Respiratory virus infections Including COVID-19: Infection Prevention and Control (IPC) Guidance
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Respiratory virus infections
Including COVID-19:
Infection Prevention and Control (IPC) Guidance
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 1
Contents
1. Introduction ....................................................................................................................................................4
2. Screening tool for respiratory infections, including COVID-19 ........................................................5
Community settings .....................................................................................................................................5
3. Patient pathways ...........................................................................................................................................5
Patient’s attending for an outpatient appointment ...............................................................................6
Patient placement..........................................................................................................................................6
4. Respiratory virus, including COVID-19 testing .........................................................................................6
Overview of who to test and when............................................................................................................8
General information on testing for respiratory viruses including COVID-19 ................................9
5. Personal protective equipment (PPE) required ........................................................................................9
Social/Physical distancing ..........................................................................................................................9
Patients ............................................................................................................................................................9
Staff: ...............................................................................................................................................................10
a) Staff in the following areas ..................................................................................................................10
b) Patients in the following areas............................................................................................................13
c) Visitors.......................................................................................................................................................13
6. Fit testing14
7. Aerosol generating procedures (AGP) ....................................................................................................14
NON-RESPIRATORY PATHWAY AGP ....................................................................................................14
RESPIRATORY PATHWAY AGP ..............................................................................................................15
8. Standard infection control precautions (SICPs) ....................................................................................15
9. Ward visiting guidance .................................................................................................................................16
Birthing Partners .........................................................................................................................................16
10. Patients on a NON-RESPIRATORY WARD with suspected respiratory viral infection, including COVID-19 ..17
11. Step down guidance ....................................................................................................................................18
Isolation and discharge guidance RESPIRATORY ward and ICU patients ..................................18
12. Isolation and discharge guidance - Severely Immunosuppressed .................................................19
Definitions of severe immunosuppression ..........................................................................................20
Definition of Vulnerable (with respect to COVID-19) ..........................................................................20
Discharge home ...........................................................................................................................................21
13. Categorisation of COVID-19 cases and surveillance ..........................................................................21
Appendix 1: Respiratory virus including COVID-19 screening tool .....................................................22
Copy of NHS Vulnerable letter: ................................................................................................................23
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 2
Appendix 2: IPC Management of patients with suspected or confirmed viral respiratory tract
infections .......................................................................................................................................25
Appendix 3: PPE posters in ward and areas, available on the intranet to download. .....................26
Appendix 4: Respiratory Hygiene Poster ....................................................................................................27
Appendix 5: Care Plan for patients with a Respiratory Virus including COVID-19 ..........................28
Appendix 6: Transporting Patients with Known or Suspected Respiratory viruses ......................30
Appendix 7: Visitor information……………………………………………………………………………..31
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 3
1. Introduction
This document sets out the infection prevention and control (IPC) advice for Harrogate and
District Foundation Trust (HDFT).
It is based on the national guidance issued by UK Health Security Agency (UKHSA) and adapted
for use in our Trust. It is a dynamic document and will be updated to reflect changes in the
prevalence or severity of respiratory viruses, including COVID-19 at both local and national level.
UKHSA guidance can be accessed via this link:
https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-
and-control/covid-19-guidance-for-maintaining-services-within-health-and-care-settings-
infection-prevention-and-control-recommendations
Specific areas may have risk assessed local guidance which is not included in this document.
Staff respiratory virus, including COVID-19 isolation guidance is not included in this document,
please refer to the Staff Respiratory Infection (Including COVID-19) Isolation / Testing / Return
to Work Guidance on the intranet.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 42. Screening tool for respiratory infections, including COVID-19
Screening questions should be asked to all patients and visitors attending any of our services. Where
possible screening should be undertaken prior to arrival for example by telephone or as soon as
possible on arrival.
A printable version of the screening tool can be found in appendix 1
Community settings
Areas where it is not possible to screen for respiratory viruses including COVID-19 via a questionnaire
(for example a community pharmacy or outpatient phlebotomy services) should use signage at entry
points to advise patients of the necessary precautions. Patients with symptoms should be advised not
to enter the premises.
3. Patient pathways
HDFT uses three patient pathways RESPIRATORY, NON-RESPIRATORY & VULNERABLE
Pathway Criteria Placement
RESPIRATORY Confirmed positive: Side-room (S/R) or cohort with other
SARS-CoV-2 (COVID-19) known positives unless there is another IPC
Influenza A need for isolation
Influenza B
RSV
Suspected (symptomatic): S/R, or 2 metre socially distanced waiting
SARS-CoV-2 (COVID-19) area until result available.
Influenza A
Influenza B
RSV
Un-triaged (symptoms not known or 2 metre socially distanced waiting area or
assessed) S/R
NON- Emergency Admission: NON-RESPIRATORY WARD – Bay or S/R if
RESPIRATORY Screened and asymptomatic and COVID-19 other IPC need for isolation
result negative
Outpatient attendance: Waiting area (physical distancing not
Screened and asymptomatic required)
Elective care – day attendance: Waiting area (physical distancing not
Screened and asymptomatic and required)
Negative lateral flow test or 72 hour pre-
attendance PCR test.
