Clinical update

COVID-19: infection prevention and control advice for all healthcare settings

The government has issued advice for all healthcare workers 

Picture: Jim Varney

Essential information

COVID-19 has spread around the world and is officially a global pandemic, according to the World Health Organization.

The main symptoms of COVID-19 (which stands for coronavirus disease 2019), are high temperature and new, continuous cough. It was initially seen in Wuhan in China and the city was placed in lockdown at the end of January 2020 to combat the spread of the virus.

UK government guidance states patients will probably not be infectious until the onset of symptoms, and measures to control the spread of the disease in the UK are being implemented.

View our COVID-19 resources

What’s new

Infection prevention and control advice for healthcare workers caring for patients who have, or are suspected of having, COVID-19 has been published by the government.

It has been backed by public health agencies in all four UK countries and covers all healthcare settings, including hospitals, care homes, primary care settings and ambulances.

Transmission of COVID-19 is thought to occur mainly via respiratory droplets generated by coughing and sneezing, and via contact with contaminated surfaces. Initial research has identified the presence of live virus in the stools and conjunctival secretions of people with confirmed cases.

There has been some suggestion in the media from health professionals that this new government advice downgrades the previous level of personal protective equipment (PPE) that is required. It has also been reported that there are shortages of vital protective equipment.

The guidance states that all healthcare staff in all settings should be using standard infection control measures for all patients at all times. This includes good hand hygiene and segregating patients with suspected or confirmed cases of COVID-19.

It provides advice on what PPE should be worn in different settings. In a general ward when having close personal contact with a patient with COVID-19, it recommends disposable gloves, apron and mask, with a risk assessment to determine if a visor is needed.

In all settings, a fluid-resistant surgical mask should be worn by all staff who come within 2 metres of a patient who has, or is suspected of having COVID-19.

Airborne precautions should be implemented in clinical areas where there are aerosol-generating procedure ‘hot spots’, including intensive care units and high dependency units (HDU) that are managing COVID-19 patients. These precautions include wearing a filtering face piece respirator and visor.

Key points for nurses

  • Fluid-resistant surgical masks should be well-fitting, covering both nose and mouth. They should not be allowed to dangle around the neck of the wearer and should not be touched once they are on. They should be changed when they become moist or damaged, and should be worn once and then discarded.
  • Assigning a dedicated team of staff to care for patients in isolation/cohort rooms and areas is an additional infection control measure. Where possible, staff who have recovered after having a confirmed case of COVID-19 should work in cohort areas where there are patients with the virus.
  • If there is no laundry facility available in the workplace, nursing uniforms should be transported home in a disposable plastic bag that is then thrown away. Uniforms should be laundered separately from other household linen in a load that is not more than half full at the maximum temperature the fabric can tolerate. The uniform should then be ironed or tumble-dried.

Expert comment

Rose Gallagher is RCN lead for infection prevention and control 

‘Nursing is a highly complex, safety-critical profession. It is vital that nurses on the front line have the right equipment they need – including appropriate personal protective equipment (PPE) for their health, safety and well-being.

‘The law requires that healthcare staff are provided with the right protective equipment and the RCN is clear that all nursing staff should be provided with this equipment whatever setting they are working in. Alongside this, there needs to be consistent information about the type of PPE that is needed in each setting.

'Only with this equipment and information can health and care staff deliver care while keeping their patients and themselves safe. This is important across the whole of the health and social care sector, including for nurses in the community visiting people in their own homes, and not just in hospital settings.’

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