Response and Escalation Framework - COVID-19 Infection Prevention and Control Version 2.0 November 2020 - Clinical ...
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COVID-19 Infection Prevention and Control Response and Escalation Framework Version 2.0 November 2020
Contents
Escalation Principles .....................................................................................................................................................2
Background ...................................................................................................................................................................2
Transition between risk levels ......................................................................................................................................2
General principles – apply to all settings and all scenarios ..........................................................................................2
Risk Matrix Model.........................................................................................................................................................3
Risk Matrix ....................................................................................................................................................................4
Green Alert Poster ........................................................................................................................................................7
Green Alert: Frequently Asked Questions (FAQs) ........................................................................................................8
Health Workers ....................................................................................................................................................8
Patients ................................................................................................................................................................9
Cloth Masks....................................................................................................................................................... 10
Home Visits ....................................................................................................................................................... 11
Carer in a Healthcare setting ............................................................................................................................ 11
Visitors .............................................................................................................................................................. 11
Aged Care Facilities/Multi-Purpose Service (MPS) ............................................................................................11
Volunteers in a Healthcare setting ................................................................................................................... 12
Contractors ....................................................................................................................................................... 12
Stock Delivery to Clinical Areas – External Delivery/Courier Companies ......................................................... 12
Valve Masks ...................................................................................................................................................... 13
Amber Alert Poster .................................................................................................................................................... 14
Amber Alert: Frequently Asked Questions (FAQs) .................................................................................................... 15
Health Workers ................................................................................................................................................. 15
Patients ............................................................................................................................................................. 17
Cloth masks ....................................................................................................................................................... 18
Home Visits ....................................................................................................................................................... 20
Carer in a Healthcare setting ............................................................................................................................ 20
Visitors .............................................................................................................................................................. 20
Aged Care Facilities/Multi-Purpose Service (MPS) ........................................................................................... 21
Volunteers in a Healthcare setting ................................................................................................................... 22
Contractors ....................................................................................................................................................... 22
Contractors ....................................................................................................................................................... 22
Stock Delivery to Clinical Ares – External Delivery/Courier Companies ........................................................... 23
Valve Masks ...................................................................................................................................................... 23
Amber Alert: Scenario Table ...................................................................................................................................... 23
Red Alert Poster ......................................................................................................................................................... 26
COVID-19 Infection Prevention and Control
Response and escalation framework
Version 2.0, November 2020
UNCONTROLLED WHEN PRINTED
Page 1 of 26Escalation Principles
Background
This COVID-19 Infection Prevention and Control Response and Escalation Framework (risk matrix) has been
developed to provide guidance to NSW health facilities on the various levels of COVID-19 transmission risk. The
development of this framework has been informed by NSW, national and international experience and evidence.
The intent is that any changes to risk level are state-wide, an approach informed by consultation with the Ministry
of Health and Local Health Districts (LHDs)/Special Health Networks (SHNs).
During situations of increased risk, it is important to be able to escalate and provide a proportionate response
with specific infection prevention and control precautions to align with the level of community transmission and
onward spread. The state-wide risk is based on a variety of data sets as follows
1. Geographic clusters within Local Health Districts, Local Government Areas or State-wide
2. Level of Community Transmission and the Public Health Response
3. Number of COVID-19 tests/percentage of tests that are positive
4. Number of patients requiring hospitalisation and changes in the burden of COVID-19 within health
facilities
5. Outbreaks in facilities e.g. residential aged care facilities, multi-purpose services and community
residential care homes
6. Number of health worker infections
The level of risk and escalation or de-escalation is provided and assessed by the Risk Escalation Review Panel
(RERP) (COVID-19 Public Health Response Branch, the Agency for Clinical Innovation (ACI), Workforce and the
Clinical Excellence Commission (CEC)), which reviews various factors including NSW COVID-19 cases statistics -
Local COVID-19 transmission in the last two weeks.
Transition between risk levels
Although the risk of community transmission and consequent impact on health services varies across LHDs/SHNs
the agreed approach is to have a state-wide decision-making process. The criteria used to transition between risk
levels of green, amber and red are a composite of community transmission, the public health response and the
burden of infection in the health system. Data supporting these is reviewed weekly by Risk Escalation Review
Panel. Where an LHD/SHN local community risk warrants additional assessment, this should be escalated by the
Chief Executive of the LHD/SHN to the Chief Health Officer (CHO) who will call an extraordinary meeting of the
RERP to agree on an NSW Health response.
Escalating to higher transmission risk levels requires LHDs and SHNs to rapidly respond and implement the key
controls aligning with each risk level. De-escalation may require additional communication and implementation
may take longer.
Private and independent health care providers may refer to our advice for guidance and to inform their own local
risk assessments.
General principles – apply to all settings and all scenarios
The following principles provide a robust framework for LHD/SHNs to manage risk. A key focus during escalation
is to ensure that the hierarchy of controls are in place and to look at the use of personal protective equipment
(PPE) in response to the level of community transmission.
