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Mae diogelu’r bobl fwyaf agored i niwed yn ein cymunedau wedi bod yn flaenoriaeth yn ystod pandemig Covid\-19\. Fel rhan o becyn o fesurau i atal trosglwyddo Covid\-19 mewn cartrefi gofal a diogelu preswylwyr a staff, mae rhaglen brofi asymptomatig ar gyfer staff wedi bod ar waith yng Nghymru ers mis Mehefin 2020\. Ar hyn o bryd, mewn ymateb i gyfraddau heintio uchel yn y gymuned, mae staff cartrefi gofal yng Nghymru yn cael eu profi’n wythnosol yn unol â’r ddogfen lefelau rhybudd ar gyfer gofal cymdeithasol, a gyhoeddwyd ar 23 Rhagfyr; https://llyw.cymru/cynllun\-rheolir\-coronafeirws\-lefelau\-rhybudd\-yng\-nghymru\-ar\-gyfer\-gwasanaethau\-gofal\-cymdeithasol\-i\-oedolion\-a\-phlant


Mae staff cartrefi gofal, awdurdodau lleol a thimau diogelu iechyd yn parhau i weithio’n ddiflino i atal cyflwyno a throsglwyddo Covid\-19 yn ein cartrefi gofal. Fodd bynnag, er gwaethaf ymdrechion glew, rydym yn dal i weld canlyniadau profion positif mewn cartrefi gofal ymysg staff a phreswylwyr ac mae nifer cynyddol o gartrefi gofal yn delio ag achosion lluosog a brigiadau o’r feirws ar hyn o bryd. Er ein bod yn gwneud cynnydd da o ran cyflwyno ein rhaglen frechu, mae hi’n ddyddiau cynnar o hyd. Mae’r sefyllfa’n cael ei dwysáu gan y ffaith bod amrywiolynnau sydd wedi’u canfod yn ddiweddar yn trosglwyddo’n gyflymach fyth, ac mae hyn yn ffactor allweddol y tu ôl i frigiadau o achosion lleol. Mae profion felly’n parhau i fod yn rhan hanfodol o’n hymateb i’r pandemig ac mae’n glir bod angen ymyrryd ymhellach i helpu i ganfod unigolion heintus mewn cartrefi gofal yn gynharach a rheoli achosion yn fwy effeithiol.


Ar ôl i brofion sy’n defnyddio Dyfeisiau Llif Unffordd (LFD) gael dilysiad gwyddonol, gwnaethom gyflwyno profion LFD ar gyfer ymwelwyr â phob cartref gofal yng Nghymru ym mis Rhagfyr 2020 i hwyluso ymweliadau gan deulu a ffrindiau â phobl sy’n byw mewn cartrefi gofal. Oherwydd y newidiadau i gyfyngiadau lefel 4 a gyflwynwyd ar 19 Rhagfyr, ychydig iawn o ymweliadau a phrofion cysylltiedig sydd wedi’u cynnal. Fodd bynnag, yn unol â chanllawiau cynllun rheoli’r coronafeirws ynghylch lefel rhybudd 4 ar gyfer gofal cymdeithasol, mae profion ar gyfer gweithwyr proffesiynol sy’n ymweld â chartrefi gofal hefyd wedi’u cyflwyno. Mae gofyn i weithwyr proffesiynol nad ydynt yn cael profion asymptomatig rheolaidd gael prawf LFD yn y cartref gofal y maent yn ymweld ag ef. Dim ond ddwywaith yr wythnos y bydd angen profi gweithwyr proffesiynol sy’n ymweld, felly ar ôl prawf cyntaf yr wythnos ni fydd angen prawf arall ar y gweithiwr proffesiynol am y tri diwrnod nesaf.


