S.P.I.C.E the Strategy: Prevention, Isolation, Containment and Elimination
What is Social/Physical Distancing?
In public health, social distancing, also called physical distancing, is a set of non-pharmaceutical interventions or measures intended to prevent the spread of a contagious disease by maintaining a physical distance between people and reducing the number of times people come into close contact with each other
Wikipedia 2021
The management of COVID 19 in the care home has taken care homes to recognise infection control is not something we just do it is woven through every aspect of the care home.
Every policy and process that has been written for COVID 19 focuses on Social Distancing.
Below is a summary of the infrastructures of the care home that have social distancing at the core of them to try and protect the people living withing the care homes.
Practical Prevention Strategies.
A fundamental aspect of maintaining social distancing in the care homes is when people are presenting with either SOFT signs, symptoms, had potential exposure to COVID 19 or are confirmed to be positive for COVID 19. Each one of these situations require a different internal management approach. Cases are reviewed individually.
Zoning
Zoning enables care homes to split the home into separate areas that become self-contained. Each area can then function separately from other areas within a home. This plays a significant role in preventing infections from spreading through a whole home.
The example below shows how all aspects of a care home can be separated to maintain social and physical distancing.
Floor Plans
Every home has a set of floor plans. These are required as part of the fire management requirements for any care home. The floor plans split the home into fire zones. Through looking at the floor plans and using the existing splits in the building, the fire doors, the existing different ways of entering the home, a zoning plan can be created.
The graphic representation below shows the layout of a nursing home split into AMBER and GREEN zones when there has been concerns around potential exposure. The features described through this policy can be identified in this zoning example.
Graphic Representation of a Zoning Plan across two floors
Example 1
Graphic Representation of a Zoning Plan across one floor to achieve an element of social and physical distancing
No suspected or confirmed cases
Example 2
Each person living in the care home should be assumed as vulnerable and in need of shielding from the virus, but we recognise that isolation itself is hard for people, with potentially serious effects on their mental and physical wellbeing. The situation is likely to be in place for many months to come and so each care home must be able to reduce the risks of transmission between people as far as possible whilst not causing illbeing owing to ongoing strict isolation measures. The sharing of a homely, communal living spaces and, at times, a bedroom space can be beneficial in supporting emotional and physical wellbeing.
So, while strict isolation measures are to be used when there is a suspected or confirmed case in the home, we need to invent safe and risk-reducing ways for interaction when there are no confirmed cases.
An outline of ways in which can achieve this are detailed below. These measures will also be effective in preventing the risk of other airborne viruses and viruses transmitted through touch within the care home.
- By the home being zoned into areas/houses a natural but significant reduction in people mixing is achieved [both in staff and people living in the home]
A home may be zoned by the natural delineation of the building by the number of floors or through different breaks in the building, often separated by fire doors and resulting fire zones. The diagram on page 63 shows a home separated by fire zones and fire exit points to achieve social and physical distancing across two floors. The diagram on page 64 shows a house of 32 people zoned into a house of 22 and 12 .
- For people who wish to remain in their rooms they must be supported to do so in a safe way
- For additional seating areas to be created within communal spaces and areas so there is the opportunity for independent social distancing
- For people who require the full support to be physically moved and taken to a communal area by staff, they are not grouped/placed next to each other without the consideration of social distancing
- Lounge chairs are to be placed opposite each other unless a 2-metre distance can be achieved, chairs are to be placed at angles, facing open windows if possible. Side by side seating is less of a risk that face to face.
- To create smaller dining tables/spaces so group seating at a mealtime achieves an element of social distancing.
- For homes with larger tables then an agreed occupancy number is to be in place for each mealtime. Sanitising tables, changing of tablecloths in between groups of people using the table. If this is the strategy deployed in the home, then as far as possible the same people are grouped and supported to eat together at any one time.
- A proactive plan to maintain ventilation within communal areas by keeping windows open as far as possible.
Living with a Dementia
It must be acknowledged and understood by all stakeholders that for people living with a dementia or other cognitive impairments that freedom of movement is a key aspect of being in control. People must be supported and enabled to spend time in their house where they choose in order not to increase the risk of expressive behaviours and illbeing. The exception being when there is a suspected or confirmed case.
Visitors in the Care Home
There is a separate policy for Relatives and Friends vising the care home and for professionals visiting the care home. Please refer to these individual policies re maintaining physical and social distancing and the measures in place to reduce infection risks.
Maintaining social/physical distancing and the chain of infection.
How does Maintaining social/physical distancing fit into the Strategy of S.P.I.C.E?
By implementing strategies of physical and social distancing within care homes the focus becomes on preventing and reducing the opportunity an infectious agent has of spreading though the home. Through the various methods in this SICP and through the policy guidelines an infectious agent that is airborne and highly transmissible can be isolated and contained in one area. Through a combination of robust Infection Control measures the infection can be eliminated from the home.
There is therefore the opportunity to break the chain of infection at every cycle when all strategies are combined and work uniformly.
