Victorian Health Service Guidance and Response to COVID-19 Risks
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Victorian Health Service Guidance and Response to COVID-19 Risks
Victorian Health Service Guidance and Response to COVID-19 Risks - Contents Slide 3 presents the background and context of the concept Slide 4 describes how the Victorian Guidance and Response to COVID-19 risks will work Slide 5 displays images of the four risk ratings Slide 6 displays a table demonstrating how guidance changes across each of the risk rating Slides 7-10 display the guidance and advice associated with each risk level Slide 11 provides key resources for further information Slides 12-14 provides key definitions referred to in the document
Victorian Health Service Guidance and Response to COVID-19 Risks The Victorian Health Service Guidance and Response to COVID-19 Risks (VHSGR) has been developed to inform health service responses and interventions in response to changing risks of COVID-19 transmission in the community. The role of the VHSGR is to bring together and collate in a central repository, guidance and advice which will support health services mitigate the risks of COVID-19 transmission, whilst at the same time providing appropriate care and safety for patients, staff and visitors. This includes information and guidance relating to PPE use, asymptomatic health care worker testing, patient/resident testing/screening, elective surgery, visitor information, outpatient consultations, Emergency Department policy and healthcare workforce. The VHSGR lists four risk ratings, ranging from low (COVID Ready) to very high (COVID Peak). These risk ratings will be used by the Department of Health to determine what the COVID-19 transmission risk rating is at a State, geographic region (e.g., suburb, LGA etc.) or individual health service level.
How the Victorian Health Service Guidance and Response to COVID-19 Risks will be used When a change in COVID transmission is identified, this will be discussed by Department of Health COVID-19 operational leads and relevant senior management. A range of information will used to inform the discussion. This could include COVID-19 incidence and prevalence data, the origin and strain of the virus, any genomic data available, socioeconomic and cultural factors, and the number of COVID-19 cases from an unknown source. Decisions to change risk rating can be made immediately in response to a sudden surge in cases. This will mean that health services in areas where the risk is very low will be able to continue with service provision, but services in high-risk areas will need to adopt the relevant interventions and processes to reduce COVID-19 transmission risk (e.g. reduced elective surgery, increased PPE use, restrictions on visitors). The Department of Health will be responsible for enacting and communicating any decision to move risk ratings. Whilst the below slides provide a high-level overview of the actions health services are required to take, a response document will also be circulated to support workers with more granular detail. This document will align to the roadmap risk ratings below.
Victorian Health Service Guidance and Response to COVID-19 Risks levels COVID Ready COVID Alert COVID Active COVID Peak
COVID Ready COVID Alert COVID Active COVID Peak
PPE Tier 1 Routine care of COVID negative. Masks should be worn by all staff in public/patient/resident facing areas, Addition of eye protection when treating COVID negative patient/residents. Masks should be worn
maintained. public facing areas where physical distancing cannot be maintained.
PPE Tier 2
Routine care of Low-risk SCOVID patients
PPE Tier 3
AGPs and risk of AGBs in low-risk SCOVID
For staff undertaking testing at port of entry and community COVID testing locations
For staff undertaking testing at port of entry COVID testing locations
Patient/resident testing & screening Testing patients/residents with compatible
caesarean testing. Additional patient testing as
assessment
per risk assessment.
