COVID-19 Bulletin: Wednesday 8 July

July 9, 2020

This is our weekly bulletin and will be issued every Wednesday. Please use this bulletin and cascade arrangements within care and corporate groups to guide your actions. We are determined to reduce avoidable harm and death in the people we are taking care of. Kindness remains the guiding principle of all the actions in our work to tackle the virus – kindness in how we look after patients, visitors, and one another.

Numbers not statistics: Today’s totals (Wednesday 1 July’s totals)

1. Don’t forget to complete your COVID-19 assessment

Our Trust is providing COVID-19 risk assessments for all of our colleagues to help categorise the level of risk to each individual person and enable managers to be provided with the actions they are required to take to keep colleagues safe at work. We launched the risk assessments a few weeks ago and colleagues to date have been able to contact occupational health to have their assessment completed.

Unless you have already had this assessment with occupational health please complete the form here: COVID Risk Assessment Form

Completed risk assessments should be sent to swbh.riskassessmentoh@nhs.net.

Thank you to the many colleagues (over 2000 of you) who have already completed and sent back their risk assessment form. Anyone who has responded so far should get a response letter from occupational health this week.

All the data is collated and aggregated within occupational health. As an organisation we are required to report nationally on the following:

• Number of staff risk-assessed and percentage of whole workforce.
• Number of black, Asian and minority ethnic (BAME) staff risk assessments completed, and percentage of total risk assessments completed and of whole workforce.
• Percentage of staff risk-assessed by staff group.
• Additional mitigation over and above the individual risk assessments in settings where infection rates are highest.

For more information please call 0121 507 3306.

2. Red vs Blue: New ED streaming criteria

Changes to the red/hot and blue/cold ED streaming criteria, as agreed by the ED, acute medicine, respiratory and microbiology teams rolled out yesterday.

Patients presenting with following conditions should be streamed to the RED stream:

1. An influenza like illness or fever >37.8, with one of the following respiratory symptoms, which must be acute in onset: a new persistent cough (with or without sputum), hoarseness, nasal discharge or congestion, shortness of breath, sore throat, wheezing or sneezing.
2. A new loss of sense of smell or taste (anosmia) either in isolation or combination with any of the other symptoms.
3. A new onset of persistent cough.
4. A new and unexplained shortness of breath.
5. A recent COVID-19 positive test (within last 28 days) with any new systemic or unexplained symptom.
6. History of exposure to a COVID-19 positive patient within the last 14 days and symptomatic with any of the above symptoms (contacted by NHS Test and Trace).
7. Any patient in cardiac arrest, needing AGP ( Airway management/support in low GCS patients or conscious sedation), needing chest procedures (seldinger/surgical drain) should be streamed to the RED

The following patients can be streamed to the BLUE stream :

1. Patients known to have COPD/asthma or cardiac failure presenting with symptoms in keeping with exacerbation.
2. Patients with fever with clear alternative (non-COVID) explanation.

3. Swabbing patients – Do you know when and how often you should be swabbing?

It is vital that inpatients are not only placed in the right care environment (Red, Lilac , Blue ward) but also that swabbing is carried out appropriately and effectively in each environment.

Remember:

1. Every patient MUST be swabbed on admission.
2. Patients on Lilac wards MUST be swabbed every 3 days.
3. Patients on Blue wards MUST be swabbed every 5 days.

Alongside swabbing at the right time, it’s critical that swabbing is carried out using the right swabbing kit and collected in the right manner.

White\Green\Yellow swab kits should be used for all inpatient swabs and for retesting in blue and lilac areas.

Black swabs are only for urgent testing in pre-agreed areas. Pre-agreed areas include:

• Patients being admitted through the red stream in ED/AMU.
• Patients in blue or lilac wards. If they develop new or worsening symptoms, they must be promptly isolated and urgently swabbed for a quick 2hrs COVID PCR.

Please note, if samples are not appropriately packaged with three patient identifiers they will be rejected. Similarly, all lids on red and green tubes must be secured properly. Any leaking samples will be rejected to ensure our lab safety is not compromised. Thank you for your understanding and continued support.

 Guidance on how to collect samples is available in the linked document.

• COVID-19 Patient Swabbing Guidance

Where swabs are taken, colleagues must ensure that they are hand delivered to the pathology departments as soon as possible so that they can be tested and reported without delay. Samples must not be left on wards for extended periods of time as this significantly delays the time taken to report results and ultimately puts patients and colleagues at risk.

Triple bagging swab samples for safety

Remember when you are bagging your swab sample, you must ensure the red topped bottle is first put in a clear specimen bag, this should then be placed in a clear zip lock bag and finally packaged in a blue specimen bag alongside any paperwork.

