused.


If staff wear prescription glasses, would they be exempt from wearing eye shields/face shields or are they expected to wear them over top of their glasses?

Eye shields are to be worn on top of prescription glasses.

Eye shields can be removed while driving if necessary.


We cannot guarantee that a resident will not come within six feet of staff at any time. What should we do?

Try to reinforce the importance of social distancing (two metres or six feet) and help them understand the role they play, that no one is immune and that their behaviours can make others sick. Whenever possible, encourage clients to follow social distancing, hand hygiene and cough/sneeze etiquette. Screen for people who are ill, wash your hands often and use PPE when required.


Are there any rules around allowing other professionals into the homes (plumber, maintenance personnel)?

At this time, only essential service delivery should occur. Consultation with supervisors will determine who should come into the home, how often and for what purpose. Limiting the number of people in and out of the home does help reduce the risk of exposure and is part of social distancing and proper prevention measures.

We received direction regarding visitors to the homes to assist with stopping the potential spread of COVID. Should Individuals then be accessing the community for personal items (cigarettes, personal hygiene items, etc)?

There is always risk of exposure when going out into the community. If individuals do go out, it should be for essential reasons only. Individuals should practice physical distancing when out and perform good hand hygiene to mitigate the risk.


Many staff members have multiple jobs, pick up shifts, or provide support in a variety of settings or other care settings. This presents a potential hazard, yet is difficult to manage since we need to maintain staff numbers. What recommendations does the Province have in this area?

Wherever possible, agencies should do their best to limit the number of homes that staff work in. However, we understand this is not always possible. Staff are to follow the same protocol in every home/environment that they attend. Hand washing, safe social distancing and use of appropriate PPE will mitigate the potential for contamination across environments.


If we are quarantining sick children or vulnerable adults in a hotel, what is best practice to support them during their isolation?

Public health officials will be heavily involved in providing direction on the appropriateness of isolation. They will provide advice on what isolation looks like and work with agencies to develop appropriate care plans. These plans may include ongoing agency involvement and support.


On reserve, in overcrowded homes, what is the recommended practice when a family member is sick, potentially with the virus? What protocols should be followed? Should the sick person be moved out of the house?

Public health officials will make recommendations regarding the appropriateness of isolation for any COVID positive person.

If a person is symptomatic, that person should be self-isolated from the well people in the home. If possible, the person should be reminded to wash their hands, use respiratory etiquette and practise social distancing. Health Links should be contacted and Public health direction followed.


Our Individuals are involved in programming which includes baking, meal preparation, etc. Is it recommended to cancel this type of programming altogether during this time?

One person should prepare and put food on plates. Avoid buffet style eating and sharing bowls such as fruit bowls, popcorn, chips, etc. If a sick person is being isolated, food should be delivered to the isolation area and consumed there.

Providing that social distancing can be practised, we are confident program areas will find creative solutions to keep clients engaged.


Staff generally share meals with people they support as part of their shift - I am assuming this should be stopped?

Staff can continue to share meals with the people they support if social distancing guidelines are followed (i.e. seating people at opposite ends of the table instead of next to each other). If children or vulnerable adults require assistance while eating, staff should continue to assist with food consumption and remember to wash their hands before and after meal time and avoid touching their eyes, nose and mouth while assisting with food consumption.

One person should prepare food and put it on plates. Avoid buffet style eating and sharing bowls such as fruit bowls, popcorn, chips, etc.


Many residents come and go at will. We are screening them when they come home, having them change clothes and shower. Are there any other recommendations that you can provide in these situations? Is it okay for them to spend time in the community (go to store, etc.)?

There is always risk of exposure when going out into the community. If individuals do go out, it should be for essential reasons only. Individuals should practice physical distancing when out and perform good hand hygiene often to mitigate the risk.


For staff onsite, do they need to wear the mask and eye mask regardless of their task, (cooking, working on the computer etc.), or only when they are providing care less than the recommended six feet away, such as when they are holding a baby, or serving food?

