Coronavirus COVID-2019 Healthcare Associated Infections (HAI) Clinical Excellence Commission - PowerPoint Presentation

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Coronavirus COVID-2019

Healthcare Associated Infections (HAI) Clinical Excellence Commission

(updated June 2020)

TO BE UTILISED AND UPDATED BY LHDs

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CONTENT

What is SARS-CoV-2

Update on Outbreak

NSW Health ResponseTestingInfection Prevention and ControlAdditional Resources

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What is Coronavirus & COVID-19

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Coronaviruses are a large family of viruses, some cause illness in humans, and others cause illness in animals, such as bats, camels, and civets.

Human coronaviruses cause mild illness, such as the common cold

Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-

CoV

)

Previous Coronaviruses have included SARS-

CoV

and MERS-

CoV

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus that has not been previously identified in humans

. 

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Human Coronavirus Origins

The most likely ecological reservoirs for coronaviruses are bats, but it is believed that the virus jumped the species barrier to humans from another intermediate animal host.

This intermediate animal host could be a domestic food animal, a wild animal, or a domesticated wild animal which has not yet been identified.

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Coronaviruses

Coronaviruses belong to the

Coronaviridae

family in the Nidovirales orderCorona represents crown-like spikes on the outer surface of the virus; thus, it was named as a coronavirusCoronaviruses are enveloped viruses, minute in size (65–125 nm in diameter) and contain a single-stranded RNA as a nucleic material, size ranging from 26 to 32kbs in lengthClinical Excellence Commission

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COVID-19

The virus that causes COVID-19 is known as SARS-CoV-2

It appears to have first emerged in Wuhan, China, in late 2019.

The outbreak has since spread across China to other countries around the world. By the end of January, the new coronavirus had been declared a public health emergency of international concern by the WHO.The most commonly reported symptoms include a fever, dry cough and tiredness, and in mild cases people may get just a runny nose or a sore throat. In the most severe cases, people with the virus can develop difficulty breathing, and may ultimately experience organ failure. Some cases are fatal.Clinical Excellence Commission

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COVID-19 Timeline

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COVID-19 Worldwide 29 June 2020Clinical Excellence Commission

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10,072,616

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COVID-19 cases and tests reported in NSW, up to 20 June 2020

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Total number of COVID-19 cases by age group and health status NSW 2020

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Coronavirus (COVID-2019)

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February 2020 NSW Health responded to an outbreak of a coronavirus (COVID-2019), first reported in China in December 2019.

The WHO has declared that the official new name for the virus that also formerly went by the names “2019 novel coronavirus” or “2019-nCoV” is now to be known as “SARS-coV-2” which causes COVID-19.

This name change is to differentiate it from other coronavirus outbreaks that include the common cold, but also the severe acute respiratory syndrome (SARS-

CoV

) and Middle East Respiratory Syndrome (MERS-

CoV

) which have previously afflicted the world

.

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Australian National Response

The Australian Government’s health response to the COVID-19 outbreak aims to:

minimise the number of people becoming infected or sick with COVID-19

minimise how sick people become and the mortality ratemanage the demand on our health systemshelp you to manage your own risk and the risk to your family and community

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Australian Department of Health

Government and private agencies are working together to support the Australian Government response

regularly reviewing response

moving resources into activities that are working wellscaling back activities that are not working

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NSW Health Response

Infection with COVID-19 is a notifiable condition under the NSW Public Health Act, so all cases and suspected cases must be reported by doctors and pathology to NSW Health

NSW Health have implemented a range of measures to promptly identify cases of COVID-19 infection and prevent transmission in NSW

Leading & Coordinating a Statewide ResponseClinical Excellence Commission

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NSW Health Response to COVID-19

Should a person in NSW be confirmed to have COVID-19 infection, NSW Health has procedures in place to identify people they have been in close contact with. Those people are provided with advice about self-isolation to minimise spread of the infection. NSW Health response included:

establishing a NSW COVID-19 Clinical Council and 30 Clinical Communities of Practices across key clinical specialities to support the response to COVID-19

providing advice to GPs, pharmacists, emergency departments, and the broader health system on the situation as it evolves to enable possible cases to be rapidly identified, diagnosed and managed

developing diagnostic tests through public health laboratories to rapidly diagnose cases

offering testing at public COVID-19 clinics throughout the state

managing any cases with appropriate infection prevention and control and public health measures to minimise the risk to health care workers and the community

providing regular updates to the community, through media briefings, media releases and social media including in community languages