Increased testing of asymptomatic staff who are exposed and/or provide care to high-risk SCOVID
Routine testing of asymptomatic staff who are Increased testing of asymptomatic staff who
and confirmed COVID-19 patients
HCW surveillance testing exposed and/or provide care to high risk SCOVID and are exposed and/or provide care to high-risk
Health services with an outbreak to follow outbreak-based testing program as per directions/advice
confirmed COVID-19 patients SCOVID and confirmed COVID-19 patients
from the Public Health unit, Department of Health
Workforce attestations & Screening
Elective surgery All categories undertaken Category 1, 2A only Category 1 only
Visitors Patients/residents restricted to one visit, from
No restrictions on patient visitors, unless in circumstances where health services determine their own
screening, based on clinical and
Pre-attendance screening based on clinical and epidemiological factors, at a minimum
epidemiological risk factors
Face to face or telehealth appointments to occur as Telehealth encouraged Telehealth recommended wherever possible Face-to-face outpatient appointments by
Specialist outpatient consulting
per normal arrangements Risk assessment for face-to-face appointments Risk assessment for face-to-face appointments exception
As per normal ED triage and risk assessment
Emergency Department Consider COVID service plans Implement COVID service plans Escalated COVID service plans
protocols
Health services should re-deploy high-risk
Appropriate for high risk employees to attend work Where possible, high-risk employees should be employees based on risk assessment. Where not High-risk employees are to be redeployed or if
Vulnerable workers (high-risk employees)
as per normal working arrangements. considered for re-deployment possible, consider whether appropriate to not possible, furloughed
attend work
Workforce mobility Where practical, consider restricting all care
campus/facility
Student clinical placements restricted from
Student clinical placements providing care/being exposed to high-risk
Student clinical placements permitted in all settings Student clinical placements permitted in all settings but restricted from providing care/being
high-risk SCOVID and confirmed COVID patients. Students restricted to one campus/site only
high-risk hospital work premises including ED,
ICU, COVID/SCOVID wards and aged careVictorian Health Service Guidance and Response to COVID-19 Risks
– COVID Ready
COVID Ready
PPE Tier 1 Routine care of COVID negative. Masks should be worn by all staff in public/patient/resident facing areas, public shared areas and in non-clinical and
non-public facing areas where physical distancing cannot be maintained
PPE Tier 2 Routine care of low-risk SCOVID for staff
For staff undertaking testing at community COVID testing locations
PPE Tier 3 AGPs and risk of AGBs in low-risk SCOVID
Exposure/care/contact with high-risk SCOVID and confirmed COVID patients
For staff undertaking testing at port of entry COVID testing locations
Patient/resident testing & screening
HCW surveillance testing Routine testing of asymptomatic staff who are exposed and/or provide care to high risk SCOVID and confirmed COVID-19 patients
Workforce attestations & Screening
Daily attestations at a minimum
Elective surgery All categories undertaken
Visitors
No restrictions on patient visitors, unless in circumstances where health services determine their own requirements based on local risk assessment
Pre-attendance screening based on clinical and epidemiological factors, at a minimum
Specialist outpatient consulting Face to face or telehealth appointments to occur as per normal arrangements
Emergency Department As per normal ED triage and risk assessment protocols
Vulnerable workers (high-risk employees) Appropriate for high risk employees to attend work as per normal working arrangements
Workforce mobility
Care facility workers and HCWs who meet high risk hospital work premises worker definition limited to working at one facility (where practical). All other
Student clinical placementsVictorian Health Service Guidance and Response to COVID-19 Risks
– COVID Alert
COVID Alert
PPE Tier 1 Routine care of COVID negative. Masks should be worn by all staff in public/patient/resident facing areas, public shared areas and in non-clinical and non-public facing areas
where physical distancing cannot be maintained
PPE Tier 2 Routine care of low-risk SCOVID
For staff undertaking testing at community COVID testing locations
PPE Tier 3 AGPs and risk of AGBs in low-risk SCOVID
Exposure/care/contact with high-risk SCOVID and confirmed COVID patients
For staff undertaking testing at port of entry COVID testing locations
Patient/resident testing & screening
HCW surveillance testing Increased testing of asymptomatic staff who are exposed and/or provide care to high-risk SCOVID and confirmed COVID-19 patients
Workforce attestations & Screening
Daily attestations and enhanced screening based on clinical and epidemiological risk factors
Elective surgery All categories undertaken
Visitors
No restrictions on patient visitors, unless in circumstances where health services determine their own requirements based on local risk assessment
Pre-attendance screening based on clinical and epidemiological factors, at a minimum
Telehealth encouraged
Specialist outpatient consulting Risk assessment for face-to-face appointments
Emergency Department Consider COVID service plans
Vulnerable workers (high-risk employees) Where possible, high-risk employees should be considered for redeployment
Workforce mobility
Care facility workers and HCWs who meet high risk hospital work premises worker definition limited to working at one facility (where practical). All other HCWs permitted to work