4. SIREN sounding out new R&D study

Our research and development team are pleased to announce the launch of an exciting new study called SIREN which is expected to open in the next few days. The principal investigator for the study is Dr Masood Aga, Consultant and Specialty Lead in Occupational Medicine. The overall aim of this study is to determine if previous COVID-19 infection in healthcare workers confers future immunity from having the infection again. It will also look at any new infection and therefore will involve both repeat swab and the antibody blood test every two weeks on average (variable from 1 to 4 weekly sampling), for one year. The study is not blinded and participants will know their results after each test.

The study is open to healthcare workers in a clinical setting where patients are present. If you are currently participating in any other research, the team would need to discuss this with you individually. As part of recruitment, the team will be offering consent conversations on a one-one basis or as groups via Webex or face to face, if you would prefer. Appointments will be made at a time that is convenient to participants and recruitment will be taking place at City & Sandwell Hospitals.

More information will follow in subsequent bulletins and will also be on Connect when the study is ready to accept participants.

The research team continue to work on a wide selection of urgent public health COVID-19 studies and three further patient studies will open in the next couple of weeks. One of these; FALCON is looking at different new diagnostic tests for COVID-19. Prof Dan Lasserson is the principal investigator and the study is expecting to recruit in the emergency departments.

Each week the COVID-19 bulletin features the number of patients recruited into research projects. This number (156 this week) only includes patients where there has been a consent discussion either with the patient, a family member or the treating team. There are six other studies where data is being returned by the research or treating teams, the data on more than 780 patients has been completed or completion is underway.

A number of clinicians within the Trust have developed their own COVID-19 research protocols and two projects are underway with several others being progressed. If you are planning on do this, please liaise with Zaida Khalil, RM&G Manager, early in your study development as she will be able to advise on HRA approval and completing the IRAS form.

5. PPE hub on the move at City

An important note for those at City Hospital regarding PPE and scrubs.

As of Monday 13 July the PPE hub presently on D18 at City will be relocating to the reception area outside the Foot Health and Diabetes Outpatients Clinic – on the first floor, just above Arches Cafe.

This area is sufficient for PPE but unfortunately cannot facilitate space for scrubs. Scrubs should therefore only be collected from the wards where they are delivered daily.

Are you wearing your mask correctly?

Speaking of PPE, it is important that masks are worn correctly over the mouth and nose to protect your airways – your chin and neck are not the areas in need of protection! A guide to putting on a clinical mask correctly can be seen on the right.

6. Domestic abuse and the ‘5 R’s of Enquiry’

As you may have seen in the news, there has been increasing concern during the pandemic at the prospect of an increase in cases of domestic abuse. Likewise due to COVID-19, victims of domestic abuse may struggle to get help or to access support services. Presenting for clinical care may be the only opportunity to offer support.

The ED independent domestic violence advisor service is still supporting victims that come through ED. They can be contacted on 07823 336964 (Sandwell) and 07989 843233 (City).

Alternatively, you can contact the safeguarding team on ext. 2844, Monday-Friday, 9am-5pm.

Note: It may not be safe for the team to make contact with a victim once they have left ED or hospital. If this is the case and it is safe to do so, please give them any of the Black Country Women’s Aid contact details listed below:

• Text/WhatsApp referral option: 07384 466181 (messages checked Monday-Friday, 9am-9pm)
• 24-hour helpline: 0121 552 6448
• Email:  idva@blackcountrywomensaid.co.uk (messages checked Monday-Friday, 9am-5pm)

As well as women, the ED independent domestic violence advisor service and Black Country Women’s Aid also support men who are victims of domestic abuse/sexual abuse/forced marriage/same sex relationships/historic domestic/sexual abuse. Helplines can also be found listed below.

• Men’s advice line helpline: 0808 801 0327
• Mankind helpline: 01823 334244

 If you would like to learn more about learning how to spot signs of domestic abuse, as well as guidance on “The 5 R’s of Enquiry” that can be used when speaking with patients at home or online please click here.

7. Let your mental health Thrive

As always, we end with a note about your wellbeing. We continue to talk about this as it is not something the Trust takes lightly.

We know that sometimes it can feel like life is conspiring against you and that things start to get top of us. Negative experiences can linger far past the initial impact and it is important to address that. There are numerous projects around the Trust, such as the Recharge Booth but you may not be aware that we also have an app specifically for wellbeing.

The Trust have partnered with Thrive to give you exclusive access to an award winning mental health and wellbeing app that can help with managing depression, anxiety and stress.

The app tackles common stressors such as sleep, bereavements, work issues and more. It also signposts to external support services – with users able to seek immediate help directly from the app.

1. Go to https://swb.thrive.uk.com/ to create an account and claim your free access to Thrive.
2. visit the Google Play or App Store and search and download the Thrive: Mental Wellbeing app.
3. Log in using the email and password you created your account with and enjoy using the app

To find out more about how Thrive can help you, and how to access it, click here.

You can also access the full range of health and wellbeing support on Connect.

The Connect Coronavirus page is continually being updated with the latest news and guidance regarding the virus, please take the time to read and familiarise yourself with the available guidance.