In today’s update:
- Changes to testing of asymptomatic patients for COVID-19
- Changes to repeat testing of patients after admission
- Changes to Trust PPE guidance
Changes have been made to COVID-19 guidance in a number of areas – please see below update.
However, please note that guidance on testing of symptomatic patients, pre-care home/domiciliary care discharge testing guidance, staff self isolation/testing guidance remains the same.
Guidance on pre-elective admission testing also currently remains the same but is being reviewed. Updates on this will be issued in due course.
Changes to testing of asymptomatic patients for COVID-19:
As of 1 September 2022, there is no longer a requirement to test all asymptomatic patients requiring inpatient admission (i.e. at least admission overnight) for COVID-19 except for the following groups of patients who must still be tested for COVID-19 on admission even if they are asymptomatic:
- Any immunocompromised* patients requiring inpatient admission, to be tested on admission.
- Any immunocompromised* patients requiring transfer between inpatient wards – to be screened by the receiving ward.
- All inpatient admissions to wards 2A, 4D and 4E on admission to those wards (patient do not need to await a COVID result before being admitted into these areas).
*Definition of immunocompromised is below (note that this is not an exhaustive list, further details are available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/655225/Greenbook_chapter_6.pdf:
- Any haematological malignancy e.g. leukaemia/lymphoma/myeloma
- HIV/AIDS
- Cellular immune deficiencies (e.g. Severe combined immunodeficiency, Wiskott-Aldrich syndrome, 22q11 deficiency/DiGeorge syndrome)
- Bone marrow transplant (allogeneic or autologous)
- Solid organ transplant
- Received any chemotherapy or radiotherapy in the past 6 months
- Received immunosuppressive biological therapy (e.g. anti-TNF therapy such as alemtuzumab, ofatumumab and rituximab) in the past 12 months
- Received steroids in the last 3 months – high dose (>40mg prednisolone per day or 2mg/ kg/day in children under 20kg) for more than 1 week OR lower dose corticosteroids (>20mg prednisolone per day or 1mg/kg/day in children under 20kg) for more than 2 weeks
- Received non-biological oral immune modulating drugs e.g. methotrexate >25mg per week, azathioprine >3.0mg/kg/day or 6-mercaptopurine >1.5mg/kg/day
In the above cases, even if the patient does not have any symptoms of COVID-19 detailed above, 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 CareFlow (under test name COVID-19 Novel Coronavirus PCR and on the ‘Test required’ drop down, select ‘Asymptomatic admission screen [COVA]’).
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).
Changes to repeat testing of patients after admission
As of 1 September 2022, there is no longer a need for patients to be routinely tested repeatedly for COVID-19 after admission unless they fulfil one of the criteria for testing stated above, as a part of outbreak screening advised by the Infection Prevention Team or for the purposes of discharge to a care home.
Changes to Trust PPE guidance
As 1 September 2022, PPE guidance has been updated.
Full details can be found at What to wear and when – STHK COVID-19 Guidance
Wearing of masks:
Masks no longer need to be worn in Trust buildings – With some exceptions (see below)
ALL Staff MUST wear type IIR surgical masks when:
- Providing direct clinical care to untriaged patients in areas where potential for respiratory infection is high
(specifically Emergency Department including SDEC, AMU, 5C, Bevan Court 1 Ambulatory Care, Urgent Treatment Centre as well as first home visit by Community Services staff)
- Providing direct clinical care to any patients on 2A (including Satchi Suite) and Lilac Centre (as these patients are more likely to be highly vulnerable to respiratory infections including COVID-19)
Providing direct patient care – not carrying out an aerosol generating procedure:
There is no longer a requirement to wear a full set of standard PPE when providing direct clinical care (i.e. within 2m) of any patient. However,
- Staff MUST wear a standard full set of PPE (i.e. type IIR surgical mask, gloves, apron plus if there is significant risk of exposure to bodily fluids eye protection) when caring for any patient with any suspected or confirmed respiratory infection (including COVID-19)
- Staff MUST wear gloves and apron when caring for any patient without suspected or confirmed respiratory infection but with non-respiratory cross infection hazards requiring contact precautions (e.g. MRSA/CDI/VRE/CPE)
Aerosol generating procedures (AGPs):
- When carrying out AGPs on patients with any suspected or confirmed respiratory infection, staff MUST continue to wear an FFP3 mask, visor, gloves and long sleeved fluid repellent gown
- When carrying out AGPs on patients without a suspected or confirmed respiratory infection, staff MUST wear : FFP3 mask, visor, gloves and apron. In such patients, a long sleeved gown is required only if there is significant risk of exposure to bodily fluids
For staff who wish to continue to wear masks, based on personal preference or their individual Health Work and Well Being risk assessment, in scenarios other than those detailed in the PPE guidance, type IIR surgical masks will continue to be available in all clinical and non-clinical areas.