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Healthcare workers


Status of Covid-19

As of 19 March 2020, Covid-19 was classified as no longer being a High Consequence Infectious Disease (HCID) in the UK.

This revision was made from the interim decision made in January 2020. Now that more is known about Covid-19, the public health bodies in the UK have reviewed this information, analysing it against the UK HCID criteria. As a result of this analysis, in which several features of Covid-19 have changed throughout the pandemic, it is no longer classified as an HCID, upon the support from the Advisory Committee on Dangerous Pathogens.

Cases of Covid-19 are no longer managed by HCID treatment centres only and all healthcare workers who come into contact with a confirmed or potential coronavirus case should ensure they follow the national advised guidance in dealing with Covid-19.


Advice for workers in the Health Care sector

During this pandemic, those working in the healthcare sector, throughout the NHS and the private sector have found themselves on the frontline, working to keep up with the demand of Covid-19 related cases as well as existing patients. 

During this time, healthcare providers including assistants, porters, and cleaning staff, are particularly vulnerable due to their exposure to the viral disease.

These individuals are most at risk in environments where precautionary, preventative and controlling measures have not already been established to manage respiratory infections.

These individuals are also susceptible when providing care for patients who are carrying, but have not yet been diagnosed with, the virus.

Those employees who may be affected by, or more at risk of, Covid-19 include those working in the following healthcare roles:

  • Allied health professionals
  • Ambulance service teams
  • Dental teams
  • Doctors
  • Health informatics
  • Healthcare science workers
  • Management
  • Medical Associate professions
  • Midwifery
  • Nursing
  • Pharmacy
  • Psychologists
  • Public Health workers
  • Wider Healthcare team

 

Below is guidance for these individuals in order to minimise the risks both to themselves and within their wider working environments.


Changes in General and Administrative Measures

  • Appoint a designated leader on the prevention, control and preparedness effort. This is a way of ensuring clarity and consistency.
  • All staff in a healthcare facility – not only healthcare workers themselves – should be involved in ongoing training sessions.
  • Ensure communication around hand and respiratory hygiene should be made clear to staff, patients and visitors.
  • Visitors should be kept to an absolute minimum. However, records of all visits should be maintained to help with contact tracing.
  • Equally, records of all staff providing care for Covid-19 cases should be maintained.

It is vital that bank, agency and locum staff follow the same deployment advice as permanent staff.


Triaging and Assessment

As of 13 March 2020, individuals with mild Covid-19 symptoms (fever and/or continuous cough) are asked to stay at home.

Triage should be undertaken by telephone or online where possible and risk assessments, aimed at establishing a patient’s medical and travel history, should be undertaken immediately upon presentation at a care facility.

Before engagement with patients, it is important that all staff who have patient contact are kept abreast of the latest epidemiologic situation in their locality (regionally and nationally), as well as understanding patient symptoms, risks, preventative measures and so on.

Surgical masks should be used by all patients showing any respiratory symptoms.


PPE and Medical Equipment

PPE should be put on and removed in an order that minimises the potential for self-contamination.

Standard disposable PPE (gloves, goggles, gowns and FFP2/3 respirators) should be used as a minimum to protect against droplet and airborne transmission of the virus.

The order for PPE removal is gloves, hand hygiene apron or gown, eye protection, hand hygiene, surgical face mask or FFP3 respirator, hand hygiene.


Cohorted areas

Where no patient contact is required

DO use a surgical mask when:

  • Cleaning the room, cleaning equipment, discharging, entering patient rooms.

Where close patient contact is required (within one metre)

Wherever possible, maintaining a one-metre distance from infected patients is advisable, and each worker should, as a general rule, take ongoing precautions to protect their mouth, nose and eyes.

When providing patient care, conducting a direct home care visit, diagnostic imaging, phlebotomy services, or physiotherapy etc, the following PPE should be worn:

  • Surgical mask
  • Apron
  • Gloves
  • Eye protection (if risk of contamination of eyes by splashes or droplets)

Staff Cohorting

Assigning a dedicated team of staff to care for patients in isolation/cohort rooms/areas is an additional infection control measure.

This should be implemented whenever there are sufficient levels of staff available (so as not to have a negative impact on non-affected patients’ care).

Staff who have had confirmed Covid-19 and recovered should continue to follow the infection control precautions, including personal protective equipment (PPE)

Domestic/cleaning staff performing environmental decontamination

Any domestic or cleaning staff performing environmental decontamination should:

  • Be allocated to specific area(s) and not be moved between Covid-19 and non-Covid-19 care areas.
  • Be trained in which personal protective equipment (PPE) to use and the correct methods of wearing, removing and disposing of PPE.
  • Keep the care environment clean and clutter free.
  • Remove all non-essential items including toys, books and magazines from reception and waiting areas, consulting and treatment rooms, emergency departments, day rooms and lounges.
  • Clean all toys regularly (preferably at the same time as the environment).

High Risk Areas and ICU

When carrying out aerosol generating procedures (AGP) on a patient with possible or confirmed Covid-19 in high risk areas where AGPs are being conducted (eg: ICU).

Activities that require an FFP3 respirator as advised by Public Health England:

  • Intubation, extubation and related procedures such as manual ventilation and open suctioning
  • Tracheotomy/tracheostomy procedures (insertion/open suctioning/removal)
  • Bronchoscopy
  • Surgery and post-mortem procedures involving highspeed devices
  • Some dental procedures (such as high-speed drilling)
  • Non-Invasive Ventilation (NIV) such as Bi-level Positive Airway Pressure (BiPAP) and Continuous Positive Airway Pressure ventilation (CPAP)
  • High-Frequency Oscillating Ventilation (HFOV)
  • High Flow Nasal Oxygen (HFNO), also called High Flow Nasal Cannula
  • Induction of sputum

As well as the requirement of an FFP3 respirator, a long-sleeved disposable gown, gloves and disposable eye protection should be worn.

