Quarantine is Australia's first line of defence against COVID-19, and continues to play a vital role in Australia's public health response. The National Principles for Managed Quarantine provide nationally agreed guiding principles to set benchmarks for managed quarantine programs across Australia. This acknowledges that quarantine programs should use strong end-to-end infection prevention and control (IPC) protocols with a systematic risk management approach.
As part of the AHPPC's framework supporting continuous improvement in managed quarantine, the AHPPC is regularly reviewing the outcomes of reviews, audits and evaluations. This supports making an already rigorous quarantine system even stronger. The AHPPC is using an evidence-based approach to identify and address potential weaknesses in current systems to ensure best practice approaches to quarantine.
The AHPPC has considered the recommendations and findings of recent reviews into managed quarantine (see below), and the causes of SARS-CoV-2 transmission events. The AHPPC has considered options for minimising the risk of transmission in quarantine environments, and have developed the following Principles for Infection Prevention and Control in Quarantine. These Principles apply to managed quarantine of international travellers, however may also support other quarantine arrangements. These Principles build on existing guidance and are informed by the expert medical advice of the Infection Control Expert Group, the Communicable Diseases Network Australia, and the National COVID-19 Health and Research Advisory Council.
National Principles for Infection Prevention and Control in Quarantine
Hierarchy of Controls
- As outlined in the National Principles for Managed Quarantine, quarantine programs must apply effective controls by using the hierarchy of controls. This is a systematic risk management approach to minimise the risk of transmission of SARS-CoV-2. It ranks controls from the highest level of protection and reliability to the lowest least reliable protection. Risk management plans should incorporate all controls, and should prioritise higher-level controls over lower-level controls where possible, noting that a combination of several controls are often required to manage risk.
- When applying the hierarchy of controls, quarantine programs should give due consideration to the modes of transmission of SARS-CoV-2. AHPPC acknowledges that, in line with updated guidance from the World Health Organization, SARS-CoV-2 can spread from an infected person's mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe. These particles range from larger respiratory droplets to smaller aerosols. Current evidence suggests that the virus spreads mainly between people who are in close contact with each other, typically within 1 metre (short range). A person can be infected when aerosols or droplets containing the virus are inhaled or come directly into contact with the eyes, nose, or mouth. The virus can also spread in poorly ventilated and/or crowded indoor settings, where people tend to spend longer periods of time. This is because aerosols remain suspended in the air or travel farther than 1 metre (long-range).
- As outlined in the National Principles for Managed Quarantine, quarantine programs should use strong end-to-end IPC processes. End-to-end quarantine arrangements include from when the individual arrives at the port of entry (e.g. guidance on luggage handling), through to transit to the facility, the quarantine duration including transport to healthcare services if required, and appropriate management of any cases that emerge. Quarantine programs must apply effective controls using the hierarchy of controls at all stages of the quarantine program, including transport arrangements.
Governance and oversight
- States and territories have primary responsibility for quarantine operations within their jurisdiction, including approval of alternative quarantine programs. All states and territories should consider establishing a dedicated team to govern and ensure oversight of jurisdictional IPC requirements.
- This team should be led by experienced IPC practitioners where possible, noting there is a need to enhance workforce capacity. This team should be supported by a range of specialists such as engineers, aerosol scientists, occupational physicians and someone experienced in root cause analyses.
- In addition, Occupational Health and Safety staff can support consideration of IPC issues as well as staffing issues (e.g. rostering, fatigue and welfare management) and compliance with the OHS regulatory framework in the jurisdiction.
- Once established, this team of experts would be responsible for establishing specific jurisdictional quarantine protocols in line with national recommendations, and ensuring quarantine programs operate in accordance with safe IPC practices, OHS regulatory requirements, and jurisdictional public health orders.
- Quarantine programs should designate an appropriately qualified person (e.g. a nurse manager) or group of people who are based on-site to operationalise guidance and tailor it to the particular quarantine environment.
- This person or persons should support a regular process of audit and review, as outlined in the Continuous Improvement Framework, including establishing processes to manage transmission events. To support continuous quality improvement, quarantine programs should undertake frequent unannounced audits of IPC practices, to monitor compliance and identify and address system weaknesses.
- Quarantine programs may employ a range of tools to assist with monitoring and evaluation, in line with jurisdictional guidance. This may include additional surveillance tools to support compliance such as CCTV and buddy systems (see below). The designated IPC person or persons should support implementation and monitoring of these tools. Programs should undertake root cause analyses of incidents to identify issues and adjust mitigation measures. Quarantine sites should do this in consultation with the jurisdictional IPC expertise, including an individual experienced in root cause analyses.
- States and territories should establish clear governance arrangements to support controls and IPC practices in quarantine programs. This includes:
- Clear arrangements for supervising and training all staff (including health, security, cleaners, and cliental management) on required controls and IPC practices and behaviours, including the appropriate physical distancing and use and disposal of Personal Protective Equipment (PPE).
- Establishing arrangements for monitoring and maintaining supplies of appropriate PPE (including a diverse range of PPE to allow for differing fits). This should be managed at a jurisdictional level with all programs securing a minimum stockpile of PPE to ensure quarantined individuals can be appropriately managed and cared for at all times including in the unlikely event of an incursion.
- As outlined in the Continuous Improvement Framework, quarantine programs should adopt a culture of safety and constant vigilance. This may include training staff to raise concerns, and incorporating IPC refreshers into briefing and debriefing sessions.
