COVID-19: Infection prevention and control (IPC) recommendations 

The latest guidance was issued jointly by the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS)/National Services Scotland, Public Health England (PHE) and NHS England on 21 August 2020.

The infection prevention and control principles apply to all health and care settings, including mental health and learning disability settings. This guidance supersedes the COVID-19 UK IPC guidance (18 June 2020).

 The main changes to the guidance are:

  1. Local and national prevalence and incidence data will be used to guide returning services as advised by Country specific/public health organisations.
  2. Patients/individuals to be managed in 3 COVID-19 pathways, high, medium and low risk.
  3. Sessional use of single use PPE items has been minimised and only applies to extended use of facemasks for healthcare workers.
  4. The use of facemasks (for staff) and face coverings (if tolerated by the individual) is recommended in England and Scotland, in addition to social distancing and hand hygiene for staff, patients/individuals and visitors in both clinical and non-clinical areas to further reduce transmission risk.
  5. Physical distancing of 2 metres is considered standard practice in all health and care settings.
  6. Patients/individuals on a low risk pathway require Standard Infection Prevention & Control Precautions for surgery or procedures.

 Read the guidance in full (pdf).

The three new 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.

 

This guidance provides nationally agreed epidemiological definitions for coronavirus (COVID-19) outbreaks and clusters in particular settings. The definitions are to inform local alerts and action and to provide consistency.

Within a healthcare setting (for example an inpatient setting), the outbreak criteria is as follows:

  • Two or more test-confirmed or clinically suspected cases of COVID-19 among individuals (for example patients, health care workers, other hospital staff and regular visitors, for example volunteers and chaplains) associated with a specific setting (for example bay, ward or shared space), where at least one case (if a patient) has been identified as having illness onset after 8 days of admission to hospital.

Within an institutional residential setting (for example a care home or place of detention)

  • Two or more test-confirmed cases of COVID-19 or clinically suspected cases of COVID-19 among individuals associated with a specific setting with illness onset dates within 14 days.

Read the full guidance on defining a COVID-19 outbreak or cluster in particular settings

 

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.

The Resus Council UK state that “in the absence of high-quality evidence to state that anything less than AGP PPE is sufficient for healthcare professional safety, RCUK maintains its belief that AGP PPE provides the safest level of protection when administering chest compressions, CPR, and advanced airway procedures in known or suspected COVID-19 patients". Read the Resus Council UK statement in full.

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.

You can read the Academy's full statement here.

Get in contact to receive further information regarding a career in psychiatry