Ar ôl ystyried y cyngor gwyddonol diweddaraf, rydym hefyd yn cyflwyno rhaglen profion asymptomatig rheolaidd, ddwywaith yr wythnos, ar gyfer staff cartrefi gofal yng Nghymru, gan ddefnyddio profion llif unffordd yn ychwanegol i’r prawf PCR wythnosol a gynhelir ar hyn o bryd.


Yn ogystal, rydym yn rhoi’r hyblygrwydd i dimau diogelu iechyd lleol ystyried cyflwyno mwy o ddarpariaeth brofi ar gyfer staff drwy gyfrwng profion dyddiol am gyfnod o **10 diwrnod** mewn cartrefi gofal sydd â brigiad o achosion. Mae’r ddarpariaeth brofi uwch hon yn cyd\-fynd â’r flaenoriaeth ‘*profi i ddiogelu*’ a nodir yn Strategaeth Brofi ddiwygiedig Llywodraeth Cymru https://llyw.cymru/strategaeth\-profi\-covid\-19 a’r Fframwaith Profi yn y Gymuned https://llyw.cymru/fframwaith\-profi\-am\-covid\-19\-yn\-y\-gymuned


Mae’n bwysig **nad** yw’r ddarpariaeth brofi uwch hon yn cael ei defnyddio fel dull ‘*profi i gynnal*’ i alluogi staff sy’n ynysu i ddychwelyd i’r gwaith yn gynnar. **Bydd dal angen i unrhyw aelod o staff sydd wedi dod i gysylltiad ag achos positif ynysu fel yr arfer**.Ni fydd darpariaeth brofi uwch yn cael ei chyflwyno’n awtomatig ym mhob cartref gofal sydd ag achos positif. Fodd bynnag, bydd yn cael ei hystyried fel rhan o’r cynllun asesu a rheoli risg ar gyfer brigiad o achosion a dylid ei hystyried gyda rheolwyr cartrefi gofal.


Mae profion llif unffordd yn canfod presenoldeb antigen feirysol Covid\-19 o sampl swab a gall roi’r canlyniad mewn 20\-30 munud gan ei gwneud yn bosibl canfod ac ynysu unigolion positif yn llawer cyflymach na thrwy’r broses brofi PCR bresennol.


Mewn adroddiad gan Ysgol Hylendid a Meddygaeth Drofannol Llundain ynglŷn â phrofion rheolaidd gan ddefnyddio profion antigenau, nodwyd bod defnydd aml o brofion llif unffordd yn canfod nifer cymharol o heintiau â phrofion PCR aml, ac y gall osgoi mwy o drosglwyddiadau na PCR os oes modd eu defnyddio’n fwy aml.


Nodwyd hefyd fod canlyniadau yn awgrymu bod profion aml, hynny yw bob 1 neu 3 diwrnod, yn debygol o ganfod cyfran sylweddol o heintiau asymptomatig a chyn\-symptomatig ac osgoi’r mwyafrif o drosglwyddiadau pellach, boed hynny gan ddefnyddio profion LFA\[D] neu PCR. Gan fod modd cael canlyniadau profion LFA\[D] mewn llawer llai o amser na chanlyniadau profion PCR, mae’n bosibl canfod ac ynysu unigolion heintus yn llawer cyflymach, gan wrthbwyso sensitifedd is profion LFA\[D] ac osgoi nifer tebyg o drosglwyddiadau.


Felly, drwy gyfuno profion PCR a phrofion LFD mewn cartrefi gofal, bydd mwy o unigolion heintus asymptomatig yn cael eu canfod a gallant ynysu yn gyflymach er mwyn osgoi trosglwyddiadau pellach. Rydym yn deall bod hyn yn rhoi baich ychwanegol ar y sector yn y cyfnod heriol hwn, ond mae’n cyd\-fynd â’r pwysigrwydd a roddir ar geisio canfod unigolion positif asymptomatig. Mae hefyd yn cydnabod y buddion mwy hirdymor a geir wrth helpu i reoli brigiadau o achosion yn gyflymach ac atal trosglwyddiadau pellach.