Elective care– inpatient attendance: Elective care ward/bay
Screened and asymptomatic and
Negative lateral flow test or 72 hour pre-
admission PCR test.
VULNERABLE Emergency Admission: S/R on Respiratory positive ward or virus
Symptomatic, Positive for COVID-19, specific cohort bay
Influenza A, B or RSV
Emergency Admission: S/R NON-RESPIRATORY WARD
Asymptomatic and/or Negative for COVID-
19, Influenza A, B or RSV
Outpatient attendance: S/R or Waiting area (physical distancing not
required as triaged)
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 5Elective care – endoscopy: S/R or Waiting area (physical distancing not
required as triaged)
Elective care – day surgery inpatient: S/R
Patient’s attending for an outpatient appointment
Patients should not attend the hospital for an outpatient appointment if they have respiratory
symptoms. Patients who have tested positive for COVID-19 in the last 10 days should not attend.
If it is clinically safe to delay the appointment, it should be re-scheduled for when the patient has
recovered or in the case of COVID-19 for 10 days after they tested positive. When it is not
clinically safe to delay an appointment the patient should be advised to sanitise their hands on
entering the hospital and wear a mask for the duration of the visit. Where possible they should
sit 2m away from other patients.
Patient placement
No specific physical distancing is required for patients on the NON-RESPIRATORY pathway.
Physical distancing for patients who have respiratory symptoms, suspected or confirmed
respiratory infection should remain at 2 metres at all times unless they are in virus specific cohort
bays. Where it is not possible for the required physical distancing to be maintained, a risk
assessment needs to be undertaken and authorised by the Executive team. IPC are available
to assist you in preparing this, but it should be led by the Operational Manager for that area.
Clear plastic barriers are in place between many inpatient beds. These do not replace the need
to keep patients with suspected or confirmed respiratory infection 2 metres apart but provide an
additional barrier to the spread of droplets.
Windows should be opened at least 10 minutes every hour to increase ventilation.
4. Respiratory virus, including COVID-19 testing
The diagnostic sample required for PCR testing of a patient for respiratory viruses including
COVID-19 is a nasopharyngeal swab. Using one swab to swab both the oropharynx and
nasopharynx (see following page).
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 6Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 7
Overview of who to test and when
The following guidance is for patient testing. For staff testing please refer to the Staff COVID Isolation
Guidance on the intranet.
Tests required are numbered 1, 2 and 3 as they appear on the ICE drop down menu
Who to test When to test What to test for
No symptoms:
COVID-19 via Abbott (POC
test)
Symptoms:
All emergency admissions On admission
1) COVID-19/FLU/RSV via
4PLEX
Paediatrics:
2) Biofire on all admissions.
COVID-19
3) SARS COV2 (COVID-19)
If on the LFT Pathway an LFT
should be undertaken on the
day of the procedure or
immediately prior to bowel
prep
If on the PCR Pathway
Elective admissions
undertake a PCR test up to 72
(including day surgery and
hours prior to admission for a
endoscopy)
procedure.
An accompanying carer should
have an LFT undertaken on
the day they are coming in and
then daily if the patient is not a
day case.
COVID-19 via LFT or PCR
NON-RESPIRATORY
3) SARS COV2 (COVID-19)
inpatients attending theatres Within 24 hours of procedure
or endoscopy
Inpatients - who develop 1) COVID-19/FLU/RSV via
symptoms of respiratory 4PLEX
Immediately
viral infection including
COVID-19 2) Paediatrics - Biofire
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 8Patients attending for other As stipulated by local
day interventions (e.g. As stipulated by local departmental policy
chemotherapy or departmental policy
haemodialysis)
Patients being discharged to COVID-19 via PCR
a care home, hospice or 3) SARS COV2 (COVID-19)
have a care package Within 48 hours of discharge or if COVID-19 positive
within 90 days an LFT
or hospice
Patients being transferred to
As stipulated by the receiving COVID-19 via PCR
another healthcare
institution 3) SARS COV2 (COVID-19)
institution
Patients and staff as part of When authorised by Infection As stipulated by the IPCT
an outbreak investigation Prevention and Control
Which patients not to test for COVID-19
Patients who have tested positive in the last 90 days (excluding vulnerable patients)
providing there is documented evidence, they do not require testing on admission. There is
no need to re-test within 90 days, unless they have recovered and develop new symptoms.
Routine testing of inpatients on days 3&5
Routine testing of contacts of a positive inpatient
ICU patients having AGP procedures. If admission swab is negative and patient
asymptomatic, further swabbing not required and can have the AGP in a bay
General information on testing for respiratory viruses including COVID-19
Tests are requested via ICE, please select the reason for testing from the available
options
Swabs cannot be sent via the POD system, they need to be delivered to pathology
specimen reception
Testing is available on-site 7 days per week, but not 24 hours per day (08:00-21:00)
Please ensure swabs are delivered to the laboratory promptly
5. Personal protective equipment (PPE) required
Posters are displayed at the entrance to wards and departments identifying what PPE is
required to be worn by staff (see Appendix 3 for a selection of the posters used).
Social/Physical distancing
Patients:
Social distancing is not required if a patient has been triaged* and has no
respiratory symptoms.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 9 2 metre distancing applies if a patient is not triaged e.g. ED and has respiratory
symptoms
*All patients must be triaged to assess for respiratory symptoms, the exception being
Phlebotomy Services.
