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Infection Prevention and Control Practice Guidance Note Guidance for the management of patients with suspected or confirmed COVID-19 infection – V01
IPC-PGN-31
Date Issued Sep 2020
Planned Review Sep 2023
Author/Designation
Samantha Cooke – Infection Prevention and Control Nurse
Responsible Officer/ Designation
Anne Moore – Director of Infection Prevention and Control
Part of CNTW(C)23 – Infection Prevention and Control Policy
Contents Section
Description
Page No:
1
Introduction
1
2
Background Information
1
3
Mode of transmission
2
4
Standard Precautions
3
5
Diagnosis and Management of Suspected COVID-19 Infection
4
6
Management of patients with suspected/confirmed COVID-19 infection
4
7
Infection Prevention and Control
5
8
References
14
Appendices – attached to Practice Guidance Note
Document No:
Description
Appendix 1
How to obtain combined throat and nose swab for diagnostic sampling
Appendix 2
PPE guidance
Appendix 3
Donning and Doffing PPE
Appendix 4
How to wear a fluid-resistant surgical face mask (FRSM) safely
Appendix 5
AGP PPE
Appendix 6
COVID-19 outbreak notification signage
Appendix 7
Line Lists
IPC-PGN-31 1
Introduction
1.1
This Practice Guidance Note (PGN) should be read in conjunction with Cumbria Northumberland, Tyne and Wear NHS Foundation Trust’s (the Trust/CNTW), CNTW(C)23, Infection Prevention and Control Policy.
1.2
This PGN refers to the diagnosis and management of COVID-19 infection within the patient population.
2
Background Information
2.1
COVID-19 is a disease caused by a type of virus called a coronavirus. This is a common type of virus that affects both animals and humans. Coronaviruses often cause symptoms like those of the common cold, but sometimes they can cause more serious infections. The coronavirus that causes COVID-19 is a new type of coronavirus.
2.2
COVID-19 is able to spread from person to person. The virus seems to spread when people cough or sneeze, and when people touch objects and surfaces that have the virus on them.
2.3
The incubation period is from 1 -14 days with the median being 5 days.
2.4
At this time, there are no specific vaccines or treatments for COVID-19. However, there are many ongoing clinical trials evaluating potential treatments.
2.5
Signs and Symptoms of COVID-19 Infection
2.6
Some people can have COVID-19 without any symptoms. If you do develop symptoms, the most common symptoms can include fever, coughing, shortness of breath, loss of sense of smell, reduced sense of taste, aches and pains, feeling tired, feeling nauseous or vomiting and diarrhoea.
2.7
If any person develops a new, continuous cough, a raised temperature (above 37.8 C) or a loss of sense of taste or smell, they should self-isolate for a minimum of 10 days from the onset of symptoms. Isolation must extend beyond 10 days if high temperature continues. In order for the isolation period to end, the person should be apyrexial (free from fever) for at least a 48 hour period. A cough and loss of sense of smell/taste can last for several weeks after the infection has gone and do not warrant isolation after the 10 day period.
2.8
Case-by-case reviews will be required where any patient is unable to follow advice on isolation and testing. Clinicians should decide on the appropriate use of the relevant legal framework for each case, with support from medicolegal colleagues as required. Non-concordance with isolation represents a clear risk 1
Cumbria Northumberland, Tyne and Wear NHS Foundation Trust IPC-PGN-31– Guidance for management of patients with suspected or confirmed COVID-19 - V01-Iss1-Sep 2020 Part of CNTW(C)23 Infection Prevention & Control Policy
IPC-PGN-31 to others and should, in the first instance be conveyed to the patient helping them to understand the clinical reasons for self-isolation and testing. 2.9
If COVID-19 infection is suspected, medical assessment is urgently required.
2.10 Initiation of the Sepsis Tool should be implemented in all cases of suspected or confirmed COVID-19 infection. A web-based incident report should also be completed.
Please refer to the following PGNs which form part of the Trust’s CNTW(C)29 – Trust standard for the assessment and management of physical health policy:
AMPH-PGN-05 - Sepsis Assessment Tool
in conjunction with AMPH-PGN-03 – National Early Warning Scores (NEWS2) NB. In the context of COVID-19, an outbreak refers to two or more cases within an area. In the event that an outbreak of COVID-19 is suspected/confirmed, this PGN should be read in conjunction with Outbreak Management–Major Incidents–IPC-PGN-06. 2.11 It is important to note that patients with a learning disability, autism or dementia and a co-morbid physical health condition may present with additional, softer signs or early indicators of deterioration, e.g. mood or behaviour changes, becoming unsteady when walking, increasingly tired, sleeping more, restlessness and agitation. 2.12 People with mental health needs, a learning disability, autism or dementia should receive the same protection and support with managing COVID-19 as other members of the population. This includes, where required, rapid access to acute care. 3
Modes of transmission
3.1
Droplet
3.2
Respiratory droplets carrying infectious pathogens can transmit infection when they travel directly from the respiratory tract of an infectious individual to susceptible mucosal surfaces of a recipient, generally over short distances. This can be in the form of sneezing, coughing or speaking. Droplet transmission occurs when a person is in in close contact (within 1 m) with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Transmission may also occur through fomites in the immediate environment around the infected person. Therefore, transmission of the COVID-19 virus can occur by direct 2
Cumbria Northumberland, Tyne and Wear NHS Foundation Trust IPC-PGN-31– Guidance for management of patients with suspected or confirmed COVID-19 - V01-Iss1-Sep 2020 Part of CNTW(C)23 Infection Prevention & Control Policy
IPC-PGN-31 contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g. stethoscope or thermometer). 3.3
Contact
3.4
Another way to catch the new coronavirus is when you touch surfaces that someone who has the virus has coughed or sneezed on. You may touch a countertop or doorknob that's contaminated and then touch your nose, mouth, or eyes. The virus can live on surfaces like plastic and stainless steel for 2 to 3 days. To stop it, clean and disinfect all counters, knobs, and other surfaces that are touched several times a day.
3.5
A fomite is defined as an object that becomes contaminated with infected organisms and which subsequently transmits those organisms to another person. Examples of potential fomites are surfaces, toys, mobile telephones or any inanimate objects.
3.6
Aerosol
3.7
Airborne transmission is different from droplet transmission as it refers to the presence of microbes within droplet nuclei, which are generally considered to be particles