The fundamental principles of infection prevention and control must always be applied across all settings. These
principles apply across all scenarios and are not outlined in detail in the tables below but are listed here:
1. Administrative and engineering controls as per Management of COVID-19 in Healthcare Settings
2. Physical distancing
Response and escalation framework associated with COVID-19
Version 2.0, November 2020
UNCONTROLLED WHEN PRINTED
Page 2 of 263. Standard precautions for all healthcare interactions
4. Hand hygiene
5. Enhanced cleaning of high touch surfaces
6. Ensure relevant staff have completed donning and doffing of PPE training
7. Ensure there is on-site, readily available COVID-19 testing for staff
8. Health workers (HWs) stay at home if they are unwell
9. Entry screening for visitors and staff as per NSW Health guidelines
Risk Matrix Model
MODERATE HIGH TRANSMISSION
LOW TRANSMISSION
TRANSMISSION (RED ALERT)
(GREEN ALERT)
(AMBER ALERT)
Standard Precautions
Transmission based
Precautions
Surgical mask for ED HWs Escalate PPE controls Escalate PPE controls
caring for patients mask use for all HWs Universal mask use by HWs
providing care within 1.5m
ED Patients to wear mask in addition to standard Patients to wear masks on
on arrival to ED and transit precautions presentation and during
transit
ACFs, DCFs and home care Patients & visitors to wear
services should take extra masks on presentation and Risk assessment of cases
precautions including the and community
during transit
use of masks where there transmission will be
are areas for increased determined by the Risk
Risk assessment of cases
testing* Escalation Review Panel
and community
transmission will be
Risk assessment of cases Visitors by exception
determined by the Risk
and community
Escalation Review Panel
transmission will be
determined by the Risk
Escalation Review Panel
*https://www.health.nsw.gov.au/Infectious/covid-19/Documents/covid-19-racfs-advice.pdf
Ensure screening and triage processes are in place to manage patients with suspected, probable
or confirmed COVID-19
Response and escalation framework associated with COVID-19
Version 2.0, November 2020
UNCONTROLLED WHEN PRINTED
Page 3 of 26MODERATE (AMBER ALERT) HIGH (RED ALERT)
Risk Matrix LOW (GREEN ALERT) TRANSMISSION
TRANSMISSION TRANSMISSION
Patients
All patients to wear a mask (surgical or own
cloth mask) on presentation and during transit
All patients to wear a mask (surgical or own if possible
Standard precautions: hand hygiene, physical
cloth mask) on presentation and during transit Manage suspected, probable and confirmed
distancing, cough etiquette, respiratory
if possible COVID-19 patients in a single room where
All patients in hospital hygiene and personal hygiene
Manage suspected, probable and confirmed possible
Exclude outpatients if suspected, probable and
COVID-19 patients in a single room where Prioritise single rooms based on patients’
confirmed COVID-19 unless urgent
possible clinical condition and risk of transmission level
or cohort if no single rooms available (pending
result of COVID testing)
Standard precautions: hand hygiene, physical
distancing, cough etiquette, respiratory All patients to wear a mask (surgical or own All patients to wear a mask (surgical or own
Presenting directly to Emergency hygiene and personal hygiene cloth mask) on presentation and during transit cloth mask) on presentation and during transit
Department (ED)
All patients to wear a mask (surgical or own if possible if possible
cloth mask) on presentation to ED
Standard precautions: hand hygiene, physical
Patient presenting directly to distancing, cough etiquette, respiratory All patients to wear a mask (surgical or own All patients to wear a mask (surgical or own
delivery suite medical imaging, hygiene and personal hygiene cloth mask) on presentation and during transit cloth mask) on presentation and during transit
outpatients, rehabilitation groups
Patients to wear a mask if acute respiratory if possible if possible
and community health services
illness (ARI) suspected or confirmed
Mother and baby to stay together. All adult
Standard precautions: hand hygiene, physical Mother and baby to stay together patients to wear a mask during presentation
Maternity & paediatric patients distancing, cough etiquette and respiratory Children 12yrs and under are not required to and during transit if possible.
hygiene. wear a mask Children 12yrs and under are not required to
wear a mask
Standard precautions: hand hygiene, physical Standard precautions (as per green alert level)
Home based care (patients seen All patients to wear a mask (surgical or own
distancing, cough etiquette and respiratory and mask (surgical or own cloth mask) should
in their own home) cloth mask) when receiving care if possible
hygiene. be worn by patients at their discretion
4MODERATE (AMBER ALERT) HIGH (RED ALERT)
Risk Matrix LOW (GREEN ALERT) TRANSMISSION
TRANSMISSION TRANSMISSION
Standard precautions: hand hygiene, physical
distancing, cough etiquette and respiratory
hygiene. ACFs, DCFs and home care services Standard precautions (as per green alert level) Patient mask use should be based on facility
Residents of residential aged care
should take extra precautions including the or local decision based on case locations risk risk assessment and NSW Health
facilities
use of masks where there are areas for level see NSW Health advice for RACFs recommendation
increased testing NSW Health advice for
RACFs
Health workers:
Standard precautions and physical distancing apply at all times.
All HWs to wear surgical mask in addition to
standard precautions
Universal surgical mask use when outside the
Physical distancing to apply at all staff breaks
defined clinical area
where possible
Physical distancing to apply at all staff breaks
HWs to follow contact and droplet
where possible
precautions if suspected, probable and
confirmed COVID-19. HWs to follow contact and droplet
precautions when providing care
Add Airborne precautions for respiratory AGPs
for patients with probable and confirmed
COVID-19 or acute respiratory illness (ARI) Airborne Precautions are required when:
Providing care within 1.5m of Standard precautions
patients Airborne precautions are required in the • Working in high-risk clinical areas e.g. hot
Physical distancing to apply at all staff breaks
following circumstances when caring for zones, COVID-19 wards/units, ED and
probable or confirmed COVID-19 patients: ICU/critical care (consider
extended/sessional use of respirators)
• In situations where there are
patients/residents cohorted in one area or • when performing respiratory AGPs
ward; AND/OR
• providing direct care to a patient who has
• Where there is prolonged and close suspected, probable or confirmed COVID-
contact with these patients; AND/OR 19
• For respiratory aerosol-generating
procedures (AGPs)
5MODERATE (AMBER ALERT) HIGH (RED ALERT)
Risk Matrix LOW (GREEN ALERT) TRANSMISSION
TRANSMISSION TRANSMISSION
Standard precautions.
Physical distancing at breaks.
