Respiratory infection advice to residential aged care facilities (RACFs)

​​​​As of 6 December 2024

This advice includes information for RACFs about:

1. Residents
1. Vaccination for residents
2. Pre-assessment for testing and antiviral medicines
3. Residents who test positive to COVID-19
4. Leaving the facility
2. Visitors
1. Entry restrictions for visitors
2. Mask wearing
3. Staff
1. Entry restrictions for staff
2. Staff exposed to COVID-19
3. Testing staff for COVID-19
4. Mask wearing for staff
5. Vaccination for staff
4. Ventilation

Many residents are at higher risk of severe illness if they develop COVID-19, influenza or respiratory syncytial virus (RSV) infections. Providers of residential aged care need to balance their responsibilities to reduce the risk of COVID-19, influenza, RSV and other infections entering RACFs while meeting the physical, social, and emotional needs of residents.

Facilities should have preparedness plans in place to ensure a timely response to acute respiratory infections (ARIs). Facilities should refer to Guidance for Aged Care Facilities on the Public Health Management of Acute Respiratory Infections (RACF ARI Guidance) for outbreak management advice.

Residents

Vaccination for residents

• It is strongly encouraged that residents stay up to date with recommended vaccinations to protect them from severe COVID-19 and influenza. Read the latest vaccination advice for:
• COVID-19
• Influenza
• An RSV vaccine is available to adults 60 years and above. Residents who are 60 years and above can talk to their GP about the benefits of, their eligibility for and the out-of-pocket cost of the RSV vaccine. See the advice for the RSV vaccine in the Australian Immunisation Handbook for more information.
• The Australian Government Department of Health and Aged Care is funding pharmacists to administer free National Immunisation Program vaccines, including influenza vaccines, to residents in aged care facilities.
• Facilities can contact the Australian Department of Health and Aged Care at racfvaccineclinics@health.gov.au  if they have issues accessing the COVID-19 vaccines.

Pre-assessment for testing and antiviral medicines

• GPs and RACFs are encouraged to establish and annually update a Pre-assessment action plan for respiratory infections in aged care facility residents for if the resident develops COVID-19 or influenza. This supports timely testing and access to antiviral medicines.
• Administering antiviral treatment as soon as possible after symptom onset, especially for people with COVID-19, reduces the risk of severe disease and can prevent hospitalisation and death.

COVID-19 antiviral medicines

• COVID-19 antiviral medicines are available on the Pharmaceutical Benefits Scheme (PBS) for eligible aged care residents.

Influenza antiviral medicines

• RACFs are encouraged to replenish supply of oseltamivir (Tamiflu) in case there is an influenza outbreak.
• Facilities can order oseltamivir (Tamiflu®) directly from the State Vaccine Centre by completing the online RACF influenza antiviral treatment access form.
• For advice on preparing and administering oseltamivir capsule contents, refer to the Clinical Excellence Commission's Information for clinicians – preparing individual doses and suspensions of oseltamivir using capsule contents.
• For further information on antivirals, refer to Guidance on use of antivirals in residential aged care facilities (RACF).

Residents who test positive to COVID-19

If a resident tests positive to COVID-19, refer to the RACF ARI Guidance.

Leaving the facility

If residents who have tested positive or have symptoms of acute respiratory symptoms need to leave the facility, they should wear a mask and be provided with appropriate mask wearing advice.

Visitors

Receiving visitors is essential for resident wellbeing and helps to reduce social isolation. Facilities can determine their own advice to support visits while minimising risk to residents. Risk mitigation strategies include:

• highlighting that visitors should not enter RACFs if they have respiratory symptoms
• consider offering RAT testing to the visitor at reception
• where possible, visits should be held outdoors or in well-ventilated areas away from other residents.

Entry restrictions

Visitors should not enter the facility if they have:

• Tested positive for COVID-19 - visitors should not enter an RACF for at least 7 days after their positive test, unless agreement has been reached with the RACF (for example, for compassionate reasons)
• any acute respiratory symptoms.

If a visit must occur when a visitor meets the above circumstances, the visitor must wear a mask when moving through the facility and minimise movement within the facility.

Mask wearing for visitors

All visitors are encouraged to wear a mask indoors when respiratory viruses are circulating at moderate or high levels in the community as indicated by the NSW Respiratory Surveillance Report.

Staff

The Australian Government Department of Health and Aged Care provides outbreak support in advance to aged care services through the Aged Care Outbreak Management Supplement. This supplement contributes to the cost of planning for and managing outbreaks such as purchasing of rapid antigen tests (RAT), personal protective equipment (PPE) and associated workforce requirements.

Entry restrictions for staff

Staff, including students, contractors, volunteers, pathology collectors and therapists should not enter an RACF if they have:

• tested positive for COVID-19.  Facilities should follow the RACF ARI Guidance to determine when it is safe for employees to return to work
• any acute respiratory or influenza-like symptoms
• been in close contact with a person who has COVID-19. See below for further information.

Staff exposed to COVID-19

If a staff member has been exposed to COVID-19, managers should refer to Appendix 2 of the RACF ARI Guidance for when staff can safely return to work, particularly if they are critical to service delivery.

Testing staff for COVID-19

Facilities are encouraged to provide free RATs to staff to promote testing but regular surveillance testing is not required when there are low levels of COVID-19 in the community as indicated by the NSW Respiratory Surveillance Report.

Staff with respiratory symptoms should not attend work even with a negative RAT result.

Mask wearing for staff

Masks should be worn by staff when there are moderate or high levels of respiratory viruses circulating in the community as indicated by the NSW Respiratory Surveillance Report.

Please remember that masks can be removed for staff:

• while communicating with people who are hearing impaired
• if wearing a mask creates a risk to health and safety
• where clear enunciation or visibility of your mouth is essential
• if they are working alone in an indoor area
• to eat or drink - staff are encouraged to enjoy their meal breaks in areas with good natural ventilation or outdoors.

Staff removing a mask for one of the above reasons can decrease the risk of transmission by physically distancing from others, if appropriate.

Vaccination for staff

Staff are strongly encouraged to stay up to date with all recommended vaccines including COVID-19 and influenza.

Providers should review COVID-19 staff vaccination rates and facilitate access to vaccination for those who are due. For information on recommended COVID-19 vaccinations, see the latest advice.

Providers must comply with the Australian Government Department of Health and Aged Care's mandatory flu vaccination program, which includes:

• offering free flu vaccinations to all aged care staff and keeping records of their vaccinations
• demonstrating how flu vaccinations have been promoted and how aged care staff and volunteers have been encouraged and informed about the benefits of vaccination

For further information, visit:

• Australian Government Department of Health and Aged Care COVID-19 vaccination for residential aged care workers
• Australian Government Department of Health and Aged Care responsibilities of residential aged care providers.

Ventilation

Ventilation is an important factor in minimising spread of COVID-19 and other respiratory viral infections. The key principle is to bring in fresh air to dilute the indoor air; simply re-circulating indoor air (for example, a fan) is not effective.

Natural ventilation should be used wherever possible. RACFs can consider seeking professional advice from an occupational hygienist or ventilation engineer. Carbon dioxide (CO2) monitors and HEPA filters may play a role but require users to have a good understanding of how to use them.