Infection prevention FAQs

The transmission of COVID-19 is thought to occur mainly through respiratory droplets generated by coughing and sneezing, and through contact with contaminated surfaces.

Note these can be symptoms of flu as well as other common respiratory infections:

•           new onset continuous cough

•           high temperature, fever or chills

•           loss of, or change in, normal sense of taste or smell

•           shortness of breath

•           unexplained tiredness, lack of energy

•           muscle aches or pains that are not due to exercise

•           loss of appetite

•           headache that is unusual or longer lasting than usual

•           sore throat

•           a blocked or runny nose

•           diarrhoea

•           feeling sick or being sick

Patients frequently have lymphopenia and chest x-rays may show bilateral pulmonary infiltrates.

For contact tracing purposes current guidance indicates that someone with COVID-19 should be considered infectious from 48 hours beforesymptom onset until up to 10 days after symptom onset or until 48 hours from symptom resolution (not including a cough or loss of sense of smell or taste), whichever is longest. Emerging evidence, although still limited, shows that people with COVID-19 who are mildly ill and are recovering have a low but real possibility of infectiousness between 7 and 9 days after illness onset. This duration could theoretically be longer in immunosuppressed patients or patients with severe illness requiring ITU admission.

Any patient requiring admission to hospital with symptoms/clinical or radiological evidence of COVID-19, pneumonia, acute respiratory distress syndrome or influenza like illness (or develop these after admission), do the following immediately:

1. Isolate patient in a single room with respiratory precautions (if no side room is available, patient can be cared for in a bay with appropriate precautions).

2. Minimise number of staff entering the room.

3. Wear the appropriate PPE: Click here to see a summary of PPE to be worn

4. Send samples for testing, in addition to usual investigations appropriate to the patient’s clinical condition, as per GOV.UK guidance. COVID-19 test can be requested on Careflow (under the test name COVID-19 Novel Coronavirus PCR and on the ‘Test required’ drop down, select ‘SYMPTOMATIC patient test’.

The infection control precautions are discussed further in the section “What infection control precautions are required for a patient that meets the criteria for possible COVID-19 or is confirmed positive for COVID-19?”

There is only a limited availability of rapid/urgent tests for COVID-19. Extremely exceptional requests (i.e. where the result will make an immediate and significant difference to patient management compared with routine non-rapid testing of which results are available within 24 hours), must be discussed on a case by case basis with the laboratory. Note: exceptions do NOT include requests for rapid testing to facilitate same day discharge to care home or with domiciliary care; to determine ward/bed space placement of new admissions or pre-operative testing.

Non-rapid testing is done at the Microbiology Laboratory at Whiston and the turnaround time for results is within 24 hours of the receipt of sample in the laboratory.

COVID-19 tests can be requested on Careflow under COVID-19 Novel Coronavirus PCR.

There is a drop down box to select the test required as shown below:

Please note guidance related to COVID-19 is updated regularly hence always refer to the most up to date version of the guidance online at https://covid.sthk.nhs.uk/

When managing such patients there is the requirement for specific PPE and wherever possible to place the patient in an isolation room or single room. Minimise the staff entering the room.

The trust PPE guidance follows the national guidelines which can be found here

Please note that this PPE guidance (as well as other general infection prevention measures) must be adhered to regardless of whether staff members have had confirmed COVID-19 infection in the past and regardless of whether they have antibodies against COVID-19.

The type of PPE required is dependent on whether aerosol generating procedures (AGPs) are being carried out. Further details regarding AGPs are given at Aerosol Generating Procedures – STHK COVID-19 Guidance.

Upper respiratory tract sample(s) either nose and throat swab in viral transport medium (single swab used for throat then nose into one pot of viral transport medium OR a viral nose swab and a viral throat swab combined into one pot of viral transport medium – bacterial or charcoal swabs are not suitable)
OR a nasopharyngeal aspirate in a sterile universal container
OR ideally if obtainable
Lower respiratory tract sample (sputum or BAL), in sterile universal container.