HW to wear a surgical mask for all patient care
HWs working in ED areas As above As above
Contact and droplet precautions if patients
have an acute respiratory illness or suspected,
probable or confirmed COVID-19
No contact within 1.5m of
Standard precautions Standard precautions Surgical masks (universal mask use)
patients
Standard precautions
HWs who work in DCFs and home care services
Home based care (patients seen Surgical mask within 1.5metres of
should take extra precautions including the use Surgical masks (universal mask use)
in their own home) patient/client
of masks where there are areas for increased
testing see NSW Health advice for RACFs
HWs who work in RACFs, DCFs and home care
HWs who work in RACFs should take extra
services should take extra precautions
Residential aged care facility precautions including the use of masks where
including the use of masks where there are Surgical masks (universal mask use)
(RACF) there are areas for increased testing see NSW
areas for increased testing see NSW Health
Health advice for RACFs
advice for RACFs
Visitors:
Visitors must wear a mask before entering the Visitors, including any children will require an
facility (surgical or own cloth mask) exemption to visit.
All visitors over 12 years of age Standard precautions
Children 12yrs and under are not required to
wear a mask
Visitation should be based on the latest advice Visitation should be based on the latest advice Reduce visitors to essential only
Visitors to RACF from COVID-19 Public Health Response Branch from COVID-19 Public Health Response Branch
see NSW Health advice for RACFs see NSW Health advice for RACFs No visits from children under 12 years of age
Note: Although these principles apply across healthcare environments, when caring for vulnerable patients/residents, individual circumstances should be considered.
The evidence shows that SARS-CoV-2 can spread from hand-to-hand contact from inanimate objects and highly touched fomites, including medical equipment. There is also growing evidence on the
transmission of COVID-19 in common areas when masks are off, in tea rooms, changing rooms, and crowded transport to and from the hospital where physical distance cannot be maintained. The
importance of hand hygiene, physical distancing, enhanced cleaning for shared equipment and environment remains critical to ensure safety of health workers.
6COVID-19 Infection Prevention and Control:
Green Alert - Low Transmission
Mask use NOT required on entry
STANDARD PRECAUTIONS ALWAYS APPLY
Ensure screening and triage processes are in place to
manage patients with suspected COVID-19
Standard precautions: hand hygiene, physical distancing, cough
etiquette, respiratory hygiene and personal hygiene
Patients
Unless urgent, exclude outpatients with
suspected/probable/confirmed COVID-19
Patients with an acute respiratory illness on presentation to wear a
mask
Standard Precautions
Health workers
Transmission based precautions for patients with
(HW)
suspected/probable/confirmed COVID-19
Surgical mask use for ED HWs caring for patients
Physical distancing to apply for all staff breaks
No restrictions if approved during the COVID-19 entry screening
Visitors
criteria
Promote hand hygiene and physical distancing at entry to health
facility and patient rooms
COVID-19 Infection Prevention and Control
Green Alert – Low Transmission
Version 1.0, November 2020
UNCONTROLLED WHEN PRINTED
Page 1 of 1GREEN Alert: Frequently Asked Questions (FAQs) November 2020
The FAQs provide an explanation of when masks need to be worn during HW patient
interactions, patients, visitors, carers and other people coming into NSW health
facilities.
HEALTH WORKERS
When should I wear a mask? • A decision about using a mask for patient care should be considered as part
of the risk assessment for standard precautions (see Risk assessment). Part
of the risk assessment is the anticipated exposure risk of blood or body
fluid to eyes/mouth/nose
• Masks should still be worn when assessing or providing care to any patient
with acute respiratory symptoms
• Masks/respirators are still required for respiratory aerosol generating
procedures
Why do I need to wear a • Although the risk of COVID-19 infection is very low in the community, the
mask when working in the emergency departments are thought to be a higher risk environment and a
ED? surgical mask is recommended for all patient care within 1.5m of a patient.
• If a patient has acute respiratory illness or is a known contact of COVID-19,
then contact and droplet precautions are required.
When in crowded areas of • This will be at the HW’s discretion.
the hospital e.g. eating • Physical distancing, cough etiquette, respiratory hygiene and hand hygiene
areas/cafeteria, do HWs is always to be practiced.
need to wear a surgical
mask?
During this PPE GREEN Alert, • Vulnerable HWs should be individually risk assessed to determine their
should HWs with conditions suitability for clinical areas.
that place them in a • Vulnerable HWs may choose to wear a surgical mask when within 1.5
‘vulnerable’ group be metres of any patient to reduce this risk and this should be considered in
redeployed? the risk assessment.
If a HW is in a non-clinical
No, masks do not need to be worn in these settings.
area or office, should they
• Physical distancing, cough etiquette/respiratory hygiene and hand hygiene
wear a surgical mask?
are always to be practiced.
If a visitor asks why a HW is • Masks are not required for routine patient care. Information about the risk
not wearing a surgical mask, levels should be placed in public spaces for patients and the relatives and
how should the HW carers.
respond?
If a HW travels in a shared Masks are unlikely to be required.
health vehicle with another • Please refer to Appendix D – Transport Health Worker Advice Guidance
HW, do they need to wear a
surgical mask?
8GREEN Alert: Frequently Asked Questions (FAQs) November 2020
HEALTH WORKERS (cont.)
Should HWs entering a • For school-based programs, masks are not routinely recommended.
school for the provision of a However, a risk assessment must always be performed and there may be
service wear a mask? situations where a mask is worn.
(E.g. Immunisation or school • For schools located within health facilities, HWs can wear a mask if they
within a health facility) are required to provide direct care for high risk person/client (acute
respiratory illness) within 1.5 metres.