Staff:
Masks are required in all clinical areas and when moving around non clinical areas
such as corridors in a healthcare setting.
Masks are not required when seated in a non-clinical area such as a meeting room
or office, but it is good practice to maintain 1m distance between people at all times
when not wearing a mask in a healthcare setting.
a) Staff in the following areas
NON-RESPIRATORY Mask Eye protection Apron/Gown Gloves
pathway
At all times* Fluid resistant - - -
surgical mask
When providing hands Fluid resistant Worn if blood/body Apron if contact If contact with
on patient care surgical mask fluid contamination with blood/body blood/body fluid
to the eyes or face is fluid is anticipated is anticipated
anticipated
Single use Single use
Sessional use but
cleaned in-between
patients
When undertaking an Fluid resistant Yes Apron Yes when
Aerosol Generating surgical mask providing hands
Procedure (AGP) Sessional use but Single use on care
providing the patient FFP3 mask may cleaned in-between
has no other infectious be worn at patients Single use
agent transmitted via individual’s
the droplet or airborne request.
route
1. *Masks are required in all clinical areas and when moving around non clinical areas such as
corridors in a healthcare setting
2. * Masks are not required when seated in a non-clinical area such as a meeting room or office,
but it is good practice to maintain 1m distance between people at all times when not wearing a
mask in a healthcare setting
RESPIRATORY pathway Mask Eye protection Apron / Gown Gloves
At all times Fluid resistant - - -
surgical mask
Before entering a side Fit tested FFP3 Yes Apron worn when Worn when
room / bay masks worn providing hands on providing hands
entering the patient care on patient care
room / bay of Sessional use
confirmed
respiratory Single use Single use
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 10positive
inpatients
When undertaking an Fit tested FFP3 Yes Fluid resistant Yes
AGP. AGP precautions mask gown
need to be maintained Sessional use but Single use
until the appropriate cleaned at the end of Single use
air-clearance time has the AGP
passed*
VULNERABLE pathway Mask Eye protection Apron/Gown Gloves
At all times Fluid resistant - - -
surgical mask
When providing hands Fluid resistant Worn if blood/body Apron if contact If contact with
on patient care surgical mask fluid contamination with blood/body blood/body fluid
to the eyes or face is fluid is anticipated is anticipated
anticipated
Single use Single use
Sessional use but
cleaned in-between
patients
When undertaking an Fluid resistant Yes Apron Yes when
Aerosol Generating surgical mask providing hands
Procedure (AGP) Sessional use but Single use on care
providing the patient FFP3 mask may cleaned in-between
has no other infectious be worn at patients Single use
agent transmitted via individual’s
the droplet or airborne request.
route
Vulnerable patients Follow the Respiratory pathway above
who have respiratory
symptoms
Non-clinical staff Mask
At all times Fluid resistant surgical mask when within 1 metre of colleagues.
Masks are not required when seated in a non-clinical area such as a meeting room or
office, but it is good practice to maintain 1m distance between people at all times
when not wearing a mask in a healthcare setting
Community settings Mask Eye protection Apron/Gown Gloves
(Healthcare facility)
At all times Fluid resistant - - -
surgical mask
NON-RESPIRATORY Fluid resistant Worn if blood/body Apron worn when If contact with
When providing hands surgical mask fluid contamination providing hands on blood/body fluid
on care or within 1 to the eyes or face is patient care non-intact skin or
metre of patient anticipated mucous
Sessional use but membranes is
cleaned in between Single use anticipated
patients
Single use
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 11RESPIRATORY Fit tested FFP3 Yes Apron worn when Worn when
For patients with mask Sessional use but providing hands on providing hands
respiratory symptoms cleaned in between patient care on patient care
postpone if possible for patients
10 days after onset of Single use Single use
symptoms
**Dental practices please refer to the national guidance dental appendix available at:
https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-
and-control/covid-19-infection-prevention-and-control-dental-appendix
Community settings Mask Eye protection Apron/Gown Gloves
(Patient’s own home)
At all times Fluid resistant - - -
surgical mask
When within 1 metre of Fluid resistant Worn if blood/body Apron worn when If contact with
patient surgical mask fluid contamination providing hands on blood/body fluid
to the eyes or face is patient care non-intact skin or
anticipated mucous
Single use membranes is
Sessional use but anticipated
cleaned between
patients Single use
When undertaking an Fit tested FFP3 Yes Fluid resistant Yes
AGP on a patient with mask gown
suspected or confirmed Sessional use but Single use
respiratory infection. cleaned at the end of Single use
AGP precautions need AGP
to be maintained until
the appropriate air-
clearance time has
passed*
For patients with Fit tested FFP3 Yes Apron worn when Worn when
symptoms of a mask Sessional use but providing hands on providing hands
respiratory virus or cleaned in between patient care on patient care
known positive result, patients
if clinically safe Single use Single use
postpone for 10 days,
or follow this guidance
* Air clearance time – this is the time taken for any airborne contamination to be removed. Clearance of infectious
particles after an AGP is dependent on the air change rate and ventilation system within the room. After 5 air changesto the eyes or face is exposure to blood/body fluids or non-
Sessional use anticipated intact skin
Staff administering vaccinations/injections must apply hand hygiene between patients.
b) Patients in the following areas
Colour Masks – (surgical face mask unless stated Eye Apron Gloves
otherwise) protection
NON-RESPIRATORY At point of entrance to the hospital until at - - -
their bed space and when transferring from
one ward/department to another
RESPIRATORY When transferring from one - - -
ward/department to another
ward/department
When moving around the ward and cannot
maintain physical distancing of 2 metres from
other patients (i.e. going to the bathroom).
