Thank you for all your hard work over the weekend. Today’s cabinet meeting update is below:
Discharge/De-isolation guidance
Public Health England has issued new guidance relating to de-isolation and discharge of positive and highly suspected patients. This information is included in the updated Infection Prevention FAQs available on the Staff Covid website.
It is also below:
How long do isolation precautions need to be continued if the patient is COVID-19 positive and in hospital?
Isolation precautions can be discontinued 14 days after the date of the positive test result (not the date of the onset of symptoms) if there has been:
- clinical improvement with at least some respiratory recovery
- absence of fever (> 37.8°C) for 48 hours
- no underlying severe immunosuppression
If patient has severe immunosuppression, isolation precautions must be continued until there is complete resolution of all symptoms or a repeat test for COVID-19 is negative (this must be taken more than 14 days after the date of the last positive test).
Discharging a patient
If the patient is well enough, can they be discharged to their own home?
Yes, patients can be discharged before complete resolution of symptoms provided they are deemed clinically fit for discharge and the guidance below is followed:
After discharge:
- All patients should self-isolate at home until their fever has resolved for 48 hours consecutively without medication to reduce their fever (unless there is another known cause for the fever other than Covid-19).
- Patients with severe immunosuppression or those who required critical care should complete self-isolation at home until 14 days after their first positive test result
- All other patients (i.e. those without severe immunosuppression and those who did not require critical care) should complete their self-isolation until 7 days after their first positive test result.
Please note: Cough may persist in some individuals. Persistent cough is not an indication of ongoing infection when other symptoms have resolved.
If the patient is awaiting the results of a COVID-19 test at the time they are discharged, discharge can continue as long as they have been advised to self-isolate until they receive the result.
If the result is positive, they must self-isolate as above.
If the result is negative, there is no need to continue self-isolation unless there was a high clinical suspicion of Covid-19.
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 patient is being discharged to a household where there are other non-infected vulnerable individuals, staff must ensure that the discharged patient is advised of the strict infection prevention and control measures outlined in the Stay at Home guidance for vulnerable individuals.
If the patient is being discharged to a household where there are other non-infected extremely vulnerable individuals, as outlined in the guidance on shielding, it is highly advisable for patients to be discharged to a different home until they have either finished their self-isolation period or received a negative Covid-19 test result for a test taken 14 days after the date of the last positive test.
If the patient is well, can they be discharged to a care home?
Patient with no symptoms consistent with COVID-19: can be discharged as normal.
Patient with confirmed COVID-19: Before discharge the patient must no longer be showing symptoms and
- If 14 days or more have passed since the date of the last positive test the patient can be discharged as normal.
- If it is less than 14 days since the last positive test the patient can be discharged. However, on discharge, the patient will need to be isolated and care home staff will need to wear PPE until 14 days after the last positive test.
Patient with high clinical suspicion of Covid despite negative test or patient with clinical suspicion of Covid pending results of testing: Before discharge the patient must no longer be showing symptoms and
- If 14 days or more have passed since the onset of symptoms the patient can be discharged as normal.
- If it is less than 14 days since the onset of symptoms the patient can be discharged. However, on discharge, the patient will need to be isolated and care home staff will need to wear PPE until 14 days after the symptoms began.
Why are different isolation periods recommended for people with Covid-19 in different circumstances?
In general, people with COVID-19 who are admitted to hospital will have more severe disease than those who can remain in the community, especially if they require critical care.
In addition, these patients are more likely to have pre-existing conditions such as severe immunosuppression.
In healthcare settings (hospitals or care homes), there are considerable numbers of immunocompromised and vulnerable patients which is why a precautionary approach with more stringent rules is recommended for hospitalised patients or those discharged to care homes ie. 14 days from the date of the positive test result. This compares with the 7 days since the onset of symptoms rule applied to people who stay in the community /in their own homes.
Patients with severe immunosuppression and those who required critical care are more likely to hold onto the virus (shed) for longer than other patients. In these groups of patients, an extended period of self-isolation, 14 days from the positive test result, is recommended even after discharge to their own home or back to the community.
Staff Testing
Staff are reminded to contact the Trust as soon as they, or a member of their household, becomes unwell
The Trust has a fast staff testing process in place that is running 7 days a week:
- Staff member or Line Manager completes a self-isolation form for staff member and/or family member
- This is triaged within 24 hours
- Test (where appropriate) will be offered the same or next day
- Results returned within 48 hours and communicated with individuals and where appropriate Line Managers
Staff Wellbeing
The Trust has produced a staff wellbeing booklet packed with support and tips to help staff deal with their mental and physical wellbeing, and to help colleagues, team members, friends and family during this time.
This is now available online via the Staff Covid Website. See the Wellbeing page here to access the document directly click here
The booklet will also be printed and distributed to staff this week.
#HiddenHospitalHeroes
Today we celebrate the amazing Receipt and Distribution Team.
In recent weeks we have been inundated with kind donations from businesses and individuals and if it wasn’t for the fantastic Lenny and his equally brilliant team we wouldn’t have been able to manage the deliveries and share the goodies.
Thank you so much for all your help and support, it means the world!