Neck breathers (tracheostomy/laryngectomy patients) should have their stoma swabbed if it is accessible and not contraindicated for some reason.

It is important to ensure a good sample is taken (taking time to swab the back of the throat or equivalent), as a poor quality sample may lead to no result, potentially a long delay and the test having to be repeated. All samples should be double bagged (which can be clear sealable plastic bags or usual request form bags). Specimens can be sent to the laboratory via the air tube/pod system as long as they are packaged correctly.

Please ensure the samples are labelled appropriately (viral swab container and blood bottle with patient details).

During periods of high prevalence of other respiratory viruses (e.g. the winter season), the laboratory will be providing PCR testing for influenza A/B and RSV (respiratory syncytial virus) in addition to SARS CoV-2/COVID-19 for patients with symptoms of respiratory viral infection.

For these patients select ‘SYMPTOMATIC patient test [COVIDS]’ on the CareFlow dropdown menu on the COVID-19 Novel Coronavirus PCR test request (or write COVIDS in the clinical details section on any hand written requests) . There is no need to request testing for influenza/RSV separately.

All the above tests will be performed on a single sample (i.e. either viral nose swab and a viral throat swab combined into one pot of viral transport medium; single viral swab used for throat then nose into one pot of viral transport medium or  nasopharyngeal aspirate in a universal transport pot).

During low prevalence of influenza/RSV symptomatic patients will be tested for SARS CoV2/COVID-19 only with the exception of ICU and haematology patients who will still be tested automatically for an extended virus panel. If testing for additional respiratory viruses is clinically indicated on any other patients, please discuss with the Microbiology Laboratory on extension 1837 on a case by case basis.

Samples will be tested at the Whiston laboratory and non-urgent tests will be resulted within 24 hours.

Rapid tests are performed, when meeting the eligibility criteria, in the Whiston microbiology laboratory and results can be available within 2 hours of the sample reaching the laboratory.

Negative AND positive results will be reported directly on to Careflow. Ward clinical teams must check results regularly. The clinical team in charge of the patient’s care is responsible for communicating the result to the patient.

All linen used in the direct care of patients with suspected and confirmed COVID-19 should be managed as ‘infected’ linen as per the Laundry Policy. Linen must be handled, transported and processed in a manner that prevents exposure to the skin and mucous membranes of staff, contamination of their clothing and the environment.

• Wear disposable gloves and apron when handling linen.
• All linen should be handled inside the patient room/cohort area. A laundry receptacle should be available as close as possible to the point of use for immediate linen deposit.

PPE should be worn by staff, including domestic staff, as described above. Decontamination of equipment and the care environment must be performed using: 

A combined detergent/disinfectant solution at a dilution of 1000 parts per million chlorine (e.g. Chlorclean). 

a. Equipment

Patient care equipment should be single-use items if possible. Reusable (communal) non-invasive equipment should as far as possible be allocated to the individual patient or cohort of patients.

Reusable (communal) non-invasive equipment must be decontaminated:

• between each patient and after patient use;
• after blood and body fluid contamination; and
• at regular intervals as part of equipment cleaning.

An increased frequency of decontamination should be considered for reusable non-invasive care equipment when used in isolation/cohort areas.

Avoid the use of fans that re-circulate the air.

There is no need to use disposable plates or cutlery. Crockery and cutlery can be washed by hand or in a dishwasher using household detergent and hand-hot water after use.

b. Ventilators

• Ventilators should be protected with a high efficiency filter, such as BS EN 13328-1.
• Closed system suction should be used.

c. Environment

• Patient isolation/side rooms, cohort areas and clinical rooms must be decontaminated at least daily with 1000ppm chlorine/Chlorclean. Note that domestic staff are able to perform their usual duties in areas including side rooms/isolation rooms where there are current patients who are suspected or confirmed positive COVID-19 while wearing the appropriate PPE.
• Patient cubicles and bay bed spaces must be terminally cleaned (with 1000 part per million chlorine/Chorclean). This clean can be done by ward domestic staff during normal hours rather than awaiting Rapid Clean Team. For vacated bed spaces, curtains must also be changed as a part of the terminal clean. The Rapid Clean Team to be contacted to change the curtains

