Clinical update

Infection prevention and control in emergency departments during the COVID-19 pandemic

New guidelines from the Royal College of Emergency Medicine are aimed at protecting staff and patients from the spread of infectious diseases

New guidelines from the Royal College of Emergency Medicine are aimed at protecting staff and patients from the spread of infectious diseases

Socially distanced chairs in an emergency department Picture: Alamy

Essential information

COVID-19 represents a major public health challenge, putting health services and staff, including those working in emergency care, under significant pressure. People of all ages and acuities present unpredictably at emergency departments (EDs), and often little is known about them before their arrival.

New guidelines from the Royal College of Emergency Medicine are aimed at protecting staff and patients from the spread of infectious diseases

Socially distanced chairs in an emergency department Picture: Alamy

Socially distanced chairs in an emergency department Picture: Alamy

Essential information

COVID-19 represents a major public health challenge, putting health services and staff, including those working in emergency care, under significant pressure. People of all ages and acuities present unpredictably at emergency departments (EDs), and often little is known about them before their arrival.

Although attendances in June 2020 were down 33% compared with the same month last year, the risks posed by COVID-19 mean there is still a need to increase the level of protection provided to patients, alongside preventing staff from acquiring COVID-19.

What’s new?

The Royal College of Emergency Medicine (RCEM) has published a best practice guideline on infection prevention and control during the COVID-19 pandemic. The document’s overall aims are to prevent the spread of infectious diseases between patients, prevent patients from acquiring infection from clinical staff and prevent staff from acquiring infection in their workplace.

Key recommendations

  • ED waiting rooms should implement social distancing of two metres, identifying the maximum occupancy of waiting and clinical areas to allow safe distancing. Reception areas should be modified and fitted with screens.
  • ‘Outbreaks are commonly linked to non-clinical areas,’ says the guidance. Social distancing should also be implemented in communal spaces, further mitigating risks, with provision of personal protective equipment (PPE), increased frequency of cleaning and staggering of staff breaks.
  • On arrival, all patients should be screened for symptoms of COVID-19 and other infectious diseases needing isolation. Staff should wear sufficient PPE to be able to provide immediate care to someone before their infectious status is known.
  • Multiple, repeated clinical assessments should be avoided unless strictly necessary, with the aim of minimising the number of clinical interactions with patients.
  • Keeping the department clean should be a collective responsibility for all staff, with initiatives to encourage engagement.
  • Access for visitors should be restricted, with case-by-case exceptions for patients who are critically ill, dying, socially vulnerable or children.
  • Staff should make sure they are easily identifiable while wearing all levels of PPE, including their name and role.
  • There should be adequate supplies of PPE for all staff, including support workers. To ensure it is worn appropriately, comfort should be a priority.
  • Patient care equipment should be single-use if possible.

View our COVID-19 resource centre

How you can help your patients

Nurses can play a vital role in helping to reassure patients who may feel afraid at seeing staff wearing PPE.

This includes children and those who are vulnerable. Use clear communication that explains more about PPE in a variety of different formats, including posters and leaflets. Photographs showing how someone looks underneath their PPE may help to allay fears.

Expert comment

RCN professional lead for acute, emergency and critical care Anna Crossley
Anna Crossley

Anna Crossley is RCN professional lead for acute, emergency and critical care

‘This Royal College of Emergency Medicine guidance highlights the infection prevention and control challenges in emergency departments (EDs) as a critical point of COVID-19 transmission.

It is important that service managers and clinical commissioning groups understand the unique place of EDs in the COVID-19 pandemic, as people present to hospital with acute care needs.

As the guidance says, we need to focus on the needs of healthcare workers delivering care in a challenging environment. If staff spend long periods wearing personal protective equipment, we must take into account adequate breaks to rest, refuel and rehydrate, and the importance of skin care.

‘While social distancing may present challenges, such as in staff rooms and canteens, staff must be given adequate time to rest for their physical and mental well-being. As the pandemic evolves we are constantly learning, and this guidance will add to the global picture.’


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