Student clinical placements
Student clinical placements permitted in all settings but restricted from providing care/being exposed to high-risk SCOVID and confirmed COVID patients. Students restricted toVictorian Health Service Guidance and Response to COVID-19 Risks
– COVID Active
COVID Active
PPE Tier 1 Addition of eye protection when treating COVID negative patient/residents. Masks should be worn by all staff in public/patient/resident facing areas, public shared areas and in
non-clinical and non-public facing areas where physical distancing cannot be maintained
PPE Tier 2
As per standard precautions for COVID negative patients/residents
PPE Tier 3 All exposure/care/contact with low-risk/high-risk SCOVID and confirmed COVID patients
For staff undertaking testing at port of entry and community COVID testing locations
Patient/resident testing & screening
Testing patients/residents with compatible clinical and/or epidemiological risk factors
HCW surveillance testing Health services with an outbreak to follow outbreak-based testing program as per directions/advice from the Public Health unit, Department of Health
Workforce attestations & Screening
Daily attestations and enhanced screening based on clinical and epidemiological risk factors
Elective surgery Category 1, 2A only
Visitors Patients/residents restricted to one visit, from one household, once per day
Pre-attendance screening, based on clinical and epidemiological risk factors
Telehealth recommended wherever possible
Specialist outpatient consulting Risk assessment for face-to-face appointments
Emergency Department Implement COVID service plans
Vulnerable workers (high-risk employees) Health services should re-deploy high-risk employees based on risk assessment. Where not possible, consider whether appropriate to attend work
Workforce mobility
Student clinical placements
Student clinical placements permitted in all settings but restricted from providing care/being exposed to high-risk SCOVID and confirmed COVID patients. Students restricted toVictorian Health Service Guidance and Response to COVID-19 Risks
– COVID Peak
COVID Peak
PPE Tier 1 Addition of eye protection when treating COVID negative patient/residents. Masks should be worn by all staff in public/patient/resident facing areas, public
shared areas and in non-clinical and non-public facing areas where physical distancing cannot be maintained
PPE Tier 2
As per standard precautions for COVID negative patients/residents
PPE Tier 3 All exposure/care/contact with Low-risk/high-risk SCOVID and confirmed COVID patients
For staff undertaking testing at port of entry and community COVID testing locations
Patient/resident testing & screening
Testing patients/residents with compatible clinical and/or epidemiological risk factors
HCW surveillance testing Health services with an outbreak to follow outbreak-based testing program as per directions/advice from Public Health, Department of Health
Workforce attestations & Screening
Daily attestations and enhanced screening based on clinical and epidemiological risk factors
Elective surgery Category 1 only
Visitors
Visitors limited to selected circumstances only
Specialist outpatient consulting Face-to-face outpatient appointments by exception
Emergency Department Escalated COVID service plans
Vulnerable workers (high-risk employees) High-risk employees are to be redeployed or if not possible, furloughed
Workforce mobility
Student clinical placements
Student clinical placements restricted from providing care/being exposed to high-risk SCOVID/Confirmed COVID patients. Student clinical placementsKey resources
Title Webpage
Personal Protective Equipment (PPE) - coronavirus (COVID-19) https://www.dhhs.vic.gov.au/personal-protective-equipment-ppe-covid-19
Assessment and testing criteria for coronavirus (COVID-19) https://www.dhhs.vic.gov.au/assessment-and-testing-criteria-coronavirus-covid-19
Health service planning - coronavirus (COVID-19) https://www.dhhs.vic.gov.au/health-service-planning-covid-19
Aged care sector - coronavirus (COVID-19) https://www.dhhs.vic.gov.au/aged-care-sector-coronavirus-disease-covid-19
Visiting hospitals in Victoria https://www.coronavirus.vic.gov.au/visiting-hospitals
Visiting care facilities https://www.coronavirus.vic.gov.au/visiting-care-facilities
https://www.dhhs.vic.gov.au/help-and-support-healthcare-workers-coronavirus-covid-
Help and support for healthcare workers - coronavirus (COVID-19)
19
Surveillance testing industry list https://www.dhhs.vic.gov.au/surveillance-testing-industry-list-covid-19
Clinical guidance and resources - coronavirus (COVID-19) https://www.dhhs.vic.gov.au/clinical-guidance-and-resources-covid-19Key definitions
Confirmed COVID case: A person who tests positive to a validated SARS-CoV-2 test.
Low risk SCOVID case: Includes persons awaiting the results of a test, where there may be symptoms that could be consistent with coronavirus (COVID-19) but no epidemiological risk
factors. Where a patient/resident’s history cannot be obtained, they should be considered as a low-risk suspected case until further screening information can be obtained, at which
point a revised diagnosis of the patient/resident’s condition can be made and appropriate changes to PPE implemented.
High risk SCOVID case:
• A person in quarantine for any reason (including; being a close contact of a confirmed case or coronavirus (COVID-19) or a returned traveler from overseas, or a relevant
interstate area with outbreaks as defined by public health, in the last 14 days) with or without a compatible clinical illness. This group of people is also referred to as ‘at-risk’.
