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COVID-19 Bulletin: Monday 1 February

February 1, 2021

1. New: Be smart on uniforms

There is light at the end of what has been a very long and very dark tunnel for us all. As we continue our battles there’s a number of day-to-day today factors and processes that we can all do to help reduce risks and continue good healthcare practice. One item of note that has come up recently is that of uniforms.

It’s important we maintain uniform standards, including abiding by infection control protocols – being bare below the elbows in clinical areas (depending upon current PPE levels), etc.

To directly quote the NHS guidance on the matter: “Effective hygiene and preventing infection transmissions are absolutes in all healthcare settings. Although there is no conclusive evidence that uniforms and workwear play a direct role in spreading infection, the clothes that staff wear should facilitate good care practices and minimise any risk to patients. Uniforms and workwear should not impede effective hand hygiene and should not unintentionally come into contact with patients during direct patient care activities. Similarly, nothing should be worn that could compromise patient or staff safety during care, for example any nails products, rings, earrings other than studs, and necklaces.”

2. Update: Swabbing pathway changes

As always, we are constantly evaluating our procedures and recommendations to see what provides the best outcome. Sometimes this results in change: as a result of guidance from outside the Trust, in reaction to the changing situation in our local community, as a necessity due to altered supplies or the availability of our clinical partners, and of course our own findings as a healthcare Trust.

Our existing guidance relating to the swabbing pathway are the latest to receive an update.

In summary, the sensitivity of a PCR (polymerase chain reaction) test is around  80 per cent. With this in mind, colleagues must look at the clinical presentation with swab result  when deciding how to stream a patient. For example if the swab is negative but the clinical presentation is highly suggestive of COVID-19 they must be streamed onto a Red ward or for patient presenting with low suspicion of COVID-19 and in Red stream initially, with subsequent negative swab result must be transferred onto a Contact ward (Newton 3) while they await a further PCR test.

You can find the guidance in full on the Connect swabbing pathways page.

3. Reminder: Start the week safely, let’s talk PPE

After uniform, let’s talk PPE. A reminder once again that following further risk assessment in relation to PPE usage in our clinical areas, taking into account:

  • Current high volume of infection rates in the community
  • The corresponding high number of COVID-19 admissions
  • Some cases where patients on amber non-COVID wards have subsequently had a positive COVID PCR swab test after initial negative test
  • The ventilation in our ward areas.

The required level of PPE in these inpatient environments has increased for some staff. This is above and beyond the current national guidelines.  This is under constant review and may well change if the regular review of the risk assessment indicates that the risk is lowered.

For all inpatient areas where there is direct patient contact (in red and amber wards), staff should wear:

  • A silicone mask/FFP3 mask and a visor, these can be sessional use. Single use gloves and aprons (please ensure you have been fit tested for an FFP3 mask before use).
  • You should wear a fluid-resistant surgical face mask if you do not have direct patient contact.  Non-direct patient contact includes walking on a ward area, pharmacists, clerical staff, estates and facilities staff. Disposable gloves/aprons should be worn for contact with patients/immediate environment. Porters who are transferring patients should wear FFP3/silicone face mask when transferring patients to red and amber wards.
  • If you are visiting the ward from another area, a minimum requirement when entering the unit will be to wear a fluid resistant surgical face mask

Please note: staff must follow their individual risk assessment for PPE, occasionally this will recommend a higher level of protection depending on your individual assessment.

For all outpatients and community staff inclusive of health visitors/school nurses/GP practices, for staff visiting care home facilities, patients and families homes, surgical face masks and visors should be worn as a minimum with a disposable apron and gloves for direct patient care.

If clinical intervention is required, a clinical risk assessment should be undertaken prior to the contact to establish whether there is a requirement for a higher level of PPE.

For example if a patient with a known respiratory condition has a persistent cough (not COVID related), an FFP3 and a visor should be worn in the event that the contact is essential and cannot be delayed.

Porters and facilities staff on wards can continue to wear a surgical face mask. However, if they are in direct patient contact they will then need to follow the guidelines outlined above for inpatient staff.

If you have any questions please speak to your line manager or infection control who will advise you.