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COVID-19 Bulletin: Wednesday 11 November

November 11, 2020

To keep up to date with the pace of change we will be sharing a bulletin on a daily basis. There’s a lot of change taking place at the moment so please make sure you catch up with the latest bulletins throughout the week, as even if some points seem familiar you may very well find the details have been updated a great deal.

 During this second lockdown restrictions, we must ensure we look after ourselves and others within our community. Make sure you keep in touch with those you love and your neighbours. People may well be feeling anxious, lonely and scared at this time. Thank you for looking out for one another.

  1. Reporting hospital acquired COVID-19

We are now required to report all incidences of hospital acquired COVID-19 as a patient safety incident both locally and nationally. The aim is to share any emerging understanding on how and why infection has occurred.

Please see the pathway which details the process to follow for reporting, reviewing and investigating hospital-onset COVID-19 cases and COVID-19 deaths. You are also encouraged to read the guidance provided by NHS England and NHS Improvement.

The Root Cause Analysis tool is available on Connect.

We must all continue to do what we can to reduce the risk of spread of COVID-19 infection in hospital by following the well-publicised infection control processes.

2. Face masks to be worn in all Trust buildings at all times

Alongside social distancing and stringent hand hygiene, there is now a requirement to ensure you are wearing a face mask in all Trust buildings at all times whether in a clinical setting or office.

 Steps for all colleagues to take:

  1. All colleagues will need to wear a fluid resistant surgical face mask while inside all SWBH buildings. Masks are available at the welcome stations in the main entrances to each clinical building. Alternatively departments can order and collect masks from stores.
  2. A mask needs to be worn throughout the duration of the time spent in the SWBH buildings.
  3. When leaving work it is essential that masks are disposed of safely when finished. In non-clinical areas they can be disposed of in a black bag waste bin. PPE disposal process in clinical areas remains unchanged. Remember to maintain frequent handwashing/ sanitising at all times.
  4. Face masks must be worn at all times unless you are working in a room on your own. If you leave that area for any reason or someone else enters the room, you MUST immediately wear a mask. This includes corridors and communal areas.

Patients are also asked to wear a mask when they are moving about in the ward or sitting in the bedside chair. Please continue to inform and encourage our admitted patients to wear masks when possible during their stay.

Wear your mask properly

Masks only work if they are worn properly, we have all seen people wear masks in some truly bizarre ways.

The instruction here is simple – your mask should cover your mouth and your nose.

Protecting your skin from damage beneath PPE

If you are finding that your masks are uncomfortable or are causing you issues with your skin, please take the time to read the helpful guidance produced by the tissue viability team for colleagues to protect and treat skin from damage beneath PPE 

3. Sweet treat scrubs amnesty next week at Sandwell Hospital

Next week we will be encouraging colleagues at Sandwell to ‘Scrub in’ and return scrubs that may have made their way in to their lockers or home. No questions will be asked, each and every staff member who returns scrubs will earn themselves a delicious chocolate bar.

Currently we do not have sufficient sets of scrubs to meet the increase in demand as many have been stored and stockpiled by individuals, contrary to Trust policy.

On the 17, 18 and 19 November a drop off point will be available in the main reception at Sandwell Hospital where returned scrubs can be deposited and once laundered will return back in to circulation.

The systematic supply and laundering of the scrubs is dependent on staff returning them at the end of their shift pattern, when people take scrubs home or store them in their lockers they remove them from our stock and deplete the numbers available for circulation, putting a strain on supplies and our ability to provide scrubs where they are required.

Please support us by taking scrubs to the drop off point at Sandwell Hospital main reception next week, and earn yourself a tasty treat for your journey home.

No Scrubs rules:

  • No scrubs should be stockpiled in lockers – they must be laundered regularly on site
  • No scrubs should be worn in undesignated areas
  • No scrubs should be binned, they should be deposited in to the blue trollies situated on the links and in departmental areas
  • No scrubs should be worn outside the hospital or while travelling to and from hospital or taken home for laundering. By doing so you are putting yourself, your family and the public at risk.

