COVID-19: Infection prevention and control (IPC)

The revised IPC guidance was issued jointly by the Department of Health and Social Care, Public Health Wales, Public Health Agency Northern Ireland, Health Protection Scotland/ National Services Scotland, Public Health England, and NHS England on 21 January 2021. The latest version can be found at the link below:

Read the guidance in full.

To support the safe and efficient management of patients with suspected or proven COVID-19 or other respiratory diseases through the winter, the UK Health Security Agency (UKHSA) has published revised UK infection preventionand control (IPC) guidance.

The Chief Nursing Officer for England and the National Medical Director have written a letter to trusts to highlight the key changes. 

The main changes/updates are:

  • removal of the 3 COVID-19 specific care pathways (high, medium and low). This is in response to stakeholder feedback and to facilitate local application of the guidance by organisations/employers. The use of, or requirement for, care pathways should be defined locally
  • addition of a section on the criteria to be applied within the ‘hierarchy of controls’ to further support organisations/services with maximum workplace risk mitigation
  • recommendation for universal use of face masks for staff and face masks/ coverings for all patients/visitors to remain as an IPC measure within health and care settings over the winter period. This is likely to be until at least March/April 2022
  • recommendation that physical distancing should be at least 1 metre, increasing whenever feasible to 2 metres across all health and care settings
  • recommendation that physical distancing should remain at 2 metres where patients with suspected or confirmed respiratory infection are being cared for or managed
  • recommendation that screening, triaging and testing for SARS-CoV-2 continues over the winter period. Testing for other respiratory pathogens will depend on the health and care setting according to local / country-specific testing strategies / frameworks and data

The guidance is issued jointly by the Department of Health and Social Care (DHSC), Public Health England and NHS England as official guidance. This guidance is for England only. 

Read the guidance in full

  • Patients or individuals will fall into either low, medium or high-risk COVID-19 pathways.
  • Patients must be triaged and tested on admission. A SARS-CoV-2 PCR test is required on admission, that is day 1, day 3, and day 5 to 7 of admission.
  • Patients will require to be re-tested on their return if they leave the ward or unit over a 24 hour period.
  • Patients who do not consent to testing should undergo a dynamic clinical risk assessment to take into consideration their individual risk factors and whether they have had contact with a known COVID-19 case. These patients will be managed on the medium-risk COVID-19 pathway for 14 days unless testing can be undertaken.
  • Patients who are known to have been exposed to a confirmed COVID-19 patient while on the ward should be isolated or cohorted (grouped together) with other similarly exposed patients who do not have COVID-19 symptoms, until their hospital admission ends or until 14 days after last exposure.
  • If symptoms of COVID-19 occur in the 14 days after exposure then SARS-CoV-2, PCR testing should be undertaken. These patients should be isolated or cohorted in the high-risk pathway.
  • Patients can still be discharged during the period of isolation and isolation would continue at home. Refer to the relevant pathway discharge section within the Infection Prevention Control guidance.
  • Patients requiring management on a high-risk COVID-19 pathway may require a dynamic clinical risk assessment by a multi-disciplinary team to determine the most appropriate care setting. Patient placement and assessment for infection risk as per care pathways should always be guided by their clinical needs. 
  • Airborne precautions are required for all patients on the medium and high-risk pathways if an AGP is undertaken.
  • Sessional use of single-use personal protective equipment (PPE) items only applies to the extended use of facemasks and eye or face protection for healthcare workers.
  • Staff should use a dynamic risk assessment when making decisions around the use of PPE in the medium and high-risk COVID-19 pathways. A hierarchy of control approach that considers all hazards to patients and staff should be followed, for example when conducting a risk assessment regarding patient restraint.

The Resuscitation Council UK has produced:

RCUK's guidance for patients with known or suspected COVID-19 aligns with the IPC's High and Medium risk categories. They recommend that the COVID-19 algorithms are followed and that AGP PPE continues to be used for chest compressions and advanced airway procedures for patients allocated to these two categories. 

For patients allocated to the Low Risk category, the standard pre-COVID algorithms can be used and all healthcare staff attending resuscitation events should wear a minimum of a Type II fluid-resistant surgical mask, eye protection, disposable gloves, and an apron.

PHE's recommendations

In contrast, the current expert consensus from NERVTAG, (the group that advises the government on the threat posed by new and emerging respiratory viruses) is that chest compressions are not considered to be procedures that pose a higher risk for respiratory infections including COVID-19

Based on this evidence review, the UK IPC guidance therefore will not be adding chest compressions to the list of AGPs. However, they state that “healthcare organisations may choose to advise their clinical staff to wear FFP3 respirators, gowns, eye protection and gloves when performing chest compressions but we strongly advise that there is no potential delay in delivering this life-saving intervention.” 

Our view 

We support the Academy of Medical Royal Colleges' statement which identifies that the evidence itself is inconclusive but has lead two highly respected scientific groups, NERVTAG and RCUK, to draw different conclusions as to the AGP nature of chest compressions and the appropriate course of action with regard to PPE. While that is legitimate, it may create dilemmas for individual clinicians and healthcare organisations. 

Along with the Academy, we believe that it is essential that health workers have appropriate protection for the circumstances in which they are working. It is important to recognise that clinical and situational circumstances vary and requirements in different settings will not be the same. 

We suggest that mental health and learning disability/autism organisations and clinicians should agree, as soon as possible, on the local policy regarding availability and use of PPE in resuscitation situations in order to provide the proper protection for staff. 

It is anticipated that they are guided by the consensus view of those clinicians likely to be involved in resuscitation and that local decisions are transparently agreed, understood, shared and adequately resourced. Risk assessment is the first action in resuscitation and this needs to be undertaken with staff and patient safety foremost. 

The necessary equipment must be to hand so that these risks can be met or mitigated in all situations.

Read the Academy's full statement

To support providers of mental health care, NHSE/I alongside providers have developed a suite of tools. The tools will enable mental health settings to implement Public Health England COVID-19 remobilisation guidelines. The tools are designed so that they can adapted for local use and form part of organisational risk assessment and care delivery. 

Staff isolation and testing

NHS England and Improvement have issued a letter on NHS staff and student self-isolation following updated Public Health England guidance. The guidance highlights that fully vaccinated staff and students who are identified as a contact of a positive COVID-19 case will no longer be expected to isolate and will be expected to return to work. They ask that a series of safeguards are implemented for them to safely do so.

Below, you can also find information on asymptomatic staff testing for COVID-19. This includes guidance on how lateral flow testing for asymptomatic testing for staff should be implemented and reported.
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