When a patient with confirmed or suspected COVID-19  is discharged or transferred, select one of the COVID options on the barrier clean request page of the patient flow dashboard. There are three options:

• COVID (normal working hours) curtain change only – bed space to be cleaned with 1000ppm chlorine by ward staff. Rapid clean team to be contacted to change the   curtains.
• COVID (out of hours) – BAY BED space curtain change only, bed space to be cleaned with 1000ppm chlorine by ward staff. Rapid clean team to be contacted to change the   curtains.
• COVID (out of hours) – CUBICLE cleaned by Rapid Clean Team

Following resolution of symptoms, the bed space should be cleaned with 1000ppm chlorine by ward staff, curtain change not required.

Once room is vacated by staff following an AGP the bed space should be cleaned with 1000ppm chlorine by ward staff, curtain change not required.

An increased frequency of decontamination should be incorporated into the environmental decontamination schedules for areas where there may be higher environmental contamination rates e.g.

• toilets/commodes particularly if patients have diarrhoea; and
• “frequently touched” surfaces such as medical equipment, door/toilet handles and locker tops, patient call bells, over bed tables and bed rails should be cleaned at least twice daily and when known to be contaminated with secretions, excretions or body fluids. 

Domestic/cleaning staff performing environmental decontamination should:

• Be allocated to specific area(s) and not be moved between COVID-19 and non-COVID19 care areas
• Be trained in which personal protective equipment (PPE) to use and the correct methods of wearing, removing and disposing of PPE.

The care environment should be kept clean and clutter free. All non-essential items including toys, books and magazines should be removed from reception and waiting areas, consulting and treatment rooms, emergency departments, day rooms and lounges. When made available, these items should not be shared. All toys must be cleanable and should be cleaned regularly (preferably at the same time as the environment).

PPE should be worn by staff, including domestic staff, as described above. Decontamination of equipment and the care environment must be performed using: 

A combined detergent/disinfectant solution at a dilution of 1000 parts per million chlorine (e.g. Chlorclean). 

a. Equipment

Patient care equipment should be single-use items if possible. Reusable (communal) non-invasive equipment should as far as possible be allocated to the individual patient or cohort of patients.

Reusable (communal) non-invasive equipment must be decontaminated:

• between each patient and after patient use;
• after blood and body fluid contamination; and
• at regular intervals as part of equipment cleaning.

An increased frequency of decontamination should be considered for reusable non-invasive care equipment when used in isolation/cohort areas.

Avoid the use of fans that re-circulate the air.

There is no need to use disposable plates or cutlery. Crockery and cutlery can be washed by hand or in a dishwasher using household detergent and hand-hot water after use.

b. Ventilators

• Ventilators should be protected with a high efficiency filter, such as BS EN 13328-1.
• Closed system suction should be used.

c. Environment

• Patient isolation/side rooms, cohort areas and clinical rooms must be decontaminated at least daily with 1000ppm chlorine/Chlorclean. Note that domestic staff are able to perform their usual duties in areas including side rooms/isolation rooms where there are current patients who are suspected or confirmed positive COVID-19 while wearing the appropriate PPE.
• Patient cubicles and bay bed spaces must be terminally cleaned (with 1000 part per million chlorine/Chorclean). This clean can be done by ward domestic staff during normal hours rather than awaiting Rapid Clean Team. For vacated bed spaces, curtains must also be changed as a part of the terminal clean. The Rapid Clean Team to be contacted to change the curtains

When a patient with confirmed or suspected COVID-19  is discharged or transferred, select one of the COVID options on the barrier clean request page of the patient flow dashboard. There are three options:

• COVID (normal working hours) curtain change only – bed space to be cleaned with 1000ppm chlorine by ward staff. Rapid clean team to be contacted to change the   curtains.
• COVID (out of hours) – BAY BED space curtain change only, bed space to be cleaned with 1000ppm chlorine by ward staff. Rapid clean team to be contacted to change the   curtains.
• COVID (out of hours) – CUBICLE cleaned by Rapid Clean Team

Following resolution of symptoms, the bed space should be cleaned with 1000ppm chlorclean by ward staff, curtain change not required

Once room is vacated by staff following an AGP the bed space should be cleaned with 1000ppm chlorclean by ward staff, curtain change not required

An increased frequency of decontamination should be incorporated into the environmental decontamination schedules for areas where there may be higher environmental contamination rates e.g.