PATIENTS
When should a patient wear A mask should be worn if:
a mask (see also questions • the patient is attending a health facility and has acute respiratory
regarding cloth masks symptoms (whether they have had a COVID-19 test or not). e.g. Emergency
below)? Department, Outpatient Clinic, Delivery Suite, Medical Imaging, Pathology
Collection.
Once a patient is admitted Patients will not usually be required to wear a mask.
to a clinical area, are they • If they have acute respiratory symptoms or are suspected, probable or
required to wear a surgical confirmed COVID, they are required to wear a surgical mask if they are
mask while they are an leaving their room (for example going to medical imaging department)
inpatient?
Remember: Some patients will not be able to tolerate a mask.
Why don’t children 12 years • In general, it is not practical for children to be fitted with a mask.
old and under need to wear • There appears to be limited transmission of COVID-19 from children to
a mask if they have adults.
respiratory symptoms? • If a child is wearing a mask, then this can continue while the child is inside
a health facility.
• Masks can be choking hazards for children under two, therefore, they are
not suitable for this age group.
• This advice is consistent with other jurisdictions.
Can a patient with Patients should not wear a P2/N95 respirator but may be asked to wear a
suspected, probable or surgical mask when in a shared space.
confirmed COVID-19 wear a
P2/N95 respirator?
9GREEN Alert: Frequently Asked Questions (FAQs) November 2020
CLOTH MASKS
Can a HW wear a cloth mask No.
at work? • Cloth masks vary in quality and effectiveness and they are not fluid
resistant. This means they will not prevent blood, body fluids and
respiratory droplets penetrating the mask.
• A cloth mask can be worn by HWs outside the health facility e.g. travelling
to and from work.
If a visitor comes in wearing No.
a cloth mask, should it be • If the visitor can wear the cloth mask without discomfort, they can
changed to a surgical mask? continue to wear it.
• Reminders regarding hand hygiene, physical distancing, avoiding touching
their mask and cough etiquette, respiratory hygiene are to be provided.
• If the visitor has acute respiratory symptoms or fever, they need to defer
their visit and have COVID-19 testing. They should be asked to change to a
surgical mask.
If a patient/client, without No.
any COVID-19 symptoms, • They are not required to wear a mask but may continue to wear based on
comes in wearing a cloth personal choice.
mask, should it be changed • Reminders regarding hand hygiene, physical distancing, avoiding touching
to a surgical mask? their mask and cough etiquette, respiratory hygiene are to be provided.
If a patient/client, with Yes.
acute respiratory illness or • A cloth mask will become damp very quickly when someone has an acute
COVID-19 symptoms, comes respiratory illness, fever or COVID-19 symptoms.
in wearing a cloth mask, • The mask will be much less effective when damp and may be touched
should it be changed to a frequently by the patient.
surgical mask? • A surgical mask should be placed on the patient and usual
admission/discharge processes for suspected, probable or confirmed
COVID-19 patients are to be followed.
• Reminders regarding hand hygiene, physical distancing, avoiding touching
their mask and cough etiquette, respiratory hygiene are to be provided.
• Access to tissues, alcohol-based hand rub and a bin is to be provided.
If a member of the No, these are not classified as cloth masks
community wears a towel, NSW Health has released general guidance for cloth masks. This information
scarf, tea towel etc into the should be followed.
health facility, is this
classified as a ‘cloth mask’?
10GREEN Alert: Frequently Asked Questions (FAQs) November 2020
HOME VISITS
Do HWs need to wear a • A surgical mask is recommended only if the patient has respiratory
surgical mask when they are symptoms or is in self-isolation.
visiting a patient in their • A surgical mask is recommended if in an area of increased testing
home to provide healthcare? • HWs should maintain physical distancing whenever possible.
• Patients are not required to wear a mask but may choose to wear one.
CARER IN A HEALTHCARE SETTING
Should a carer wear a Yes, if the person has symptoms of COVID and COVID has not been ruled out by
surgical face mask if within testing.
1.5 metres of a patient?
VISITORS
Are visitors required to wear No, they are not required to wear a mask.
a mask if they come to a • If they have acute respiratory symptoms, they need to defer their visit.
health facility? • If they are already wearing a cloth or surgical mask, they can continue to
wear this. See section on Cloth Masks.
What should be done if a • Offer an alternative such as a virtual visit.
visitor appears to have acute • The visitor should be asked to defer their visit if possible.
respiratory symptoms? • they must be referred for COVID testing and told to isolate until negative test
AGED CARE FACILITIES/MULTI-PURPOSE SERVICE (MPS)
Does a resident in an aged No.
care facility or MPS need to • This is classified as their home.
wear a surgical mask?
11GREEN Alert: Frequently Asked Questions (FAQs) November 2020
PATIENTS WITH A DISABILITY, COGNITIVE IMPAIRMENT, BEHAVIOURAL
ISSUES AND MENTAL HEALTH CONDITIONS
HW/carer/visitor in DCFs should take extra precautions including the use of masks
Should a HW/carer/visitor
where there are areas for increased testing see NSW Health advice for RACFs
wear a surgical mask if • HWs should wear a mask if patient has acute respiratory symptoms or if
within 1.5 metres of a there is uncontrolled behaviour by the patient/person.
patient?
• HWs, visitors and/or carers wearing a surgical mask may cause some
patients distress or trigger changes to their behaviour or mental health
condition. This will require a risk assessment and ongoing monitoring to
determine the best way to manage the risk of transmission of COVID-19
when providing care within 1.5 metres of the patient. If a risk assessment
determines that a mask will pose a physical risk to the patient, alternatives
such as physical distancing and full-face shield should be considered. The
risk assessment should determine the appropriate PPE for the HW.
• All decisions regarding the risk assessment should be documented in the
patients’ healthcare record.
VOLUNTEERS IN A HEALTHCARE SETTING
Are volunteers required to • Volunteers are not required to wear a mask. If they are in a vulnerable
wear a mask? group, they may choose to wear a mask while in the healthcare setting.
