Report: preventing and managing COVID-19 infections in care and nursing homes, examples from Germany

By Klara Lorenz-Dant, CPEC

The high risk of infection to people living in care and nursing homes has been recognised and different bodies across Germany have issued guidance and recommendations. Here we present two examples:

The Robert Koch Institute (RKI) monitors infectious and non-communicable diseases in Germany. It also conducts research and advises relevant ministries, especially the Ministry of Health. The RKI is involved in the development of guidelines and norms.

The latest information for prevention and management of COVID-19 in institutional and ambulatory long-term care for older people in Germany from the RKI (as of 23 March 2020) recommends (translated from German):

  • It is recommended that medical personnel should wear protective gear (mouth and nose) during a pandemic when caring for vulnerable patient groups to protect the patients
  • If people develop respiratory problems or a fever, diagnostic confirmation of a COVID-19 infection should be considered
  • Visitors should be notified not to visit the care home if they have an acute respiratory disease
  • Rules for visitors should be in accordance with the relevant health authority
  • Staff with acute respiratory disease should stay home
  • The health status of new residents should be established; individuals with respiratory illnesses or fever should be referred to the relevant medical doctor
  • Residents with respiratory disease or fever should be cared for in their room
  • Information on protective strategies to protect residents should be made available to staff, residents and their visitors
  • Hand sanitiser and single-use tissues should be made available in all areas residents inhabit
  • When caring for people with fever or respiratory diseases, protective equipment according to guidelines/recommendations should be used
  • Protective equipment and information for their use should be placed immediately at the entrance to living quarters
  • Bins for the disposal of single-use equipment should be placed on the inside by the door
  • Where residents are transferred between institutions, the receiving institution should be informed regarding respiratory disease prior to the transfer
  • The health status of staff should be monitored.

    While the RKI offers information based on epidemiological studies, binding guidelines and directives, as well as recommendations, are provided by the ministries responsible for health and by the Landesgesundheitsämter (health authorities) in each of the 16 federal regions (Bundesländer).

    On 16 March 2020, the Ministry for Social Affairs and Health of Lower Saxony (Niedersächsisches Ministerium für Soziales, Gesundheit und Gleichstellung), for instance, declared a ban on visitors in care and nursing homes, unless they are the loved ones of a person receiving palliative care. This document remains in force until 18 April 2020. One day later, the health authority in Lower Saxony (Landesgesundheitsamt Niedersachsen) recommended care and nursing homes to pause community activities, to strictly separate those suspected of COVID-19 and non-infected residents, and for staff to avoid close contact with each other (17 March 2020).

    In addition, the health authority provides recommendations. These include, for instance, that residents in institutional care settings should not leave the institutional premises, such as to visit their relatives or to go shopping. It was further recommended that care homes should postpone taking in new residents (non urgent cases) to free up spaces for patients released from hospital (see recommendations 20 March 2020).

    Other recommendations provide information on symptoms, ways of infection, detailed hygienic standards, physical distancing, use of protective equipment and accommodation of infected residents.

As mentioned above, rules and regulations can vary between federal regions (Bundesländer). An overview of the different regulations regarding visitors in care and nursing homes by federal region has been provided by BIVA (an organisation that supports the rights and interests of people with care needs) .

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