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Case definition – confirmed case

A

person who:i. tests positive to a validated specific SARS-CoV-2 nucleic acid test;ORii. has the virus isolated in cell culture, with PCR confirmation using a validated method;ORiii. undergoes a seroconversion to or has a significant rise in SARS-CoV-2 neutralising or IgG antibody level (e.g. four-fold or greater rise in titre).https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/COVID-19-SoNG-v3.3.pdf

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Clinical criteria

Fever (≥37.5°C) or history of fever (e.g. night sweats, chills)

OR

acute respiratory infection (e.g. cough, shortness of breath, sore throat)ORLoss of smell or tasteClinical Excellence Commission19

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Probable case A person who has detection of SARS-CoV-2 neutralising or IgG antibody AND has had a compatible clinical illness AND meets one or more of the epidemiological criteria outlined in the suspect case definition

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Suspect case Clinical and public health judgement should be used to determine the need for testing in hospitalised patients and patients who do not meet the clinical or epidemiological criteria.

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Epidemiological criteria

In the 14 days prior to illness onset:

Close contact with a confirmed or probable case

International or interstate travelPassengers or crew who have travelled on a cruise shipHealthcare, aged or residential care workers and staff with direct patient contactPeople who have lived in or travelled through a geographically localised area with elevated risk of community transmission, as defined by public health authorities

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COVID-19 Close Contact definition

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A close contact is defined as requiring:

face-to-face contact in any setting with a confirmed or probable case, for greater than 15 minutes cumulative over the course of a week, in the period extending from 48 hours before onset of symptoms in the confirmed or probable case, or

sharing of a closed space with a confirmed or probable case for a prolonged period (e.g. more than 2 hours) in the period extending from 48 hours before onset of symptoms in the confirmed or probable case

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Infection Prevention and Control Strategies

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Role of Clinical Excellence CommissionClinical Excellence Commission

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General principles for infection prevention and control to prevent or limit transmission of COVID-19

Early recognition of patients who have suspected, probable or confirmed COVID-19

Physical distancing during COVID-19 outbreak

Respiratory hygiene and cough etiquetteManagement of patients with acute respiratory symptoms and/or suspected or proven COVID19Application of Standard Precautions for all patients at all times

Implement Transmission-Based Precautions based on risk assessment

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Isolate and apply infection prevention & control precautions

Standard precautions, including hand hygiene (5 Moments) for all patients. Patients and health workers should observe respiratory hygiene and cough etiquette.

Transmission-based precautions for patients with suspected, probable or confirmed COVID-19:

Contact and droplet precautions for routine care of patients.Contact, droplet and airborne precautions for respiratory aerosol generating procedures (AGPs).

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Aerosol-generating procedures (AGPs)

Aerosol generating procedures (AGPs) are defined as any medical and patient care procedure that results in the production of airborne particles (aerosols) less than 5 micrometres (µm) in size which can remain suspended in the air, travel over a distance and may cause infection if they are inhaled.

Examples of

AGPs can be found on Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health UnitsClinical Excellence Commission

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COVID-19 transmissionGenerally, SARS CoV-2 is spread by larger respiratory particles of liquid referred to as droplets. These larger droplet particles tend to fall on adjacent surfaces (e.g. floor, tabletop) relatively quickly and do not travel long distances.

Travelling over long distances on air currents is generally not a significant factor in the spread of this infection.

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Precautions for COVID-19 Contact and droplet precautions

Addition of airborne precautions for respiratory AGPs

Hand hygiene

Environmental cleaningCleaning of shared patient care equipmentClinical Excellence Commission30

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On presentation or admission to hospital the patient should be:

given a surgical mask to put on, and

placed in a single room (ensuring air does not circulate to other areas)

placed in a negative pressure room (in the event of AGPs being performed).If transfer outside the room is essential, the patient should wear a surgical mask during transfer and follow respiratory hygiene and cough etiquette.

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Contact and droplet precautions:

For close contact <1.5meter between health worker and patients the following PPE is safe and appropriate and should be put on before entering the patient’s room:

An apron or a long-sleeved impervious gown

surgical maskSafety glasses or face shield

disposable nonsterile gloves when in contact with patient (hand hygiene before donning and after removing gloves)

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Personal protective equipment for AGPs

P2/N95 respirators are used for

airborne precautions

when respiratory AGPs are conducted on patients with suspected, probable or confirmed COVID-19 and must be discarded following the AGP along with Fluid resistant long-sleeved or isolation gownEye protection - safety glasses or face shieldDisposable nonsterile gloves when in contact with the patient (hand hygiene before donning and after removing gloves)

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P2/N95 Mask Fit Check

Unless used correctly, i.e. with fit-checking, a P2/N95 respirator (mask) is unlikely to protect against airborne pathogen spread.

