Table 1 Residential Aged Care Sector: context of the current study

Australia’s residential aged care sector is complex, with over 800 residential aged care providers from the private (for-profit), not-for-profit, and government sectors operating over 2700 RACFs [9]. Workforce turnover in the sector is high: the 2020 Australian Workforce Census reported 29% annual direct care staff turnover and 37% turnover of registered nurses in residential aged care compared to the national average of 7.5%. [10, 11]

Compared to hospitals, RACFs have fewer IPC resources such as on-site clinical staff with IPC expertise, and many have less direct access to diagnostic and support services. Staff responsible for IPC usually have multiple other responsibilities and are not trained to the same level as IPC practitioners in hospitals [12, 13]. There is also wide variation in staffing levels and skills mix in general, as highlighted by the Royal Commission into Aged Care Quality and Safety (2021) which found over half the residents were living in facilities with unacceptable levels of staffing [14]. Studies have also shown lower levels of staffing in RACFs, in particular, low proportions of registered nurses, were associated with greater risk of COVID-19 outbreaks [15, 16]

Aged Care IPC leads: As part of the Australian Government’s response to COVID-19 outbreaks in residential aged care, as of 1 December 2020 every RACF is required to appoint an on-site nurse as the IPC lead. The IPC lead role is to ensure the RACF is optimally prepared to prevent and respond to infectious diseases [17]. IPC leads must complete a specialist training course, be employed by the facility, and report directly to the provider. They are required to observe, assess, and report on IPC practices, help develop procedures, and provide advice to improve IPC within the service [17]

Several challenges related to the Aged Care IPC lead program have been reported, including a lack of a clear role description, new processes that added burden to an already overburdened job, issues related to the IPC lead training such as having to complete the training in a short period of time (6-month course condensed into 3-months) [18]. Many IPC leads have been appointed from existing members of the nursing staff and they tend to have a much broader role in the facility