Bydd swyddogion yn ysgrifennu i gartrefi gofal i roi arweiniad manylach ynglŷn â chyflwyno profion LFD ychwanegol ar gyfer staff cartrefi gofal. Fodd bynnag, fel rhan o’r rhaglen brofi LFD ar gyfer cartrefi gofal;


* Bydd staff yn cael un prawf LFD ‘ar y safle’ yn y cartref gofal ar yr un diwrnod â’u prawf PCR wythnosol.


* Bydd staff hefyd yn cael un prawf LFD ganol yr wythnos rhwng profion PCR. Gallant wneud y prawf hwn gartref cyn mynd i’r gwaith.


* Yn ddelfrydol, bydd staff yn cael prawf LFD ar ddechrau eu sifft.


* Os bydd unrhyw staff yn cael prawf positif, bydd angen iddynt archebu prawf PCR cadarnhau, ac yna hunanynysu gartref ar unwaith hyd nes y byddant yn cael y canlyniad.


* Mewn ardaloedd lefel 4, gallai cartrefi gofal sydd ag achos positif ystyried a/neu gael eu cynghori gan weithwyr diogelu iechyd proffesiynol i gynnal profion LFD dyddiol ar gyfer staff ar ddyletswydd am 10 diwrnod fel rhan o broses rheoli brigiad o achosion. (Bydd angen cyfiawnhad clir dros estyn profion dyddiol ymhellach na hyn, gan gofnodi’r cyfiawnhad hwnnw’n ffurfiol ac ystyried yn ofalus allu cartrefi gofal i gynnal y profion a chydymffurfio â’r gofynion profi.)


* Bydd dal angen i staff sydd wedi dod i gysylltiad ag achos positif ynysu fel yr arfer.


I alluogi’r rhaglen brofi ychwanegol hon, mae £3,045,000 o gyllid ar gael hyd at ddiwedd y flwyddyn ariannol i gefnogi’r beichiau ychwanegol yn sgil cynnal mwy o brofion ar gyfer staff ac ymwelwyr, gan gynnwys y gost a’r amser ychwanegol i greu mannau profi priodol a diogel, hyfforddi staff, goruchwylio profion ar gyfer ymwelwyr a hwyluso ymweliadau diogel. Bydd y cyllid ychwanegol hwn ar gael drwy’r Gronfa Caledi Llywodraeth Leol ynghyd â’r cymorth sydd eisoes ar gael i’r sector gofal cymdeithasol. Bydd cyngor manwl pellach yn cael ei ddarparu cyn bo hir.  







Translation:


 
The protection of the most vulnerable people in our communities has been a priority during the COVID\-19 virus outbreak.  As part of a package of measures for preventing transmission of COVID\-19 in care homes and protecting residents and staff, a programme of asymptomatic testing of staff has been in operation in Wales since June 2020\. At this current time, in response to high community infection rates, staff in care homes in Wales are undertaking weekly testing in line with the social care alert levels document published on 23 December 2020: Coronavirus control plan: Alert levels in Wales for social care services for adults and children.


Care home staff, local authorities and health protection teams continue to work tirelessly to prevent the introduction and onward transmission of COVID\-19 in our care homes.  However despite best efforts we continue to see positive test results in care homes amongst both staff and residents with an increasing number of care homes currently managing active incidents and outbreaks. Whilst we are making good progress with the rollout of our vaccination programme, we are still in the early stages. This situation is compounded by the even more rapid transmission of recently identified variants which are a key factor in driving local outbreaks. Testing therefore remains a pivotal component in our response to the pandemic and it is clear that further intervention is needed to help identify infectious individuals within care homes sooner and manage outbreaks more effectively.


