From the Frontlines of COVID-19 (JNA)

VOL. 3 An elderly care facility fighting COVID-19 with thorough infection control
The Geriatric Health Services Facility*1 "Yukariand correct use of PPE(Personal ProtectiveYutoen" is located near Tokyo, in Sakura City, Chiba

Equipment). November to March is the period whenPrefecture. Catering to 96 residents and 25 day careinfluenza is most prevalent, and this became therehabilitation patients, staff members include one'Enhanced Infection Control Period' in which all staff

doctor, 12 nurses (incl. four part-timers), 50 care

had their temperatures checked and were required toworkers and 5 PT/OT staff. Following the spread of thewear masks upon arrival at work, and humidifiers wereCoronavirus disease (COVID-19), thorough infectionused in the facility. In addition, an infection specialist

control measures were put in place, and as of November

was invited twice a year from a university hospital or2020, there have been no COVID-19 cases among theother facility to give lectures designed to raise theresidents or staff.

awareness of the entire staff, including those inadministration.
In late March when there was a rise in COVID-19
cases in Chiba Prefecture, control measures at Yutoen
were intensified. Unnecessary and non-urgent outings
by residents were banned, family visits were forbidden,
on-site visits by external maintenance staff/service staff
to the facility were kept to a bare minimum and medical
consultations for residents were only allowed in anemergency.

The nurses at Yukari Yutoen: Nursing and Care
Director Fujiko Maeda is at center, bottom

In addition to infection control measures, the nurses
at Yutoen put effort into the handling of residents withfever. It is not uncommon for elderly persons
accompanying

Fujiko Maeda, the Nursing and Care Director, has
worked hard to take infection control initiatives since
her appointment two and a half years ago, given thatsuch control is essential on a daily basis for elderlygroup homes/facilities. With the basics of standard
precautions

andtransmission-basedprecautions,thorough measures were taken including having all
nurses and care workers carry their own hand sanitizer
with a policy of 'one care, one hand-wash (or handsanitize)'. There were also appropriate procedures
established for disposal of bodily excrement andcontaminants, as well as efforts made toward the early
detection and treatment of abnormalities in facility
users. The nurse became Infection Control Committee
Leader and carried out regular checks for handwashingchronic

diseases

toexperience

unexplained fevers. It was anticipated that it would bedifficult to differentiate these fevers from those caused
by COVID-19, that local hospitals may not accept
patients from Yutoen, and that it could be difficult to
get a PCR test.
Ms. Maeda explains: "The elderly often experience
unexplained fevers, so we created a flow chart fordifferentiation from COVID-19." If the patient has afever or cough, even if infection cannot be confirmed,
he or she would be placed in a private room forobservation, and infection control intensified. If thefever were high, they would be tested for influenza. Inaddition, treatment following the facility's 'Pneumonia
Manual' was commenced, and blood tests were taken toFrom the Frontlines of COVID-19 (JNA)

check CRP values and a white blood cell picture.

They also simulated the procedures to be taken if aresident was infected with COVID-19. Ms. Maeda
continues: "Even if a PCR test is positive, the hospitals
won't take the patients immediately. We knew we had
to care for them ourselves for a time, so there was aneed to put systems in place". All of the rooms at
Yutoen are private with each door opening straight into
the living room, so there was no place to put on orA resident with a care staff

remove PPE. They therefore created a small 'anteriorcompartment' out of blue sheets outside each room.

With these control measures in place, for the sake of

They ordered N95 masks and caps, and created a

the residents' mental health, through-window visits andprocedure whereby nurses would put on and remove

remote meetings with family members were conducted.

their PPE in this space. By simulating the actual

Remote meetings enabled residents to see family

procedure, staff were able to be ready to deal withmembers who lived far away and had not previously

infected patients anytime."

been able to visit them, and this was something they felt
they could use in the future as well. They continue toprevent the build-up of stress among residents, withstaff taking them into the facility's garden more
frequently, among other measures. As Ms. Maeda says,"What we have realized, through strengthening these
infection control measures, is that maintaining social
distance in elderly care settings is difficult. The optimalmental health care for them includes touching, being
next to them and listening. We would, as much as
possible, like to continue to place importance oninteraction with the residents as well."(Last updated:Nov.2020)*1
PPE were put on and removed in an 'anterior
compartment' created from blue sheets

Geriatric Health Services Facility:

A rehabilitation facility for the elderly needing longterm care to assist them to return home.