• If volunteering in ED a mask should be worn within 1.5m of a patient.
• Reminders regarding hand hygiene, physical distancing, cough etiquette
and respiratory hygiene and not coming to the facility if unwell are to be
provided.
CONTRACTORS
When should a contractor • They are not required to wear a mask while in the facility unless they
wear a mask? require one for dust/gas/environmental exposures.
• If working within ED a mask should be worn within 1.5m of patients.
• Reminders regarding hand hygiene, physical distancing, cough etiquette
and respiratory hygiene are to be provided.
• It is expected that contractors maintain adequate supplies of PPE and hand
sanitisers as part of their work health and safety (WHS) obligations.
STOCK DELIVERY TO CLINICAL AREAS – EXTERNAL DELIVERY/COURIER
COMPANIES
Do delivery/courier staff No, masks are not routinely required unless within 1.5m of patients in the ED
need to wear a mask setting.
(surgical or own cloth) if • Alcohol hand rub should be made available to delivery/courier staff.
they are making a delivery to • Reminders regarding physical distancing, cough etiquette, respiratory
clinical areas? hygiene and not being onsite if they have acute respiratory symptoms or
fever.
12GREEN Alert: Frequently Asked Questions (FAQs) November 2020
VALVE MASKS
If a patient or a visitor is Yes, if the patient/visitor is wearing a mask because of respiratory symptoms,
wearing a mask with a valve, this should be changed.
do we need to change it to a • These masks should not be worn as the wearer can breathe out the virus
surgical mask? through the valve.
13COVID-19 Infection Prevention and Control:
Amber Alert - Moderate Transmission
Targeted surgical mask use for all health workers caring/working
within 1.5m of any patient
STANDARD PRECAUTIONS ALWAYS APPLY
Ensure screening and triage processes are in place to
manage patients with suspected COVID-19
Patients presenting directly to a health service from the
community will be required to wear a mask if possible
Patients already in hospital may be required to wear a
Patients
mask outside their room
Children 12yrs and under are not required to wear a mask
Note: Although these principles apply across healthcare environments when
caring for vulnerable patients/residents, individual circumstances should be
considered
Health workers are required to wear a surgical mask if
caring/working within 1.5 metres of any patient
Health workers
Contact and droplet precautions for suspected,
probable or confirmed COVID-19 (if within 1.5 m of
patients)
Physical distancing to apply for all staff if possible.
Non-patient areas such as tea rooms – physical
distancing, hand hygiene and regular cleaning are
important
Visitors
Visitors must wear a mask before entering the facility
(own mask or provided by the facility)
COVID-19 Infection Prevention and Control
Amber Alert – Moderate Transmission
Version 1.1, November 2020
UNCONTROLLED WHEN PRINTED
Page 1 of 1Amber Alert: Frequently Asked Questions (FAQs) November 2020
The FAQs provide an explanation of when masks need to be worn during HW patient
interactions, patients, visitors, carers and other people coming into NSW health facilities.
HEALTH WORKERS
What does our clinical area do • All issues related to PPE should be escalated immediately through usual
if we have a limited number of organisational structures. This should be addressed at LHD/SHN PPE
surgical masks for a short Governance Committees.
period of time? • The COVID-19 Infection Prevention and Control: Application of PPE
document provides guidance on extended or sessional use of PPE.
• Staff are not expected to complete a task if the PPE required is
unavailable.
See question below.
Can a health worker (HW) wear Yes.
the same surgical mask for • This is called extended or sessional use of PPE.
multiple patient interactions? • Further information on the safe use of surgical masks can be located:
Guidance on Mask use in NSW.
• If a surgical mask can be worn without pulling it down or removing it for
example, to speak, it can be worn for up to four (4) hours. If it is pulled
down or removed to speak, it must be discarded immediately, and hand
hygiene performed.
• If the mask is touched, hand hygiene should be performed immediately.
• It should be removed if it becomes damp or loose.
• Extended or sessional use of a mask can be used across different clinical
areas if it is not contaminated e.g. providing direct care to a COVID-19
patient.
• Patient transport/NSW Ambulance (NSWA) staff who move patients
between facilities can wear the same mask for the duration of the
transport but must discard and change their mask before the next
patient transport. Ensure a comfortable fit if driving a vehicle.
• Safe mask use must always be considered (see Application of PPE in
Response to COVID-19 Pandemic Guidance).
When in crowded areas of the Yes where 1.5m cannot be maintained
hospital e.g. eating • Physical distancing, cough etiquette, respiratory hygiene and hand
areas/cafeteria, do HWs need hygiene is always to be practiced.
to wear a surgical mask? • Masks should be worn if distancing is not possible.
15Amber Alert: Frequently Asked Questions (FAQs) November 2020
HEALTH WORKERS (cont.)
Can HWs wear a P2/N95 P2/N95 respirators are not indicated for routine care of patients.
respirator for routine care of P2/N95 respirators are worn when:
the patient? • Providing care or treatment to a patient with a communicable disease
that is spread by the airborne route e.g. Tuberculosis (TB), measles.
• Performing a respiratory aerosol generating procedure (AGP) on a
patient with an acute respiratory illness or with suspected, probable or
confirmed COVID-19.
Airborne precautions (includes the use of a P2/N95 respirator) is required in
the following circumstances when caring for probable or confirmed COVID-
19 patients:
• In situations where there are patients/residents cohorted in one area or
ward AND/OR
• Where there is prolonged and close contact with these patients AND/OR
• For aerosol-generating procedures (AGPs)
Should HWs be wearing masks Yes, if distancing cannot be maintained.
in safety huddles, meetings,
family conferences etc on the • The decision should depend on the size of the room, number of people in
ward/other designated area? the space, ability to physical distance, ventilation and the duration of
safety huddles.