• toilets/commodes particularly if patients have diarrhoea; and
• “frequently touched” surfaces such as medical equipment, door/toilet handles and locker tops, patient call bells, over bed tables and bed rails should be cleaned at least twice daily and when known to be contaminated with secretions, excretions or body fluids. 

Domestic/cleaning staff performing environmental decontamination should:

• Be allocated to specific area(s) and not be moved between COVID-19 and non-COVID19 care areas;
• Be trained in which personal protective equipment (PPE) to use and the correct methods of wearing, removing and disposing of PPE. The care environment should be kept clean and clutter free. All non-essential items including toys, books and magazines should be removed from reception and waiting areas, consulting and treatment rooms, emergency departments, day rooms and lounges. When made available, these items should not be shared. All toys must be cleanable and should be cleaned regularly (preferably at the same time as the environment).

If they fulfil the case definition, isolate in side room and use appropriate PPE and test for COVID-19 (in addition to other investigations appropriate for clinical condition).

In line with national relaxation of restrictions for adults shielded patients i.e. those classed as ‘clinically extremely vulnerable’ in relation to acquisition of COVID-19 (definition found here) from 1 August 2020, shielded patients will no longer be required to be nursed in a cubicle.

Where shielded patients are cared for in a bay, single use PPE is recommended for the care of the shielded patient (i.e. gloves, apron, type IIR surgical face mask and eye protection) which are changed before and after each clinical interaction with the shielded patient.

Standard infection prevention procedures remain in place for all patients (including shielded patients) who require isolation for other reasons.

Any queries should be discussed with the Infection Prevention Team.

Please refer to the Trust Antibiotic Policy for the latest information on treatments available for COVID-19.

COVID-19 is a mandatorily notifiable disease. Currently, public health will be informed automatically of a confirmed case by the testing laboratory.

Isolation precautions can be discontinued 5 days after the date of the last positive PCR test (not date of onset of symptoms) if there has been:

• clinical improvement with at least some respiratory recovery
• absence of fever (> 37.8°C) for 48 hours without the use of medication
• no underlying severe immunosuppression

Any patients for COVID-19 who are inpatient on/attend the Haematology inpatient ward (2A) at Whiston Hospital, Lilac Centre at St Helens Hospital or Medical Day Unit (MDU) at Ormskirk Hospital should have isolation precautions continued for 10 days after the dates of the last positive PCR to minimise the risk of cross-infection to severely immunosuppressed patients who are present in these areas.

If patient has severe immunosuppression or has received intensive care during the current admission, isolation precautions must be continued until complete resolution of symptoms or a repeat test for COVID-19, taken more than 14 days after the last positive test, is negative. 
In such patients, if the patient is found to be still positive on repeat testing, and they remain as an inpatient, isolation precautions should be continued and the patient retested every 7 days until a negative result is obtained before isolation precautions can be discontinued. Where required, the Infection Prevention Team will be able to provide further advice on such patients who test repeatedly positive, based on their individual circumstances, in order to determine whether/when isolation precautions could be stepped down.

In a majority of patients if the COVID-19 respiratory viral PCR test is negative and there is a more likely alternative diagnosis then it would be appropriate to stop the enhanced PPE and isolation (and use PPE and isolation appropriate for the alternative diagnosis and other factors such a colonisation with MRSA, CPE etc).

If the test is negative but there is a high suspicion of COVID-19 (such as clinical and radiological features suggestive of it and/or contact with a confirmed case) then repeat testing (ideally on lower respiratory tract sample if possible) 48-72h after the initial sample before stopping isolation precautions is advised.