When in ED if respiratory symptoms.
VULNERABLE At the point of entrance to hospital until they
are in their side room/bed space.
Outpatient At the point of entrance to hospital until they - - -
departments leave the hospital
including group
activities
Community At the point of entrance to the healthcare - - -
Healthcare setting setting until they leave the setting (a face
covering provided by the patient is
acceptable)
Community setting Wear a mask if it can be tolerated for the - - -
patient’s in their own duration of the visit
home
NB: Paediatric patients – The appropriateness of asking a paediatric patient to wear a mask will depend
upon the age of the child and any underlying medical conditions. It is, therefore, entirely appropriate for
paediatric teams to assess and decide when the wearing of a mask by a child is necessary.
c) Visitors
Colour Mask Eye protection Apron/Gown Gloves
NON- Yes - surgical mask No No No
RESPIRATORY
VULNERABLE Yes – surgical mask No No No
RESPIRATORY Yes – surgical mask No No No
If the patient is having an Yes Yes Gown Yes
AGP an FFP3 mask is
required
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 13Relatives staying with a child who has tested positive for a respiratory virus are not required to wear
PPE in the room.
A surgical mask must be worn when leaving the room.
6. Fit testing
All staff who are required to wear an FFP3 respirator (mask) must be fit tested for the models
the Trust are using to ensure an adequate seal or fit (in accordance to the manufacturer’s
guidance).
Respirators should be:
Well fitting, covering both nose and mouth
Not be touched once put on
Removed outside the patient’s/individual’s room or cohort area
Respirators can be single use or single session use (disposable or reusable) and fluid-
resistant
Where fit testing fails, suitable alternative equipment must be provided, or the healthcare
worker should be moved to an area where FFP3 respirators are not required
Fit checking (according to the manufacturer’s guidance) is necessary when a respirator is
put on (donned) to ensure an adequate seal has been achieved
Respirators should be compatible with other facial protection used (protective eyewear), so
that this does not interfere with the seal of the respiratory protection
Valved respirators are not fluid-resistant unless they are also ‘shrouded’. Valved non-shrouded
FFP3 respirators should be worn with a full-face shield if blood or body fluid splashing is
anticipated. Valved respirators should not be worn by a healthcare worker when sterility directly
over the surgical field is required for example in theatres/surgical settings or when undertaking
a sterile procedure, as the exhaled breath is unfiltered.
A list of staff who are fit testers is available on the intranet under Infection Prevention and
Control, if a member of staff requires fit testing they should check the list and locate the person
in their area who is a fit tester. Further information is available from the Infection Prevention and
Control Team.
Fit testing of relatives of a positive patient who is EoL having an AGP should be undertaken by
the ward / department staff
7. Aerosol generating procedures (AGP)
For a list of the procedures that are an AGP see table on the following page.
NON-RESPIRATORY PATHWAY AGP
An AGP can take place in a NON-RESPIRATORY bay providing the following are met:
Patients are symptom free for respiratory illness
The ward does not have an outbreak of COVID-19
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 14 Windows are open during the procedure
Staff do not need to wear a long sleeved gown or FFP3 mask. A surgical mask should be
worn, with eye protection. An apron and gloves should be worn when providing hands on
patient care.
There is no restriction for visitors, a surgical mask should be worn.
RESPIRATORY PATHWAY AGP
Staff must wear a long sleeved gown, gloves, FFP3 mask, visor / goggles for patients with a
respiratory virus, for the duration of the procedure. Air clearance time is 1 hour, any person
entering the room up to 1 hour after the AGP has occurred must wear the above PPE.
Visitors to a respiratory pathway patient requiring an AGP should be fit tested for an FFP3
mask by staff on the ward /dept. and wear eye protection, long sleeved gown and gloves.
*AGP Procedures
Manual ventilation
Tracheal intubation and extubation
Tracheotomy or tracheostomy procedures (insertion or removal)
Bronchoscopy
Dental procedures using high speed devices
Induction of sputum using nebulised saline.
The use of NIV, BiPAP, CPAP, high flow nasal oxygen (HFNO)
Respiratory tract suction beyond the oro-pharynx
High speed cutting in surgery/post-mortem procedures if respiratory tract /paranasal
sinuses involved
Upper ear, nose and throat airway procedures that involve respiratory suctioning
* This list will be updated following confirmation of national guidance
8. Standard infection control precautions (SICPs)
Standard Infection Control Precautions (SICPs), as well as Transmission Based Precautions
(TBPs), should be followed at all times including for deceased patients. The 10 elements of
SICP’s are outlined below and details of where you can obtain further information if required.