Ambulance workers

It is advised by Public Health England that if AGP has been performed, paramedics are required to wear a pair of inner and outer gloves as well as coveralls and the standard healthcare PPE for contact with suspected Covid-19 cases.

Equipment required for AGP (FFP3 facemask and eye protection)

  1. Outer pair of gloves
  2. Coveralls
  3. Inner pair of gloves
  4. Eye protection
  5. FFP3 facemasks
  6. hand decontamination

AGPS: Ambulances

If AGPs have been performed (such as intubation, suctioning, or cardiopulmonary resuscitation), the vehicle will require an enhanced decontamination of all exposed surfaces, equipment and contact areas with a chlorine-based product before it is returned to normal operational duties.

  • appropriate PPE must be worn to decontaminate the vehicle - as a minimum this should include a fluid-repellent surgical mask, eye protection, apron and gloves;
  • any exposed equipment (in other words, anything not stored in closed compartments) left on the vehicle will require decontamination with a universal detergent, followed by chlorine-based solution at 1,000 parts per million
  • starting from the ceiling of the vehicle and working from top to bottom, following a systematic process, all exposed surfaces will require decontamination with a universal detergent followed by a chlorine-based solution at 1,000 parts per million
  • pay special attention to all touch points
  • ensure that the stretcher is fully decontaminated, including the underneath and the base
  • the vehicle floor should be decontaminated with a detergent solution followed by a chlorine-based solution at 1,000 parts per million

PPE Shortages

Where there are shortages, supplies should be prioritised for aerosol-generating procedures.

The WHO recommends ‘the following temporary measures could be considered independently or in combination, depending on the local situation:

  1. PPE extended use (using for longer periods of time than normal according to standards);
  2. Reprocessing followed by reuse (after cleaning or decontamination/sterilization) of either reusable or disposable PPE;
  3. Considering alternative items compared with the standards recommended by WHO.’

For more information on PPE shortages, visit the WHO website.

Cleaning of communal areas

If a suspected Covid-19 case spent time in a communal area – for example, a waiting area or toilet facilities – then these areas should be cleaned with detergent and disinfectant (as above) as soon as practicably possible, unless there has been a blood or body fluid spill, which should be dealt with immediately. Once cleaning and disinfection have been completed, the area can be put back into use.

Staff uniforms/clothes

The appropriate use of personal protective equipment (PPE) will protect staff uniform from contamination in most circumstances. Healthcare facilities should provide changing rooms/areas where staff can change into uniforms on arrival at work.

Organisations may consider the use of theatre scrubs for staff who do not usually wear a uniform, but who are likely to come into close contact with patients e.g. medical staff.

Healthcare laundry services should be used to launder staff uniforms. If there is no laundry facility available, uniforms should be transported home in a disposable plastic bag. This bag should be disposed of into the household waste stream.

Uniforms should be laundered:

  • separately from household linen
  • in a load not more than half the machine capacity
  • at the maximum temperature the fabric can tolerate, then ironed or tumbled-dried.

It is best practice to change into and out of uniforms at work and not wear them when travelling, although this is based on public perception rather than evidence of an infection risk. This does not apply to community health workers who are required to travel between patients in the same uniform.

Travelling for work

IOSH recommends the following key actions organisations can take to manage traveller health, safety and wellbeing:

  • To effectively manage travel risk, you need to ensure you have proportionate and robust policies, procedures and controls in place. Communicate them to all relevant parts of your organisation, providing information, instruction and training as appropriate.
  • Consider whether the travel is absolutely necessary: can you achieve the same result with video conferencing and spare the organisation and traveller the risk, time, cost and environmental impact? Situations such as the coronavirus outbreak in China as well as geopolitical conflicts, terrorism and natural disasters can change rapidly, potentially leaving travellers stranded or quarantined. It is therefore important to make ‘fly/no fly’ decisions based on best available guidance such as government travel advice.
  • If travel is deemed necessary then you need to effectively but proportionately manage the risk, with controls identified and implemented which reflect the nature and severity of the risk. Such controls should be identified through a travel risk assessment incorporating not only the travel, accommodation and work itself but also the traveller’s physical and mental capabilities. The travellers themselves should be involved in this process.
  • You will always need to know where your workers are and where they are going. Some travel management systems provide tracking and alert functions, and there are also products utilising GPS in either discrete equipment or smartphone apps which can provide live location tracking.
  • Should your travellers become involved in an incident or emergency situation, you need to have a means by which to provide support for them. Considering issues such as number of travellers, international time differences and weekend travel it is potentially cost and resource-effective to implement a travel assistance scheme such as those provided by business insurers or commercial organisations such as International SOS. Additionally, business should source local emergency phone numbers in country, giving employees quick access to assistance. Most schemes and business travel insurance packages offer a 24/7 helpline which triggers support services for the traveller, providing assistance with medical treatment and repatriation due to injuries and illness as well as helping with lost documents, stolen money and other common travel-related problems.
  • You should also provide relevant information, instruction and training to travellers, the nature and extent of which should be identified during the risk assessment process.
  • Finally, don’t forget your travellers’ wellbeing. Frequent international travel has been shown to have negative effects on both physical and mental health, with situations such as a disease outbreak providing further sources of concern.

Additional resources

For the latest changes in advice and guidance for national infection (IPC) on Covid-19 please visit: Infection prevention and control guidance for pandemic coronavirus.

Advice for first responders (as defined by the Civil Contingencies Act) and others who may have close contact with symptomatic people who may have Covid-19.