An air-tight seal may be difficult to achieve for people with facial hair.

Fit checking with a range of P2/N95 respirators must occur to assess the most suitable one to achieve a protective seal. If a tight seal cannot be achieved, facial hair should be removed.Clinical Excellence Commission35

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The Importance of P2/N95 Respirator Fit Check

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Infection prevention & control principles

Environmental Cleaning

using a hospital grade and TGA approved disinfectant. Waste Management

follows routine clinical and non-clinical waste processes

Utensils follows routine cleaning process

Linen Management

follows normal processes.

Hand Hygiene

using ABHR and/or hand washing.

Respiratory hygiene and cough etiquette

principles apply

PPE

Transmission based precautions

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Staff education for donning and doffing PPE is undertaken for staff managing cases

Opportunity to ensure training of staff is up to date - Limited stocks of PPE should not be used for training and other models of training should occur

PPE

Removing PPE

There are a variety of ways to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially infectious materials.

See two examples below:

Example 1

Gloves

Gown or Apron

Goggles or Face shield

Mask or Respirator

Example 2

Gown and Gloves (in a combined motion)

Goggles or Face shield

Mask or Respirator

Perform hand hygiene immediately after glove removal, before removing face protection, before removing mask/respirator and after removal of any contaminated item

Hand Hygiene

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Facility Preparedness for COVID-19



Staff needed (and suitability) to be trained in high level PPE for COVID-19  Training schedule and staff training in high level PPE –combined precautions Consumables required available, easy to locate and accessible to staff. Emergency Department trained and up to date with PPE competency and combined precautions

 Intensive Care/Critical Care Department trained and up to date with PPE competency and combined precautions

 Pandemic plan in place - reviewed and updated

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INVESTIGATION - arrange for COVID-19 testing if recommended by risk assessment

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Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units

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Advice for health workers, staff, healthcare students and volunteers in NSW

NSW Health recommends that any HW, healthcare student or volunteer with respiratory symptoms or unexplained fever (≥37.50C) should be tested for COVID-19 and immediately self-isolate. They should not return to work duties until they have been tested and cleared from COVID-19 infection

Symptoms of COVID-19 include fever (≥37.50C), cough, sore/scratchy throat and shortness of breath. Other reported symptoms of COVID-19 include loss of smell, loss of taste, runny nose, muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite.

The HW, healthcare student or volunteer must also follow the home isolation guidance for people suspected to have COVID-19. There are a number of COVID-19 Testing Clinics throughout NSW. General Practitioners and Emergency Departments can also perform COVID-19 testing

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Advice for health workers, staff, healthcare students and volunteers in NSW

If a HW, healthcare student or volunteer is tested positive for COVID-19 they must follow the

NSW Health Release from Isolation criteria

before returning to work.If a HW, healthcare student or volunteer has tested negative for COVID-19 and continues to experience respiratory symptoms or unexplained fever, they should be medically assessed prior to returning to work dutiesIf a HW has been informed that they are a close contact for COVID-19 by either the healthcare facility or local Public Health Unit, they must inform their manager or supervisor.

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RESOURCES – copy and paste below link into your browser

NSW HEALTH

https://www.health.nsw.gov.au/Infectious/diseases/Pages/coronavirus.aspx

NSW HEALTH DIRECT LINE1800 022 222CLINICAL EXCELLENCE COMMISSION

http://www.cec.health.nsw.gov.au/

http://www.cec.health.nsw.gov.au/patient-safety-programs/infection-prevention-and-control/novel-coronavirus-2019-ncov

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OTHER RESOURCES – copy and paste below links into your browser

CLINICAL EXCELLENCE COMMISSION RESOURCES

Link to High Consequence Infectious Diseases (Videos)

http://www.cec.health.nsw.gov.au/patient-safety-programs/infection-prevention-and-control/high-consequence-infectious-diseases CDNA National Guidelines for Public Health Units https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/interim-COVID-19-SoNG-v2.0.pdf Link to Videos on PPE http://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment

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{ Insert local contacts and resources }

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