Patient placement and assessment for infection risk - see section in this guidance on
screening and pathways. A Respiratory Virus Care Plan should be used (see appendix 5)
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 15 Hand hygiene - The correct technique for hand washing is displayed on the front of all liquid
soap dispensers. Hand sanitiser is available for use before entering all patient rooms and at
point of care
Respiratory and cough hygiene - Appendix 4 Respiratory hygiene poster
Personal protective equipment - See sections in this guidance on PPE required for the
Respiratory, Non-respiratory and Vulnerable Pathways. Information on the correct
procedure for donning and doffing is available on the intranet.
Safe management of the care environment - See IPC policy 019 Decontamination
available on the intranet under Infection Prevention and Control
Safe management of care equipment - See IPC policy 020 Care Equipment available on
the intranet under Infection Prevention and Control.
Safe management of linen - See IPC policy 022 Laundry available on the intranet under
Infection Prevention and Control
Safe management of blood and body fluid spillages - See IPC policy 004 Blood-borne
Viruses available on the intranet under Infection Prevention and Control
Safe disposal of waste (including sharps) - See HIF General Waste Policy
Occupational safety - Exposure management. See Workforce Resources section on
COVID-19 intranet page
9. Ward visiting guidance
Patients (see exceptions below) may have two visitors, for 1 hour between the hours of
2:00pm-4:00pm. No booking required. No active limits on the number of visitors to a bay.
Windows must be open.
Children are not routinely permitted to visit (in exceptional circumstances a case by case
discussion with the IPC team is required).
Visitors will need to read and comply with the visiting instructions on the laminated visitor sheet
upon arrival. (Appendix 7)
Exceptions to routine visiting:
- Patients who have acute respiratory virus symptoms
*If a visit is required to these patients, a risk assessment and an individual Respiratory care
plan are required. The IPC team are available to support this process.
During visiting, windows must be open and patients encouraged to wear a mask if they are
able to.
Birthing Partners
Two birthing partners are allowed. If a birthing partner is symptomatic for respiratory viruses
they cannot attend and an alternative birthing partner should be agreed.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 1610. Patients on a NON-RESPIRATORY WARD with suspected
respiratory viral infection, including COVID-19
Patient in a NON-RESPIRATORY bay or side room has symptoms of a
respiratory viral infection.
Escalate to clinician for patient review to assess if it
could be COVID-19, FLU or RSV
If COVID-19, FLU or RSV is suspected:
If COVID-19, FLU or RSV is
Patient must be swabbed promptly ( 1) COVID-
not suspected:
19/FLU/RSV via 4PLEX
No action required Inform IPC and CSM move to RESPIRATORY ward
SR, deep clean the bed space or side room
Await patient result
If result is negative:
No action required. If result is positive Patient
Patient to return to remains on RESPIRATORY
ward.
original Non-
respiratory ward
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 1711. Step down guidance
Isolation and discharge guidance RESPIRATORY ward and ICU patients
Patient with a positive test for COVID-19, Flu or RSV who is not immunosuppressed*
For COVID-19 on day 11 (with day 0 being the date of COVID-19 test)
If all 3 criteria are met:
Clinical improvement with at least some respiratory recovery (post viral cough may last
for weeks)
and
Absence of fever (12. Isolation and discharge guidance - Severely Immunosuppressed
Patient with positive test for COVID-19 / Flu/ RSV who is severely
immunosuppressed
(see definition below)
Flu / RSV
On day 11 (with day 0 being the date of the test). If the patient has complete resolution of
symptoms they can be transferred to a side room on a Non-Respiratory Ward. Repeat
testing for Flu / RSV is not required.
COVID-19
On day 15 with day 0 being the date of COVID-19 test
If the patient has complete resolution of all symptoms:
• Send a repeat viral nose and throat swab for COVID-19 testing
• Maintain COVID-19 isolation and IPC precautions pending result
Day 15 COVID-19 test Day 15 COVID-19 test
NEGATIVE POSITIVE
Patient can be transferred to Remain on a RESPIRATORY Ward. Maintain
NON-RESPIRATORY side COVID-19 isolation and IPC precautions
room
Repeat COVID-19 test after
7 days
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 19Definitions of severe immunosuppression
Immunosuppression due to acute and chronic leukemia and lymphoma (including Hodgkin’s
lymphoma)
Severe immunosuppression due to HIV/AIDS (British HIV Association advice)
Cellular immune deficiencies (such as severe combined immunodeficiency, Wiskott -Aldrich
syndrome, 22q11 deficiency/Di-George syndrome)
Being under follow up for a chronic lymphoproliferative disorder including hematological
malignancies such as indolent lymphoma, chronic lymphoid leukemia, myeloma and other
plasma cell dyscrasias
Having received an allogenic (cells from a donor) stem cell transplant in the past 24 months
and only then if they are demonstrated not to have ongoing immunosuppression or graft
versus host disease (GVHD)
Having received an autologous (using their own stem cells) hematopoietic stem cell
transplant in the past 24 months and only then if they are in remission those who are
receiving, or have received in the past 6 months, immunosuppressive chemotherapy or
radiotherapy for malignant disease or non-malignant disorders
Those who are receiving, or have received in the past 6 months, immunosuppressive
therapy for a solid organ transplant (with exceptions, depending upon the type of transplant
and the immune status of the patient)