Urgent investigations should not be postponed pending the result of COVID-19 testing, nor should the care of patients with confirmed COVID-19 positive be compromised by purely due to the positive result.  While it is prudent to delay routine tests for patients who are awaiting their swab results, urgent tests should be performed based on clinical need only.  Staff performing these tests should wear PPE as stated above, and the patient should be asked to wear a surgical mask during transfers.  Decontamination of rooms/equipment should be performed as stated above. 

The transferring team must inform the receiving team in advance of the transfer. There is no need for security to close routes or separate cleaning behind the patient. Place surgical mask on the patient if they are available to tolerate it.

If the patient is not having an AGP on transfer – staff accompanying the patient should use the following PPE: surgical mask/gloves/apron.

If the patient is having an AGP during transfer (in reality, AGPs other than high flow nasal oxygen is unlikely to be taking place during transfer), staff accompanying the patient should be in additional PPE (long sleeved disposable gown, gloves, FFP3 mask and eye protection). However, in this scenario, it is more practicable for the ward staff to transfer the patient rather than porting staff. If portering staff are assisting, they can do so as long as they are not within 2 metres of the patient.

Yes, patients can be discharged before complete resolution of symptoms when they are deemed clinically fit for discharge providing following guidance if adhered to.

After discharge:

Patients should follow the government guidance for People with symptoms of a respiratory infection including COVID-19  on discharge. Cough or loss of sense of taste or smell may persist in some individuals, and are not indicators of ongoing infection when other symptoms have resolved.

If the patient is awaiting results of COVID-19 testing at the time they are well enough to be discharged, discharge can continue as long as they have been advised to follow the above government guidance. It is the responsibility of the discharging clinical team to follow up the results of testing if they are not available at the time of discharge.

If the discharged patient is returning to a shared household during their isolation period, other household members should also follow the above government guidance for People with symptoms of a respiratory infection including COVID-19.

If there are any individuals with an underlying health condition that puts them at the highest risk of severe illness with COVID-19 [KM1] who live in the household and are currently not infected, it is highly advisable, where possible, for patients to be discharged to a different home until they have finished their self-isolation period. If these individuals cannot be moved to a different household, then the discharged patient must be advised on strict infection prevention control measures as outlined in the government guidance for People with symptoms of a respiratory infection including COVID-19 order to minimise the risk of cross infection within the household.

The following groups are at the highest risk of severe illness from COVID-19:

All patients with Down’s Syndrome

Patients with a solid cancer:

• Active metastatic cancer and active solid cancers (at any stage)
• All patients that have received chemotherapy within the last 3 months and certain patients that received chemotherapy 3 – 12 months ago
• Patients receiving radiotherapy within the last 6 months

Patients with haematological (blood) diseases and stem cell transplant recipients:

• All patients with sickle cell disease
• Allogeneic haematopoietic stem cell transplant (HSCT) recipients in the last 12 months or active graft vs host disease (GVHD) regardless of time from transplant (including HSCT for non-malignant diseases)
• Autologous HSCT recipients in the last 12 months (including HSCT for non-malignant diseases)
• Individuals with haematological malignancies who have received chimaeric antigen receptor (CAR)-T cell therapy in the last 24 months, or radiotherapy in the last 6 months
• Individuals with haematological malignancies receiving systemic anti-cancer treatment (SACT) within the last 12 months except patients with chronic phase chronic myeloid leukaemia (CML) in molecular response or first or second line tyrosine kinase inhibitors (TKI)
• All patients with myeloma (excluding MGUS) or chronic B-cell lymphoproliferative disorders (e.g. chronic lymphocytic leukaemia, follicular lymphoma) or myelodysplastic syndrome (MDS) who do not fit the criteria above
• Individuals with non-malignant haematological disorder (e.g. aplastic anaemia or paroxysmal nocturnal haemoglobinuria) receiving B-cell depleting systemic treatment (e.g. anti-CD20, anti thymocyte globulin [ATG] and alemtzumab) within the last 12 months.