What should be done if a HW This is a Work, Health and Safety risk and should be managed within this
declines to wear a surgical legislation.
mask when within 1.5 metres Surgical masks, like other PPE are provided to protect HWs, patients and
of a patient? visitors. Where masks are prescribed for use; they must be consistently used
by HWs and as such are not optional.
Should a HW wear a surgical No
mask when they are talking to A surgical mask is not required if physical distancing can be maintained.
a patient and can maintain a
1.5 metre physical distance?
During this PPE Amber Alert, • Vulnerable HWs should be individually risk assessed to determine their
should HWs with conditions suitability for clinical areas.
that place them in a • Wearing a surgical mask when within 1.5 metres of any patient will
‘vulnerable’ group be reduce this risk and should be considered in the risk assessment.
redeployed?
If a HW is in a non-clinical area No.
or office, should they wear a • If they are not within 1.5 metres of a patient, a surgical mask is not
surgical mask? required.
• Physical distancing, cough etiquette/respiratory hygiene and hand
hygiene are always to be practiced.
16Amber Alert: Frequently Asked Questions (FAQs) November 2020
HEALTH WORKERS (cont.)
If a visitor asks why a HW is not • As indicated above, not all staff who work in a healthcare facility are
wearing a surgical mask, how providing direct patient care within 1.5 metres.
should the HW respond? • Passing patients and/or visitors in the corridor is not classified as an
interaction or providing direct care within 1.5 metres. Masks are
therefore not required in these circumstances.
If a HW travels in a shared Depending on the situation.
health vehicle with another • Please refer to Appendix D – Transport Health Worker Advice Guidance
HW, do they need to wear a
surgical mask?
Should a HW wear a surgical Yes.
mask when they are examining • A baby or toddler will always be accompanied by a parent or guardian.
a baby or toddler? Our protection is for everyone. HWs providing direct care within 1.5 m
of any patient must wear a surgical mask.
Should HWs entering a school • For school-based programs, the decision to wear a mask should be
for the provision of a service based on a risk assessment considering the proximity, intensity and
wear a mask? duration of contact with children in the school.
(E.g. Immunisation or school • For schools located within health facilities, HWs are to wear a mask if
within a health facility) they are required to provide direct care within 1.5 metres.
PATIENTS
When should a patient wear a • On arrival to a health facility e.g. Emergency Department, Outpatient
mask (see also questions Clinic, Delivery Suite, Medical Imaging, Pathology Collection.
regarding cloth masks below)? • After they are admitted as an inpatient, patients are required to wear a
surgical mask if they leave their room for any reason.
Refer to the scenario table under the heading ‘patients’
Once a patient is admitted to a Patients will not usually be required to wear a mask once in their room.
clinical area, are they required • If they have acute respiratory symptoms, fever or are suspected,
to wear a surgical mask while probable or confirmed COVID, they are required to wear a surgical mask
they are an inpatient? if they are leaving their room (for example going to medical imaging
department).
• If patients are to leave the room and physical distancing is not possible,
then they will be asked to wear a surgical mask (not a respirator)
Remember: Some patients will not be able to tolerate a mask.
When a patient is discharged from While in the health facility, yes (surgical or own cloth mask).
a health facility (Emergency
Department or as an inpatient) are
they required to wear a mask?
17Amber Alert: Frequently Asked Questions (FAQs) November 2020
PATIENTS (cont.)
What should be done when a • Check the reasons for declining to wear a mask and determine if there
patient does not want to wear are alternatives that may be suitable for this patient. If they continue to
a mask on arrival (and is not decline the alternative, the patient should be placed 1.5 metres away
confused or have cognitive from other patients and informed that they are not to walk around the
impairment or other conditions clinical area until they are either discharged from the Emergency
that might cause difficulty with Department or admitted to their clinical area.
mask wearing) • We need to be mindful of the practicalities of wearing a mask for certain
patient groups e.g. those with behavioural disorders or mental health
conditions, cognitive impairment.
• Women in labour may find mask wearing difficult and may be unable to
comply.
• Where there are no obvious barriers to mask-wearing, the patient
should be informed of the current Amber Alert recommendations and
their risk for COVID-19.
Why don’t children 12 years • In general, it is not practical for children to be fitted with a mask.
old and under need to wear a • There appears to be limited transmission of COVID-19 from children to
mask? adults.
• Parents/guardians are expected to wear a mask and to assist children in
this age group with hand hygiene.
• If a child is wearing a mask, then this can continue while the child is
inside a health facility.
• Masks can be choking hazards for children under two, therefore, they
are not suitable for this age group.
• This advice is consistent with other jurisdictions.
Can a patient with suspected, Patients should not wear a P2/N95 respirator but may be asked to wear a
probable or confirmed COVID- surgical mask when in a shared space.
19 wear a P2/N95 respirator?
CLOTH MASKS
Can a HW wear a cloth mask at No.
work? • Cloth masks vary in quality and effectiveness and they are not fluid
resistant. This means they will not prevent blood, body fluids and
respiratory droplets penetrating the mask.
• A cloth mask can be worn by HWs outside the health facility e.g.
travelling to and from work.
18Amber Alert: Frequently Asked Questions (FAQs) November 2020
CLOTH MASKS (cont.)
If a visitor comes in wearing a No, a visitor can wear a cloth mask while visiting the health facility.
cloth mask, should it be • If the visitor can wear the cloth mask without discomfort, they should
changed to a surgical mask? continue to wear it.
• Reminders regarding hand hygiene, physical distancing, avoiding
touching their mask and cough etiquette, respiratory hygiene are to be
provided.