Remember, when the amnesty is over, managers and colleagues alike will be challenging colleagues they see arriving or leaving work in scrubs.

4. Microbiology – change of routine test provision

Due to the pandemic, Black Country Pathology have temporary reduced their test repertoire. They have now ceased processing samples of limited clinical value, with the caveat that they retain the ability to test individual samples if, after discussion between clinicians, it will have impact on the patient’s clinical management.

  1. Mycology – toenail clippings and skin scrapings will not be processed for microscopy or fungal culture. Treat patients on clinical grounds.
  2. Sputum samples – these will only be processed for specific locations such as critical care, respiratory wards/clinics and immunocompromised patient areas such as Haematology/Oncology. Please manage other patients clinically.
  3. Urine microscopy and culture – The majority of BCPS sites had to suspend microscopy early in the pandemic. They now need to suspend culture of clear urine samples. These will be reported with a comment “Urine clear. Infection unlikely. Consider repeat or empirical treatment if symptoms change.” They will only continue to process pre-operative urology urine samples where it is clearly stated in clinical details that the urine sample is pre-operative.
  4. Genital swabs – (except where clinical details specifically state STI or pregnant) will no longer be processed.
  5. Swabs from chronic wounds – (e.g. ulcers) will not be processed.
  6. Catheter specimens of urine – will not be processed unless specifically discussed with a microbiologist that this will change management.
  7. Parasitology – stool samples will no longer be processed unless there are specific clinical details of travel dates and destinations outside of Europe (unlikely now due to COVID-19) or that the patient is immunocompromised.

For more information read the notice in full by clicking here.

Whilst the general principles above apply across the BCPS laboratory sites, we appreciate that some local detail to clarify acceptance/rejection criteria is required. The laboratory on the SWBH site will continue to process the above sample types providing this information is clearly included in the clinical details of the accompanying request. Please see further detail on the last page of the notice.

5. Managing patients who have returned from Denmark  

You will have heard in the news about wide scale out breaks of SARS-CoV-2 in mink farms in Denmark. SARS-CoV-2 is known to cause clinical disease in various domestic and wild animals, in particular, mink.

Five clusters, comprising 214 people, of different mink-variant SARS-CoV-2 viruses have been identified in Denmark, primarily in the North Jutland region. On 4 October 2020, Danish authorities reported that sequencing of SARS-CoV-2 isolates from affected mink farms had identified seven unique mutations within these mink-variant viruses.

The Department of Health and Social Care have recommended that any patients who present at our hospitals are treated using the MERS pathway. If a patient presents with COVID-19 symptoms and has travelled from Denmark in the last 14 days they must go to single room with en-suite facilities. If they test positive for COVID-19, they should be immediately transferred to a specialised infectious diseases centre which can be arranged by contacting NHSE Regional EPRR/First on call who will arrange the transfer to the commissioned units.

Here is a summary of the guidance:

  • Patients must be admitted directly to single/negative pressure/HBN04 rooms wherever possible; avoid admission via ED and AMU.
  • Patients who present in ED must be placed in a single room whilst awaiting assessment. Staff must wear protective clothing. Rooms to be appropriately decontaminated before being used again.
  • Patients must be nursed in a single room with negative pressure/HBN04 facility. If this facility is not available then a neutral pressure single room, preferably with en-suite facilities should be used. Room doors must be kept closed.
  • Positive pressure single rooms must NOT be used.
  • Suitable information must be placed on the isolation room door indicating the need for isolation, though there will be a need to respect patient confidentiality.
  • Essential staff only must enter the isolation room.
  • Should numbers of affected patients be such that single room isolation is not possible patients may be cohorted together in a bayed area. The above recommendations should still apply. A risk assessment to be carried out with the infection prevention and control team.
  • Rooms/areas that have air conditioning systems must have them turned off and not restarted until patient discharged and decontamination performed.

More information is available in the guidance.