Patients with a renal disease:

• Renal transplant recipients (including those with failed transplants within the past 12 months), particularly those who:
  • Received B cell depleting therapy within the past 12 months (including alemtuzumab, rituximab [anti-CD20], anti-thymocyte globulin)
  • Have an additional substantial risk factor which would in isolation make them eligible for nMABs or oral antivirals
  • Not been vaccinated prior to transplantation

• Non-transplant patients who have received a comparable level of immunosuppression
• Patients with chronic kidney stage (CKD) 4 or 5 (an eGFR less than 30 ml/min/1.73m2) without immunosuppression

Patients with liver disease:

• Patients with cirrhosis Child’s-Pugh class B and C (decompensated liver disease)
• Patients with a liver transplant
• Liver patients on immune suppressive therapy (including patients with and without liver cirrhosis)
• Patients with cirrhosis Child’s-Pugh class A who are not on immune suppressive therapy (compensated liver disease)

Patients with immune-mediated inflammatory disorders (IMID):

• IMID treated with rituximab or other B cell depleting therapy in the last 12 months
• IMID with active/unstable disease on corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID with stable disease on either corticosteroids, cyclophosphamide, tacrolimus, cyclosporin or mycophenolate.
• IMID patients with active/unstable disease including those on biological monotherapy and on combination biologicals with thiopurine or methotrexate

Patients with immune deficiencies:

• Common variable immunodeficiency (CVID)
• Undefined primary antibody deficiency on immunoglobulin (or eligible for Ig)
• Hyper-IgM syndromes
• Good’s syndrome (thymoma plus B-cell deficiency)
• Severe Combined Immunodeficiency (SCID)
• Autoimmune polyglandular syndromes/autoimmune polyendocrinopathy, candidiasis, ectodermal dystrophy (APECED syndrome)
• Primary immunodeficiency associated with impaired type I interferon signalling
• X-linked agammaglobulinaemia (and other primary agammaglobulinaemias)
• Any patient with a secondary immunodeficiency receiving or eligible for, immunoglobulin replacement therapy

Patients with HIV/AIDS:

• Patients with high levels of immune suppression, have uncontrolled/untreated HIV (high viral load) or present acutely with an AIDS defining diagnosis
• On treatment for HIV with CD4 <350 cells/mm3 and stable on HIV treatment or CD4>350 cells/mm3 and additional risk factors (e.g. age, diabetes, obesity, cardiovascular, liver or renal disease, homeless, those with alcohol-dependence)

Solid organ transplant recipients:

All recipients of solid organ transplants not otherwise specified above

Patients with rare neurological conditions:

• Multiple sclerosis
• Motor neurone disease
• Myasthenia gravis
• Huntington’s disease

The criteria for discharge to a care home/package of care have been updated and may be more complex than other discharges. Please see algorithm here.

Patients can be discharged to care homes or own home with a package of care regardless of the COVID-19 status as long as they are clinically fit for discharge; however the care home or care package provider will need capacity to isolate/manage the patient appropriately. If the care provider cannot accept the patient then alternative discharge destinations must be considered such as non-acute beds which can be accessed via the Hospital Discharge Team.

The discharge guidance gives advice on which patients require clearance swabs performed prior to discharge. Clearance swabs will be prioritised for our in house COVID-19 testing which should provide same day results in order to facilitate these discharges.

If PCR clearance swab is required, once a patient is deemed medically optimised for discharge the steps to follow for any patient including positive, negative or not tested are:

• Discharge team to source placement OR liaise with existing care home/care package provider:
  • Assure care home/care package provider that clearance swab to take place imminently and they will be informed of status.
• Ward team to perform swab as per usual guidance within the 48h before planned discharge and need to electronically request the COVID -19 test choosing from dropdown box that this is a COVID-19 clearance swab.
• Clearance swab results will be ready the same day and available on Careflow as usual and also on the Trust bed management COVID-19 results dashboard.
• When result available, update section 2 of Careflow discharge proforma (free text).