Following scientific validation of testing using Lateral Flow Devices (LFDs) we introduced LFD testing for visitors to all care homes in Wales in December 2020 in order to facilitate family and friend visits to people living in care homes. Due to changes to the level 4 restrictions introduced on 19 December only very limited visiting and associated testing activity has taken place. However, in line with the social care control plan alert level 4 guidance, testing for visiting professionals to care homes has also been introduced with visiting professionals who are not yet subject to regular asymptomatic testing being expected to undertake a LFD test at the care home they are visiting. Tests for visiting professionals will only be needed twice a week so following the first test of the week the professionals will not require a further test for the next three days.


Having considered the latest scientific advice we are also introducing a programme of regular, twice weekly, asymptomatic testing of care home staff in Wales, using lateral flow test devices in addition to the weekly PCR test that is currently undertaken. 


Additionally we are providing local health protection teams with the flexibility to consider the introduction of enhanced staff testing with daily testing for a period of **10 days** in care homes where there is an outbreak. This enhanced testing is in line with the ‘*test to safeguard’* priority described in the refreshed Welsh Government COVID\-19 Testing Strategy.


COVID\-19 community testing framework.


It is important that this enhanced testing is **not** used as a ‘*test to maintain’* approach to allow staff who should be isolating to return to work early. **Any member of staff who is a contact of a positive case will still need to isolate as normal**.  Enhanced testing will not automatically be introduced into every care home with a positive case but will be considered as part of the outbreak risk assessment and management plan and should be considered in conjunction with care home managers.


Lateral flow tests detect the presence of the COVID\-19 viral antigen from a swab sample and can produce results within 20 to 30 minutes allowing for positive individuals to be identified and isolated much more quickly than through the current PCR testing process.


A report by the London School of Hygiene and Tropical Medicine on repeated testing using antigen tests found *‘that the use of frequent lateral flow testing detects a comparable number of infections to frequent PCR, and can avert more transmission than PCR if they can be used more frequently.* 


The report also found that, *‘results indicate that frequent testing, i.e. every 1 or 3 days, is likely to detect a substantial proportion of asymptomatic and pre\-symptomatic infections and avert the majority of onwards transmission, whether using LFA\[D] or PCR testing. As LFA\[D] tests results can be returned in a fraction of the time required to return PCR test results, infected individuals may be identified and isolated much more quickly, counteracting the loss in sensitivity of LFA\[D] tests and averting a similar amount of transmission.* 


Therefore by combining PCR testing and LFD testing in care homes an increased number of asymptomatic infectious individuals will be identified and can be isolated more quickly to avoid further transmission. Whilst we recognise that this places an additional burden on the sector at a time of huge challenge, it is consistent with the importance placed on trying to identify asymptomatic positive individuals and recognises the longer term benefits of helping to bring outbreaks under control more quickly and preventing further transmission. 


Officials will be writing to care homes to give more detailed guidance on the introduction of additional LFD testing for care home staff.  However as part of the LFD testing programme for care homes;


* Staff will complete one ‘on site’ LFD test at the care homes on the same day as their weekly PCR test.


* Staff will also complete one LFD test midweek between PCR tests.  This can be completed at home before coming to work.


* Ideally staff undertake an LFD test at the beginning of their shift.


* If any staff test positive, they will need to book a confirmatory PCR and then self\-isolate at home immediately until they receive their result


* In level four areas, care homes that have a positive case could consider and/or be advised by health protection professionals to undertake daily LFD testing for staff on duty for 10 days as part of an outbreak management process. (Any further extension of daily testing beyond 10 days will require clear justification that is formally recorded and careful consideration of a care homes ability to maintain and comply with the testing.


* Staff who are identified as contacts will still be required to isolate as normal.


To enable this additional programme of testing, funding of £3,045,000 is being made available to the end of the financial year to support the additional burdens associated with increased testing for staff and visiting including the additional cost and time burden of creating appropriate and safe testing spaces, training staff, supervising visitor tests and facilitating safe visits. This additional funding will be made available through the Local Government Hardship Fund in line with existing support to the social care sector and further detailed advice will follow.