Those who are receiving or have received in the past 12 months immunosuppressive
biological therapy (such as monoclonal antibodies), unless otherwise directed by a specialist
Those who are receiving or have received in the past 3 months immunosuppressive therapy
including:
o Adults and children on high-dose corticosteroids (>40mg prednisolone per day or 2mg/
kg/day in children under 20kg) for more than 1 week
o Adults and children on lower dose corticosteroids (>20mg prednisolone per day or
1mg/kg/day in children under 20kg) for more than 14 days
o Adults on non-biological oral immune modulating drugs, for example, methotrexate
>25mg per week, azathioprine >3.0mg/kg/day or 6-mercaptopurine >1.5mg/kg/day
o Children on high doses of non-biological oral immune modulating drugs
Definition of Vulnerable (with respect to COVID-19)
People at the highest risk of becoming seriously ill from COVID-19 include those who:
have Down’s syndrome
Had an organ or bone marrow transplant
are having chemotherapy or antibody treatment for cancer, including immunotherapy
are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
are having targeted cancer treatments that can affect the immune system (such as protein
kinase inhibitors or PARP inhibitors)
have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
have had a bone marrow or stem cell transplant in the past 6 months, or are still taking
immunosuppressant medicine
have been told by a doctor they have a severe lung condition (such as cystic fibrosis,
severe asthma or severe COPD)
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 20 have a condition that means they have a very high risk of getting infections (such as SCID
or sickle cell)
are taking medicine that makes them much more likely to get infections (such as high
doses of steroids or immunosuppressant medicine)
have a serious heart condition and are pregnant
have chronic kidney disease stage 4 or 5
have HIV or AIDS and have a weakened immune system
have a rare condition affecting the brain or nerves (multiple sclerosis, motor neurone
disease, Huntington’s disease or myasthenia gravis)
have severe liver disease
Discharge home
Patients can be discharged home when their clinical status is appropriate for discharge.
13. Categorisation of COVID-19 cases and surveillance
COVID-19 cases are categorised into one of four onset/acquisition groups (see table below).
The IPC surveillance officer records all cases of COVID-19 diagnosed at HDH in the IPC HCAI
tracker.
Admission length (days)
Day of admission = day 0
Community onset ≤3
Indeterminate hospital onset 4-7
Hospital onset probable healthcare acquired 8-14
Hospital onset definite healthcare acquired ≥15
A rapid post-infection review (rPIR) is carried out for all cases of hospital onset COVID-19.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 21Appendix 1: Respiratory virus including COVID-19 screening tool
Question Yes No
1 Do you have any symptoms of a respiratory illness (cold/flu-like If triaging a patient for emergency/unplanned care: If triaging a patient for
illness)? Manage the patient as per the respiratory pathway emergency/unplanned care:
Symptoms include: Manage the patient as per the
High temperature, fever or chills? If triaging a patient for outpatient appointment: non-respiratory pathway
New, continuous cough? If safe to do so, defer and re-schedule the appointment
A loss or alteration to taste or smell? If triaging a patient for outpatient
Difficulty breathing or shortness of breath If triaging a visitor: appointment:
Headache that is unusual or longer lasting than usual Defer and re-schedule the visit when symptoms have resolved. Proceed with the patient
Diarrhoea, feeling sick or being sick wearing a surgical face mask
Muscle aches or pains that are not due to exercise
If triaging a visitor:
Runny/stuffy nose, sore throat
Proceed with visitor wearing a
2 Have you had a confirmed diagnosis of COVID-19 in the last 10 If triaging a patient for emergency/unplanned care: surgical face mask
days? Manage the patient as per the respiratory pathway
If triaging a patient for outpatient appointment:
If safe to do so, defer and re-schedule the appointment
If triaging a visitor:
Defer and re-schedule the visit no earlier than 10 days after diagnosis
3 Are you currently waiting for a COVID-19 test result? If triaging a patient for emergency/unplanned care:
Manage the patient as per the respiratory pathway
If triaging a patient for outpatient appointment:
If safe to do so, defer and re-schedule the appointment
If triaging a visitor:
Defer and re-schedule the visit until test result is known, then re-triage.
4 Have you received an NHS letter informing you that in the event Patient identified as vulnerable and will require isolation for the duration of their admission
of testing positive for COVID-19 you will be eligible for treatment
(Please show copy of the letter attached) see page 23 of the
Respiratory Virus Infections including COVID-19 IPC Guidance
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 22Copy of NHS Vulnerable letter:
31/03/2022
Your NHS number:
Your reference code:
Dear
Important information about new treatments for coronavirus
Your medical records currently show you might be suitable for treatments if you get coronavirus.
You may have received a version of this letter before. It has been updated because the Government has changed the way you test for coronavirus. From 1 April you
should check coronavirus symptoms using lateral flow tests, not a PCR test.
This letter explains that:
1. You should keep lateral flow tests at home
2. You should take a test if you have coronavirus symptoms. Important: You must report your test result.
3. If you test positive, the NHS will contact you about treatments.
For more information visit: https://www.nhs.uk/CoronavirusTreatments
Why are we sending you this letter?