If you work in a staffed residential care setting for an entire shift:

  • Eye shields and masks are worn continuously to keep residents safe.
  • Gowns are only worn if a resident in a home is presumed to have COVID-19, is COVID-19 positive or has cold/flu symptoms.
  • Gloves are worn only if a resident is COVID-19 presumed or positive or has cold/flu symptoms or when providing intimate personal care (contact with bodily fluid).

If you provide unit-based services (in-home visits, dropping in to clean):

  • Ask screening questions to identify risk before entering the home
  • If you can confirm through criteria questions that no one in the home is ill and that social distancing (two meters or six feet) can be maintained – you do not need to wear PPE
  • If you cannot confirm the screening questions, if someone is ill or if social distancing cannot be maintained – you should wear PPE as outlined above

In supported independent living, our employees provide no personal care – the support is more centred around grocery shopping, house cleaning, system navigation, money management, etc. What PPE is required?

Non-essential supports should be continued. If an essential service, support can be provided without PPE if social distancing can be maintained. Agencies should provide services through alternative mechanisms, if possible (for example, using grocery store delivery services). If the service is essential and cannot be provided and social distancing maintained, or if the service recipient is ill, wear the appropriate PPE.


What do you recommend if staff are unable to wear masks? They are able to wear the face shields, but not the cloth or surgical masks due to claustrophobia and breathing difficulties when wearing something over nose and mouth.

Public health has directed the circumstances in which PPE should be worn. Staff are to follow these guidelines.


If you have Individuals within the Residential Group Home setting who are in a relationship, are they able to spend time in one another's rooms or are we to encourage social distancing?

Public health has indicated that social distancing is important. We recognize that people who have connections will continue to be close - this is no different from a family relationship. Staff should make possible efforts to prevent transmission in the home.


Are staff providing direct care to Children in Care in WCFS Emergency Placement Resource Shelters expected to wear full PPE gear?

Yes - staff are to wear mask and eye protection as directed.


If a resident gets sick, can the care provider accompany them if they are admitted to hospital?

Public health will help support care planning.


What is the protocol on residents who were hospitalized for reasons that are not COVID related and subsequently discharged? Should they be isolated?

Public health will provide direction.


By Public health, does that include what direction Health Links provides?

Yes - Health Links is part of the health system and shares up-to-date public health information.


Our message to families has been "please don't visit." How should we deal with resistance? Is there a safe return process / assessment to employ if a visit occurs?

Dr. Roussin has advised to limit visits to the greatest extent possible. Creative solutions should be found to maintain family connections in other ways (e.g., video calls). However, some family visits are critical to the well-being of vulnerable adults and children. If possible, social distancing should be maintained, and health precautions taken.


In some homes staff sleep overnight - are they exempt from wearing mask and protective eyewear unless they are providing direct care?

There is no need to wear PPE while sleeping; however, PPE is to be worn if staff must attend to someone during the night.


People with severe eczema, or dry open cracks, sores irritated due to multiple time handwashing. Are these people at greater risk of contracting the virus? Can it be contracted through broken skin or open sores?

There is no research indicating that the risk of contracting COVID-19 is greater for someone with severe eczema.

As stated by Health Canada, human coronaviruses cause infections of the nose, throat and lungs. They are most commonly spread from an infected person through:

  • respiratory droplets generated when you cough or sneeze
  • close, prolonged personal contact, such as touching or shaking hands
  • touching something with the virus on it, then touching your mouth, nose or eyes before washing your hands

The World Health Organization and Health Canada indicate that proper hand washing with soap and water is necessary to protect oneself against COVID-19. This means avoiding touching your eyes, nose and mouth with unwashed hands, particularly after being in a public space, after blowing your nose, coughing or sneezing.

Why? Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.


What are appropriate sanitizers/disinfectants?

For a full list of hard-surface disinfectants that meet Health Canada's requirements, visit:https://www.canada.ca/en/health-canada/services/drugs-health-products/disinfectants/covid-19/list.html

  • Washing your hands with soap and water is better than using hand sanitizer