If LFD clearance swab is required (i.e. for patients who are known to be COVID positive in the 90 days prior to discharge), the discharge co-ordinators will provide an LFD kit for the ward staff to test the patient prior to discharge. Details of the lot number of the LFD kit, name of the member of staff performing the test and result must be documented in the patient’s medical notes. If result is requested by Care Home or Borough Discharge teams, the serial number and result can be relayed verbally or by email. 

Clearance swab result negative:

• Discharge to care home/care package provider using trusted assessor with supportive community care if required.

Clearance swab result positive:

• Proceed to discharge to care home if care home/care package provider can isolate/manage patient with appropriate infection prevention precautions for 10 days and able to accept patient
  • Community team to arrange re-swab after 10 days to determine if isolation/ PPE can cease
• If the care provider cannot accept a COVID-19 positive patient then hospital team should consider an alternative non-acute bed
  • Re-swab after 7 days if remains in hospital or intermediary setting (and repeat every 7 days until negative).

If the patient is being discharged from a ward with an active/current outbreak of COVID-19, this information must be communicated to the care home/care provider by the ward clinical team prior to discharge. If result is requested by Care Home or Borough Discharge teams, the serial number and result can be relayed verbally or by email

The criteria for discharge to a care home/package of care have been updated and may be more complex than other discharges. Please see algorithm here.

Patients can be discharged to care homes or own home with a package of care regardless of the COVID-19 status as long as they are clinically fit for discharge; however the care home or care package provider will need capacity to isolate/manage the patient appropriately. If the care provider cannot accept the patient then alternative discharge destinations must be considered such as non-acute beds which can be accessed via the Hospital Discharge Team.

The discharge guidance gives advice on which patients require clearance swabs performed prior to discharge. Clearance swabs will be prioritised for our in house COVID-19 testing which should provide same day results in order to facilitate these discharges.

If PCR clearance swab is required, once a patient is deemed medically optimised for discharge the steps to follow for any patient including positive, negative or not tested are:

• Discharge team to source placement OR liaise with existing care home/care package provider:
  • Assure care home/care package provider that clearance swab to take place imminently and they will be informed of status.
• Ward team to perform swab as per usual guidance within the 48h before planned discharge and need to electronically request the COVID -19 test choosing from dropdown box that this is a COVID-19 clearance swab.
• Clearance swab results will be ready the same day and available on Careflow as usual and also on the Trust bed management COVID-19 results dashboard.
• When result available, update section 2 of Careflow discharge proforma (free text).

If LFD clearance swab is required (i.e. for patients who are known to be COVID positive in the 90 days prior to discharge), the discharge co-ordinators will provide an LFD kit for the ward staff to test the patient prior to discharge. Details of the lot number of the LFD kit, name of the member of staff performing the test and result must be documented in the patient’s medical notes. If result is requested by Care Home or Borough Discharge teams, the serial number and result can be relayed verbally or by email. 

Clearance swab result negative:

• Discharge to care home/care package provider using trusted assessor with supportive community care if required.

Clearance swab result positive:

• Proceed to discharge to care home if care home/care package provider can isolate/manage patient with appropriate infection prevention precautions for 10 days and able to accept patient
  • Community team to arrange re-swab after 10 days to determine if isolation/ PPE can cease
• If the care provider cannot accept a COVID-19 positive patient then hospital team should consider an alternative non-acute bed
  • Re-swab after 7 days if remains in hospital or intermediary setting (and repeat every 7 days until negative).

If the patient is being discharged from a ward with an active/current outbreak of COVID-19, this information must be communicated to the care home/care provider by the ward clinical team prior to discharge. If result is requested by Care Home or Borough Discharge teams, the serial number and result can be relayed verbally or by email.

If a member of staff/patient or visitor has been found to be positive for COVID-19, the following is a classed as a significant exposure to COVID-19:

Any close contact with the positive person which fulfills of the following criteria – close contact defined as either:

• face-to-face contact including being coughed on or having a face-to-face conversation within one metre

OR

• being within one metre for one minute or longer without face-to-face contact

OR

• being within 2 metres of someone for more than 15 minutes (either as a one-off contact, or total time of contact over 24 hours)

AND

The contact above is within the period starting 48 hours prior to the onset of symptoms of the positive case (or if an asymptomatic positive person, 48h prior to the date of the positive test) and ending 10 days from the onset of symptoms provided they have been well without fever for 48 hours (or for an asymptomatic positive person ,10 days from the date of the positive swab).