Health experts have looked at the health conditions which put people at more risk from coronavirus. Those health conditions have been agreed by UK chief medical
officers.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 23We are contacting you because your medical records currently show that you have one or more of these health conditions. This means that treatments might be
suitable for you if a test confirms you have coronavirus.
These treatments can stop you from getting seriously ill and need to be given quickly after you start to have symptoms.
1. You should keep lateral flow tests at home
The UK Health Security Agency will send you one pack of lateral flow tests by 12 April. Only use them if you develop symptoms. If you run out, you can order more from
https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests or by calling 119.
You can use any lateral flow tests supplied by the Government. Tests bought from a shop cannot currently be registered via GOV.UK or 119 and you will not be
contacted about treatment if you test positive using these tests.
If you were previously sent a PCR test you can keep it. You might be asked to take a PCR if you receive treatment from the NHS.
2. You should take a test if you have coronavirus symptoms
If you have coronavirus symptoms you should take a lateral flow test immediately, even if your symptoms are mild.
You must report your result at https://www.gov.uk/report-covid19-result or by calling 119. It’s important to provide your NHS number so you can be contacted.
If your test is negative but you still have symptoms, you should take another test on each of the next two days (three tests in total over three days).
3. If you test positive, the NHS will contact you about treatments
If any of your lateral flow tests are positive and you have reported the result, the NHS should contact you about treatment. If you are not contacted within 24 hours of
your positive test, call your GP surgery, 111, or your specialist clinician (if you have one), who can make an urgent referral.
Yours sincerely
Professor Stephen Powis
National Medical Director
NHS England and NHS Improvement
More information on how the NHS has used your information: https://www.digital.nhs.uk/coronavirus/treatments/transparency-notice
If you need this letter in easy read, braille or other languages, please visit https://www.england.nhs.uk/coronavirus/patient-letter or contact
england.contactus@nhs.net
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 24Appendix 2: IPC Management of patients with suspected or confirmed viral respiratory tract
infections
Isolation Cleaning
Required - Contact
Virus/Agent Incubation Duration ( very young / very old/ PPE
Required immunocompromised patients will bed space Tracing
shed the virus for longer) only
Coronavirus (non-COVID),
3-5 days No No No No No
enterovirus, bocavirus
Rhinovirus/adenovirus 1-2 days No No No No No
Metapneumovirus 4-6 days No No No No No
Gloves, *apron,
Parainfluenza (types 1-4) 1-7 days Yes 5 days FFP3 mask, eye **Deep clean No
protection
Gloves, *apron,
Respiratory Syncytial Virus (RSV) 3-5 days Yes 5 days FFP3 mask, eye **Deep clean No
protection
5 days from onset of symptoms if on
> 12 hr same
antiviral treatment. 7 days from onset Gloves, *apron,
bay contact
Influenza (flu) 1-4 days Yes of symptoms if not on antiviral FFP3 mask, eye **Deep clean
within the past
treatment. Immunocompromised protection
48 hrs.
patients require 10 days isolation.
Gloves, *apron,
COVID-19 1-14 days Yes 14 days from onset of symptoms FFP3 mask, eye **Deep clean No
protection
Gloves, gown,
SARS 2-7 days Yes For the duration of the admission FFP3 mask, eye HPV Yes
protection
Gloves, gown,
MERS 2-14 days Yes For the duration of the admission FFP3 mask, eye HPV Yes
protection
* Long sleeved gown is required if an AGP is undertaken in the room.
** Air clearance time after an AGP in a room is approximately 1 hour
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 25Appendix 3: PPE posters in ward and areas, available on the
intranet to download.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 26Appendix 4: Respiratory Hygiene Poster
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 27Appendix 5: Care Plan for patients with a Respiratory Virus
including COVID-19
Care
Ward Plan for patients with a Respiratory virus including COVID-19
Consultant
Date of diagnosis (date) ................................. STOP date for isolation (date) ……………..
Positive swab result COVID-19 □ Flu □ RSV □
Problem Risk associated with a Respiratory virus
To safely care for a patient with a Respiratory virus minimising the risk of
omplica complications to the patient and transmission to others.
Start isolation
Transfer to a Respiratory Ward /Cohort bay (cohort only if the same virus).
Isolate patient for 10 days if COVID-19, for Flu, RSV isolate for 7 days. If the patient is
classed as vulnerable, the isolation period will need to be increased – see IPC for further
information.
Display an isolation notice on the door and place equipment required for isolation
outside room or bay on a trolley. The door must remain closed.
PPE
Wear an FFP3 mask, eye protection, gloves and apron when entering the room or bay.
If the patient is in a bay being cohorted, remove gloves and apron after each patient
and decontaminate hands. Remove gloves and apron before leaving the bay and
decontaminate hands. Masks and eye protection are sessional and can be worn for 4
hours (providing you are only looking after Patients with the same respiratory virus.
If the patient is in a side room, remove gloves and apron and decontaminate hands
before leaving the room.