• If the visitor has acute respiratory symptoms or fever, they need to defer
their visit and have COVID-19 testing. They should be asked to change to
a surgical mask.
If a patient/client, without any No.
COVID-19 symptoms, comes in • If the patient/client can wear the cloth mask without discomfort, they
wearing a cloth mask, should it should continue to wear it.
be changed to a surgical mask? • Reminders regarding hand hygiene, physical distancing, avoiding
touching their mask and cough etiquette, respiratory hygiene are to be
provided.
If a patient/client, with acute Yes.
respiratory illness or COVID-19 • A cloth mask will become damp very quickly when someone has an acute
symptoms, comes in wearing a respiratory illness, fever or COVID-19 symptoms.
cloth mask, should it be • The mask will be much less effective when damp and may be touched
changed to a surgical mask? frequently by the patient.
• A surgical mask should be placed on the patient and usual
admission/discharge processes for suspected, probable or confirmed
COVID-19 patients are to be followed.
• Reminders regarding hand hygiene, physical distancing, avoiding
touching their mask and cough etiquette, respiratory hygiene are to be
provided.
• Access to tissues, alcohol-based hand rub and a bin is to be provided.
If a member of the community No, these are not classified as cloth masks
wears a towel, scarf, tea towel NSW Health has released general guidance for cloth masks. This information
etc into the health facility, is should be followed.
this classified as a ‘cloth mask’?
19Amber Alert: Frequently Asked Questions (FAQs) November 2020
HOME VISITS
Do HWs need to wear a Yes
surgical mask when they are • A surgical mask should be worn if providing care within 1.5 metres.
visiting a patient in their home • If physical distancing can be maintained during the visit, a surgical mask
to provide healthcare? is not required.
• Patients are not required to wear a mask but may choose to wear one
CARER IN A HEALTHCARE SETTING
Should a carer wear a surgical Yes, they can also wear a cloth mask
face mask if within 1.5 metres • If a carer is accompanying a patient/client into a health facility they
of a patient? should wear a mask (surgical or cloth mask).
VISITORS
Are visitors required to wear a Yes.
mask if they come to a health • Visitors are required to wear a mask if they are coming into a health
facility? facility for any reason.
• If they are already wearing a cloth or surgical mask, they can continue to
wear this. See section on Cloth Masks.
Labour room • If the patient is in a single room, a mask is not required. When the visitor
If a partner or family member leaves the room, they are to wear a mask until they leave the hospital as
from the same household is per the current risk framework.
supporting the women during
• During labour the partner would carry the same risk as the patient and
labour, do they need to wear a
mask when they are in the therefore would not be required to routinely wear a mask
patient’s room?
What should be done if a • The visitor should be informed of the current Amber Alert
visitor declines to wear a recommendations and the risk to the patient, themselves and others in
mask? the facility they are visiting.
• If they continue to decline to wear a mask, they should be risk assessed
to determine the location of their visit and the patient they are visiting.
• Offer an alternative such as a virtual visit.
• They should only be asked to leave the health facility if it is determined
that there will be a COVID-19 risk for the patient, themselves or to the
clinical area they will be visiting.
Who will teach visitors how to • As visitors are screened at entry areas, HWs who are responsible for
wear a mask? these areas should provide assistance on the correct mask use.
Posters and information on mask use are available here
20Amber Alert: Frequently Asked Questions (FAQs) November 2020
AGED CARE FACILITIES/MULTI-PURPOSE SERVICE (MPS)
In a NSW Health operated Yes.
residential aged care facility HWs who work in RACFs should take extra precautions including the use of
(RACF)/MPS, do these rules for masks where there are areas for increased testing see NSW Health advice for
mask wearing apply to HWs? RACFs for more detailed information. This includes aged care areas within
an MPS.
• An aged care facility can recommend the wearing of surgical masks by
HWs within 1.5 metres of residents. Cloth masks are not recommended
for HWs.
Refer to ‘Aged care facilities/multi-purpose service (MPS)’ in the scenario
table below
Does a resident in an aged care No.
facility or MPS need to wear a • This is classified as their home.
surgical mask?
PATIENTS WITH A DISABILITY, COGNITIVE IMPAIRMENT, BEHAVIOURAL
ISSUES AND MENTAL HEALTH CONDITIONS
Should a HW/carer/visitor If possible.
wear a surgical mask if within • HWs, visitors and/or carers wearing a surgical mask may cause some
1.5 metres of a patient? patients distress or trigger changes to their behaviour or mental health
condition. This will require a risk assessment and ongoing monitoring to
determine the best way to manage the risk of transmission of COVID-19
when providing care within 1.5 metres of the patient. If a risk assessment
determines that a mask will pose a physical risk to the patient,
alternatives such as physical distancing and full-face shield should be
considered. The risk assessment should determine the appropriate PPE
for the HW.
• All decisions regarding the risk assessment should be documented in the
patients’ healthcare record.
21Amber Alert: Frequently Asked Questions (FAQs) November 2020
VOLUNTEERS IN A HEALTHCARE SETTING
Are volunteers required to If a volunteer provides support or assistance in the following areas, they are
wear a mask? required to wear a surgical mask:
• Patient areas and within 1.5 metres of patients
• Concierge services, if they are unable to maintain physical distance from
people entering the healthcare facility (or cloth mask)
• Selling food or other items (or cloth mask)
They are not required to wear a mask in administrative areas if they have no
patient contact.
Reminders regarding hand hygiene, physical distancing, cough etiquette and
respiratory hygiene and not coming to the facility if unwell are to be
provided.
A risk assessment of vulnerable volunteers should be conducted based on
community transmission case locations.
CONTRACTORS
When should a contractor wear • When they are working in patient areas, they are required to wear a
a surgical mask? surgical mask.