• A person who has a compatible clinical illness and meets one or more of the following epidemiological risk factors:
In the 14 days prior to illness onset:
o Contact with a confirmed case or an exposure site as defined by public health.
o Was employed in an area where there is an increased risk of coronavirus (COVID-19) transmission for example:
- hotel quarantine workers or any workers at ports of entry
- aged care workers/ healthcare workers working in a location where there are active outbreaks
- other high-risk industries (such as abattoirs) where there are known cases /or high levels of community transmission.
o Lived in or visited a geographically localised area at high risk as determined by public health.
COVID negative:
• A person who tests negative to a validated SARS-CoV-2 nucleic acid test.
• A person who is a cleared case.
• A person who screens negative and/or has no clinical or epidemiological risk factors for COVID-19.
Routine healthcare worker testing:
Testing of asymptomatic staff who are exposed and/or provide care to high risk SCOVID (offered 1 nasal throat swab every 7 days) and confirmed COVID-19 patients (4 saliva samples
over 14 days, 1 nasal throat swab every 7 days).
Increased healthcare worker testing:
Increased testing of asymptomatic staff who are exposed and/or provide care to high-risk SCOVID and confirmed COVID-19 patients (4 saliva samples over 14 days, 1 nasal throat swab
every 7 days).Key definitions, continued
Clinical risk factors: clinical compatible symptoms with COVID-19, such as fever, cough, shortness of breath, sore throat, loss of smell or taste.
Epidemiological risk factors:
• A person in quarantine for any reason (including; being a close contact of a confirmed case of coronavirus (COVID-19) and/or a returned traveler from overseas, and/or a relevant
interstate area with outbreaks as defined by public health, in the last 14 days).
• Contact with a confirmed case of COVID-19 and/or visited an exposure site as defined by public health.
• Lived in or visited a geographically localized area at higher risk, as determined by public health.
AGP: Aerosol Generating Procedure. Procedures performed on patient/residents that are more likely to generate higher concentrations of infectious respiratory aerosols. Examples
include bronchoscopy, tracheal intubation, non-invasive ventilation (e.g. BiPAP, CPAP), high flow nasal oxygen therapy, manual ventilation before intubation, intubation,
cardiopulmonary resuscitation, suctioning, sputum induction, nebuliser use.
AGB: Aerosol Generating Behaviour. Behaviours that are more likely to generate higher concentrations of infectious respiratory aerosols. Examples include persistent and/or severe
coughing, screaming and shouting, women in active labour who exhibit heavy breathing and panting.
Visitor restrictions: There may be occasions where COVID-19 transmission risks result in health services restricting visitors to their facility. The decision to restrict the number of visitors
will be made based on ensuring the safety of staff, patients, residents and visitors themselves. However, there will be some exceptions to these restrictions even when risk levels are
increased, including:
• a parent/guardian/temporary carer of a patient under 18 years
• to provide essential care and support necessary for a patient or aged care resident’s immediate physical, emotional or social wellbeing that optimises the care and support.
delivered by workers and can’t be provided by the person by electronic means
• to provide interpreter or informal language support to enable delivery of care by workers
• in the case of a pregnant patient of the hospital whose status as a patient relates to the pregnancy, the person is the patient’s partner or support person
• in the case of a patient of the hospital who is in a maternity ward—the person is the patient's partner or support person
• end of life support or immediate family member(s) of a patient or aged care resident whose medical condition is life threatening
• patient or aged care resident who has a mental illness – the patient’s nominated person is present for matters related to their role as nominated person
• receiving education on how to support the patient or aged care resident care upon discharge.Key definitions, continued Higher risk employee categories: • Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions. • People 65 years and older with chronic medical conditions. • People 70 years and older. • People with compromised immune systems. • Pregnant women >28 weeks gestation. High risk hospital work premises: a) any ward treating confirmed cases of coronavirus (COVID-19) b) where the Chief Health Officer (or their delegate) notifies a hospital that there is community transmission in an area proximate to that hospital, that hospital’s: • ward(s) treating any high-risk suspected cases of coronavirus (COVID-19) • emergency department • intensive care unit. High-risk hospital work premises worker: any worker involved in the direct care of patients in high-risk hospital Work Premises (see above) AND those workers who interact with a high-risk hospital work premises. Enhanced screening: Additional screening over and above the Department of Health guidance, which could include local hospital-specific requirements such as temperature checks, previous exposure to COVID-19, determining whether a HCW works at other locations, etc.
Accessibility statement and publisher information To receive this document in another format email the Commissioning and System Improvement Branch . Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne. © State of Victoria, Australia, Department of Health, March 2021.
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