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.

The information below explains the current main changes and updates to the latest iteration of IPC guidance.

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

The main changes/updates on 4 April were:

The main changes/updates: versions 22 November 2021 to 17 January 2022:

  • 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 or coverings for all patients and visitors to remain as an IPC measure within health and care settings over the winter period. This is likely to be until at least May 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.
  • In response to Omicron and other variants of concern (VOCs) it is recommended that staff and organisations continue to undertake risk assessments using the hierarchy of controls which include an evaluation of the ventilation in the area, operational capacity, physical distancing and prevalence of COVID-19. Where a risk assessment indicates it, RPE should be available to all relevant staff. Staff should be provided with training on correct use. The text has been updated to make this clearer.
  • Recommendation that the inpatient isolation period for COVID-19 cases or contacts is reduced from 14 days to 10 days. There are some exceptions to reducing the isolation period and this should be considered as part of a clinical risk assessment.

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 and patient testing

On 30 March 2022, NHS England and Improvement set out their approach to delivering the UK Health Security Agency (UKSHA) advice in relation to staff and patient testing. The letter detailing this can be viewed below.

This is supported by the Novel coronavirus (COVID-19) standard operating procedure: testing for inpatients guidance and the Novel coronavirus (COVID-19) standard operating procedure: testing for elective care pre-admission patient pathways.

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