• This should be risk assessed depending on where they present to in the
healthcare facility and where they will be working e.g. Engineering,
Security, Enquiry Desk, clinical areas.
• If they are not going to inpatient/outpatient areas and will not be within
1.5 metres of patients, they are not required to wear a mask.
• Reminders regarding hand hygiene, physical distancing, cough etiquette
and respiratory hygiene are to be provided.
• It is expected that contractors maintain adequate supplies of PPE and
hand sanitisers as part of their work health and safety (WHS) obligations.
Refer to ‘Contractors’ in the scenario table below
If a cafeteria is located within a • If a physical distance of 1.5 metres CAN be maintained, a mask is not
health facility (contracted by required.
the LHD/SHN), should the staff • If a physical distance of 1.5 metres CANNOT be maintained, a mask
wear a mask when interacting (surgical or approved cloth mask) is required
with patients, staff and
visitors?
22Amber Alert: Frequently Asked Questions (FAQs) November 2020
STOCK DELIVERY STAFF TO CLINICAL AREA – EXTERNAL DELIVERY/COURIER
COMPANIES
Do delivery/courier staff need Yes.
to wear a mask (surgical or • Masks and alcohol hand rub should be made available to delivery/courier
own cloth) if they are making a staff, if they do not have their own cloth mask.
delivery to clinical areas? • Reminders regarding physical distancing, cough etiquette, respiratory
hygiene and not being onsite if they have acute respiratory symptoms or
fever.
VALVE MASKS
If a patient or a visitor is Yes.
wearing a mask with a valve, • These masks should not be worn as the wearer can breathe out the virus
do we need to change it to a through the valve
surgical mask?
23Amber Alert: Frequently Asked Questions (FAQs) November 2020
SCENARIO TABLE
PATIENTS
Scenario 1 Scenario 2 Scenario 3
Patient transferring from the A patient attending a community Home visit by a community HW.
ward to the operating theatre. health centre.
• HW to wear a surgical mask when
• Patient to wear a surgical • Patient to wear a mask on within 1.5 metres of the patient.
mask from the ward to the presentation. • Patient can wear a mask (surgical
operating theatre or until • If accompanied by any children, or cloth) at their own discretion.
anaesthetic given. A surgical those under 12 years do not
mask should be put on the need to wear a mask unless
patient before leaving the specified by the parent or
recovery room and removed guardian.
when returning to their bed.
AGED CARE FACILITIES/MULTI-PURPOSE SERVICE (MPS)
Scenario 1 Scenario 2 Scenario 3
A Registered Nurse works at an A GP has been asked to see Patient transport/NSWA have been
MPS that has acute, aged care patients/residents in both the requested to transport a patient
and the 24hour drop in/urgent acute care and aged care areas. No between a hospital facility and MPS.
care service. They are asked to one has suspected, probable or The HWs are required to wear a
see a patient in the 24hour drop confirmed COVID-19. surgical mask for the duration of the
in/urgent care service with transport and the patient should be
• The GP can implement
suspected COVID-19 and they offered a mask before leaving to be
extended use of the surgical
are currently providing wound transported.
mask and keep it on to see all
care in the aged care area.
patients/residents. Safe use of • Standard precautions must be
• The same surgical mask can the mask must be applied. adhered to.
be worn to see the • Standard precautions must be
suspected COVID-19 patient adhered to.
but must be removed and
discarded after the
completion of the
consultation before moving
to another area.
• Standard precautions must
be adhered to.
24Amber Alert: Frequently Asked Questions (FAQs) November 2020
CONTRACTORS
Scenario 1 Scenario 2 Scenario 3
A contractor is coming into the A contractor is coming into the A contractor enters through the main
facility to perform work on the facility to perform work on the air hospital entry and is visiting the
air handling unit located in the handling unit located in the roof Environmental Cleaning Services
roof space. They present to the space. They present to the Manager. They will be providing a
Engineering Department which Engineering Department which is demonstration on new equipment.
is located away from clinical and located within the main hospital
• A mask is required as they are in
patient areas. building and entry will be through
the main hospital building, which
the main door.
• A mask is not required. is accessed by HWs, patients and
• A mask is required as they are visitors. Reminders regarding
• Usual sign on procedures to
in the main hospital building, hand hygiene, physical distancing,
be completed.
which is accessed by HWs, cough etiquette and respiratory
• Reminders regarding hand patients and visitors. hygiene are to be provided.
hygiene, physical distancing, Reminders regarding hand
cough etiquette and hygiene, physical distancing,
respiratory hygiene are to cough etiquette and
be provided. respiratory hygiene are to be
provided.
25COVID-19 Infection Prevention and Control:
Red Alert - High Transmission
Mask use for everyone entering a health facility
STANDARD PRECAUTIONS ALWAYS APPLY
Ensure screening and triage processes are in place to
manage patients with suspected COVID-19
Patients presenting directly from the community, inter and intra hospital
transfers wear a mask when able to do so
Patients
Inpatient in shared rooms wear a mask when able to do so
Community Health Centre – clients/patients to wear a mask
Home visit - patient to wear a mask
HWs are required to wear a surgical mask and eye protection for all
patient/client care
Health workers (HW)
P2/N95 respirator to be worn with a full-face shield:
• in high-risk clinical areas e.g. hot zones, COVID-19
wards/units, ED and ICU/critical care (consider
extended/sessional use of respirators)
• when performing respiratory AGPs
• providing direct care to a patient who has suspected,
probable or confirmed COVID-19
Outside of these areas a surgical mask can be worn.
Visiting Restricted – visitors by exception only
Visitors
All family members, carers and support services to wear a mask when
entering and remaining in the health facility
COVID-19 Infection Prevention and Control
Red Alert – High Transmission
Version 1.0, November 2020
UNCONTROLLED WHEN PRINTED
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