AND

Correct PPE as per Trust policy has NOT been adhered to.

If a member of staff has had a significant exposure to COVID-19, they must inform their line manager.

There is no longer a need for asymptomatic members of staff who have come into contact with COVID-19 to carry out testing (including LFDs). If a staff member is symptomatic, they must follow the process for symptomatic staff outlined at Self Isolation Guidance – STHK COVID-19 Guidance.

Asymptomatic staff members who are COVID-19 contacts can continue to work as normal as long as they fulfil the following criteria:
• The staff member should not have any symptoms of COVID-19.
• The staff member does not work in an area where there are patients highly vulnerable to COVID-19 (i.e. 2A or Lilac Centre). If they do work in such an area, their manager may make the decision to re-deploy the member of staff to a lower risk area until they have completed 10 full days from the date of contact with the COVID positive person (day 0 being the first day of contact). If this is a household contact, this means 10 days from the onset of symptoms of the household contact, or if household contact is asymptomatic, 10 days from the date of the positive test.
• Staff must adhere to all the Trust’s infection prevention policies and guidelines, wear the correct PPE at all times.

Inpatients who are considered contacts of SARS-CoV-2/COVID-19 cases are no longer required to isolate if they are asymptomatic (with the exception of contacts who are on Haematology Ward/2A or Lilac Centre – see below).

If symptoms occur they should be tested and isolated or cohorted with other symptomatic contacts COVID-19.

The incubation period of SARS-CoV2 is usually 10 days with a small residual risk of developing COVID-19 after 10 days following exposure to a confirmed case.

COVID-19 contacts on Haematology Ward/2A or Lilac Centre: Given the increased susceptibility of severely immunosuppressed patients to COVID-19, COVID-19 contacts in these areas must be isolated for 10 days following exposure regardless of symptoms

If inpatients are discharged to their own home, and they are asymptomatic, they and their household should be advised to follow the government guidance for People with symptoms of a respiratory infection including COVID-19.

If inpatients are discharged to care settings, they should be advised to remain isolated from others for the remainder of the 10-days post-exposure. The discharging clinical team is responsible for informing the receiving organisation of the patient’s COVID exposure status.

Visitors are ONLY permitted for COVID-19 positive patients as follows during their period of isolation:

• A maximum of two visitors for patients at the end of their life.
• One carer that is supporting someone with a mental health issue such as dementia, a learning disability or autism or other similar complex conditions, where not being present would cause the patient to be distressed.                     
• One birthing partner accompanying a woman in labour.
• One partner accompanying woman to antenatal scans.
• One parent or appropriate adult visiting a child. This may include multiple parents, although only one may be present at any time. This also includes Neonatal services.
• In exceptional cases consideration will be given to individual requests following a comprehensive risk assessment.

Visitors in the above categories must agree visiting arrangements with the nurse in charge of the ward before attending the hospital.

They need to be counselled regarding the risks to themselves and to others and cross transmission, and they need to wear appropriate PPE (gloves/apron and surgical mask – FFP3 masks are not required). Staff need to ensure that the visitors put on and remove PPE correctly. The visitors must adhere to strict hand hygiene after removal of PPE.

Visitors must not be present whilst aerosol generating procedures are being carried out on the patient.
Visitors do not need to self-isolate afterwards, as their contact with the patient will be brief and they will be wearing appropriate PPE. Note that persons have symptoms of COVID-19 or who have had exposure to COVID-19 within the previous 10 days must not visit patients in hospital.

The risk of cross transmission of COVID-19 is from the deceased is usually lower than for living patients. Where the deceased was known or suspected to have been infected with COVID-19, there is no requirement for a body bag, and viewing, hygienic preparations, post-mortem and embalming are all permitted.