In today’s update:
- Which patients should be tested for Covid-19
- What additional steps are required in the management of patients requiring “shielding”?
- Hidden Hospital Heroes
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Which patients should be tested for COVID-19?
Emergency admissions
Testing of asymptomatic patients for COVID-19:
All patients requiring inpatient admission (i.e. at least admission overnight) require testing for COVID-19 regardless of symptoms or clinical features of COVID-19.
Therefore, even if the patient does not fulfil the case definition, send samples for COVID-19 testing, in addition to usual investigations appropriate to the patient’s clinical condition.
The test must be carried out without delay at the point where decision to admit is made.
For asymptomatic patients, a COVID-19 test can be requested on Medway (under test name COVID-19 Novel Coronavirus PCR and on the ‘Test required’ drop down, select ‘Asymptomatic admission screen’).
Patients who are tested on admission but do not have clinical features of COVID-19 do NOT need isolation in side rooms (unless they also have another reason to require this e.g. another infectious disease requiring isolation precautions or infection alert such as MRSA/VRE/CPE).
Patients with symptoms/signs of COVID-19:
The case definition(updated regularly) now includes any patient requiring admission to hospital with clinical/radiological evidence of pneumonia, acute respiratory distress syndrome, influenza like illness or anosmia (a loss of, or change in, normal sense of taste or smell) or if they develop these after admission.
If a patient fulfils criteria for a possible case, do the following immediately:
- Isolate patient in a single room with respiratory precautions (if no side room is available, patient can be cared for in a bay).
- Minimise number of staff entering the room.
- Wear the appropriate PPE: Click here to see a summary of PPE to be worn [password STHKcovid19]
- 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 Medway (under the test name COVID-19 Novel Coronavirus PCR and on the ‘Test required’ drop down, select ‘SYMPTOMATIC patient test’.
Repeat testing of patients who have a negative admission screen:
For those admitted from 18 May 2020, patients who test negative on their admission screen, a single re-test should be conducted 5-7 days after admission. Using the appropriate drop down selection on Medway (see below). Patients who are awaiting this repeat test result but who do not have clinical features of COVID-19 do NOT need isolation in side rooms (unless they also have another reason to require this e.g. another infectious disease requiring isolation precautions or infection alert such as MRSA/VRE/CPE).
Elective admissions (including Day Surgery admissions)
Please see admission pathway https://covid.sthk.nhs.uk/wp-content/uploads/2020/05/ELECTIVE-SURGICAL-ADMISSION-NON-CANCER-SURGERY-FINAL-200520.pdf [password: STHKcovid19] for further details (note patients for urgent elective cancer surgery should follow locally agreed process). In brief – patients should isolate for 14 days prior to admission along with members of their household and undergo a pre-admission COVID-19 test (conducted a maximum of 72 hours in advance).
Other elective day attendances for interventions
Please see relevant pathway https://covid.sthk.nhs.uk/wp-content/uploads/2020/05/Screening-for-day-case-FINAL-200520.pdf [password: STHKcovid19] for further details. In brief – these patients do not need to self-isolate for 14 days prior to the attendance but will need a pre-admission COVID-19 test (conducted a maximum of 72 hours in advance) if they are attending for an aerosol generating procedure or a procedure where the clinician has prolonged close contact with the patient (within 2 metres for more than 1 hour).
Discharges
All patients being discharged to a care home, hospice and, in some situations, when a patient is being discharged with a package of care (essentially if the care providers request it) should be tested up to 48 hours prior to discharge. Please see the discharge pathways for further details.
Requesting COVID-19 tests
These can be requested on Medway under COVID-19 Novel Coronavirus PCR. All requests must be accompanied by a completedform E28.
There is a drop down box to select the test required as shown below:
| Indication | Medway drop down option | Rapid test |
| Any patient (new admission or existing inpatient) with clinical features of COVID-19 | SYMPTOMATIC patient test | No |
| An emergency admission screen for COVID-19 on any patient who requires at least overnight admission to the Trust who has no clinical features of COVID-19 | Use Asymptomatic admission screen | No |
| Requesting a repeat screen on any inpatient 5-7 days after admission whose original admission screen was negative | SYMPTOMATIC patient test or Asymptomatic admission screen as appropriate according to clinical condition | No |
| For testing patients prior to discharge to care home or other healthcare setting when indicated | Clearance swab | No |
| For testing previously COVID-19 positive severely immunocompromised inpatients or inpatients who have received ICU care during the current admission prior to stepping down infection prevention precautions | Clearance swab | No |
| For testing patients other than those being admitted electively for urgent cancer surgery and those who are in the shielded/extremely vulnerable category for screening at pre-op 48-72h in advance of their elective admission for surgery/other procedure | Elective pre-op NON-urgent | No |
| For testing patients prior to urgent elective cancer surgery OR extremely vulnerable patients under shielding who attend for elective surgery/procedures on the day of admission | Elective pre-op URGENT | Yes |
Note that current availability of rapid tests is strictly limited (approximately 20 in total per day) hence these MUST only be used as stated above: Any exceptions MUST be discussed with a Medical Microbiologist on a case by case basis before the test is requested.
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/
—————————————- What additional steps are required in the management of patients requiring “shielding”?
Additional precautions are advised for protecting patients during the COVID-19 pandemic who are considered “clinically extremely vulnerable” (definition found here). This is to protect the vulnerable patients from acquiring COVID-19 whilst in hospital.
Care for COVID-19 NEGATIVE clinically extremely vulnerable patient:
- The patient must be admitted to a side room and advised to remain in the room where possible
- If the patient leaves their room (such as for investigations) they must wear a surgical face mask
- Staff entering the room must single wear (as a minimum) the following PPE in accordance with the STHK guidance for appropriate PPE use in hospital and community care setting (found here):
- Disposable plastic apron
- Disposable surgical mask
- Disposable gloves
Care for COVID-19 POSITIVE or SUSPECTED clinically extremely vulnerable patient
- Follow guidance for a confirmed or suspected COVID-19 patient (see What infection control precautions are required for a patient that meets the criteria for possible COVID-19 or is confirmed positive for COVID-19?)
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#HiddenHospitalHeroes
Tonight’s #HiddenHospitalHeroes are our fantastic team of ward administrators who have provided invaluable support to their clinical colleagues during these incredibly busy times.
With high numbers of patient moves across the Trust, the team have ensured that all information and patient records are up to date. They have also acted as runners on the ward ensuring the ward has sufficient stock of PPE by performing daily counts and collecting more stock when needed.
They have shown great team effort, dedication, support and flexibility within their role. We’re so grateful for every little thing you do. Well done team!
