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.
Read the guidance in full.
The three COVID pathways for patients/ individuals are as follows:
- High risk: There is no change in recommendations for IPC or for the use of PPE by staff when managing patients/individuals who have, or are likely to have, COVID-19 – read the high risk pathway guidance.
- Medium risk: This includes patients/individuals who have no symptoms of COVID-19 but do not have a COVID-19 SARS- CoV-2 PCR test result – read the medium risk pathway guidance.
- Low risk: Patients/individuals with no symptoms and a negative COVID-19 SARSCoV-2 PCR test who have self-isolated prior to admission for example following NICE guidance – read the low risk pathway guidance.
You can find the latest information and guidance for each of these pathways, including the PPE required, by clicking each link.
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:
- guidance for healthcare workers who are performing CPR in mental health, learning disability, and autism inpatient settings (non-acute hospital settings)
- guidance for healthcare workers in the community and primary healthcare settings
- an updated position based on the latest IPC guidance.
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.
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.”
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.