For an AGP and for 1 hour after an AGP: Wear an FFP3 mask, eye protection, a long
sleeved gown with the sleeves pushed up, a disposable apron and gloves when
entering the room or bay. Remove the gloves and apron after each patient and
decontaminate hands. Remove gloves and apron before leaving the room or bay and
decontaminate hands. Outside the room or bay remove the long sleeved gown, FFP3
mask and eye protection and decontaminate hands. Put on a surgical mask and clean
the eye protection before wearing again. In ICU: this process differs, as there is
enhanced ventilation: the step down time is 15 minutes in negative pressure side rooms
(rooms 9 and 11).
Visitors entering an AGP area need to be FIT tested for an FFP3 mask. Assist relatives
and visitors with wearing and removing PPE safely as per Trust guidelines.
Provide the patient with a mask to wear if there is a clinical need for them to leave the
bay or side room. If tolerated, ask the patient to wear a mask when staff are undergoing
direct care in the side room or bay.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 28Cleaning and hygiene
Keep the room / bay tidy and clutter-free to facilitate cleaning. Decontaminate
equipment with Tristel- fuse or Clinell green wipes before taking it out of the room / bay
and between patients. Note: if the patient has loose stool Tristel-fuse (not Clinell wipes)
must be used to clean equipment.
Advise that the patient’s own clothing should be laundered separately at a high
temperature and any other belongings sent home should be cleaned with a Clinell green
wipe first where possible.
Promote patient hand hygiene, provide tissues, waste bag and hand wipes.
Open the window for a minimum of 10 minutes every hour. Provide extra blankets if
needed.
End isolation
End isolation, for COVID-19 positive patients on day 11 if the patient is apyrexial and has
respiratory improvement. No clearance swab is required as the result is likely to remain
positive for 90 days.
If the patient has Flu end isolation after 7 days.
Continue to isolate if immunocompromised (until symptom free and a negative swab
result).
If the patient is vulnerable they should remain in a side room.
On transfer or discharge, a deep clean of the bed space or side room is required. On
transfer or discharge from an AGP area 1 hour down time is required prior to cleaning
(this time differs to 15 minutes in a negative pressure side room on ICU and 30 minutes
in the bay due to enhanced ventilation units).
Nurse initiating Care Plan ……………………………. Signature ………………………
Date……………….Time…………….
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 29Appendix 6: Transporting Patients with Known or Suspected
Respiratory viruses
STAFF/ PORTER If patient has tested positive for a Respiratory virus PPE: FFP3
mask, eye protection, plastic apron and gloves. Non-Respiratory patient: PPE
surgical mask, eye protection if blood/body fluid contamination to the eyes or
face is likely. Apron and gloves only required if providing hands on care
(touching a patient).
INFANT / BABY
ADULT PATIENT MUST
WEAR EITHER A SURGICAL MASK UNLIKELY TO WEAR MASK, THEREFORE THE
OR OXYGEN MASK PARENT SHOULD CARRY THE BABY/INFANT CLOSE
TO THEIR CHEST
AGP occurring for a positive patient: place a clean sheet on the bed, clean the head
and foot ends with green Clinell wipes or Tristel-fuse toParent does
reduce notviral
the needload.
PPE. All staff
must wear a long sleeved gown and FFP3 mask with eye protection and gloves.
When going through the corridors if a patient is positive, ensure no one is within 2
metres. If AGP is occurring on a positive patient the area must be cleared and where
possible be out of use for 1 hour afterwards, door handles and rails must be wiped
with green Clinell wipes.
If a lift is required, ensure it is empty and do not allow others to enter. The lift does
not require a deep clean. If a positive patient with an AGP has been in the lift it must
be out of use for 1 hour afterwards, then the keypads cleaned with green Clinell
wipes.
When the patient is at the required destination clean the trolley/ bed with Tristel-
fuse or green Clinell wipes.
When the task is complete remove PPE and replace with a new
surgical mask.
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 30Appendix 7: Visitor Information
Visiting Information
Dear Visitor,
Please do not visit if you have symptoms of a respiratory illness (cold/flu-like
illness) or you have tested positive for COVID-19 in the last 10 days.
Symptoms include:
High temperature, fever or chills
New, continuous cough
A loss or alteration to taste or smell
Difficulty breathing or shortness of breath
Headache that is unusual or longer lasting than usual
Diarrhoea, feeling sick or being sick
Muscle aches or pains that are not due to exercise
Runny/stuffy nose, sore throat
Please help keep patients, staff and visitors safe by doing the following:
Wear your mask over your nose and mouth during your visit, do not put it under
your nose or lower it to talk. Please discuss with staff if lip reading is required.
Wash or sanitise your hands on entering the ward and the bay.
Do not sit on the patient’s bed.
Do not walk around the bay, please just stay with your relative.
Patients may have two visitors for 1 hour between the hours of 2:00pm and
4:00pm.
On leaving the bay and the ward, wash or sanitise your hands.
Visiting may change at short notice if a bay requires temporary closure for an
infection or due to changes in national guidance.
Our hospital is still extremely busy and staff are working as hard as they can to
care for our patients, so please help them by adhering to this guidance. Your
support is greatly appreciated.
If you have any concerns regarding the above, please discuss with the ward staff.
Thank you.
Emma Nunez, Executive Director of Nursing, Midwifery & Allied Health
Professionals
Jackie Andrews, Executive Medical Director
Harrogate and District NHS Foundation Trust | Version 5.02 23/05/2022) 31You can also read
