3.8.1 Patient placement
3.8.2 Hand hygiene
3.8.3 Personal Protective Equipment
3.8.4 Safe Management of care Equipment
3.8.5 Safe Management of Care Environment
3.8.6 Waste and Linen
3.8.7 Staff
3.8.8 Management of staff exposed to a case
3.8.9 Closure of the ward/unit
3.8.10 Other control measures which may be considered by the IMT
3.8.11 Conversion of outbreak ward to COVID-19 ward
Control measures should be implemented immediately to prevent onward transmission of COVID-19. These must include:
3.8.1 Patient placement
- The PAG/IMT must agree the most appropriate placement for the suspected/confirmed cases and any contacts that are identified through outbreak assessment.
- Cohort areas may be established where required.
- Suspected cases (symptomatic) should be isolated on the ward and tested for COVID-19 as soon as possible. Symptomatic patients should not be cohorted together. The cohorting of symptomatic patients’ risks transmission of other respiratory viruses whilst the causative pathogen remains unknown.
- Doors to isolation rooms and cohorts should be closed and signage clear.
- Patient placement is regularly reviewed and documented in patient case notes.
- Restrict transfers to any other ward or department unless essential.
- A local risk assessment should be undertaken by the IMT and take account of whether the ward will remain open or closed.
- Any asymptomatic contacts identified as part of local outbreak management should be observed for symptom onset. Symptom vigilance is essential for all patients, irrespective of whether a contact.
- If a contact or any other patients develops symptoms, they should be isolated and laboratory based PCR testing should be performed as soon as possible.
- All efforts should be made to dedicate staff to the management of the cohort and ideally those staff must not then go between the case and contacts and all other unaffected patients on the ward. These staff cohorts should be maintained wherever possible for the duration of the isolation period.
3.8.2 Hand hygiene
- Reinforce hand hygiene techniques and opportunities to all staff groups and ensure hand hygiene signage is in place
- Adequate supplies of ABHR and plain liquid soap is available.
- Ensure patients are supported with hand hygiene where required and symptomatic patients are provided with disposable tissues and waste bag for disposal.
3.8.3 Personal Protective Equipment
- Reinforce appropriate PPE use as per NIPCM (general use and AGP) to all staff groups
- Ensure adequate PPE supplies are available
3.8.4 Safe Management of Care Equipment
- All non-essential items of equipment and any clutter removed from ward to aid cleaning.
- Dedicated equipment for the affected areas where possible. Ensure equipment is cleaned as per appendix 7 of NIPCM.
3.8.5 Safe Management of Care Environment
- As a minimum, twice daily cleaning with chlorine based detergent is in place throughout the ward paying close attention to touch surfaces
- Terminal clean is undertaken following a patient transfer, discharge, once the patient is no longer considered infectious and prior to ward reopening.
3.8.6 Waste and linen
- Waste associated with the affected area is disposed of as category B waste.
- All linen used by patients in the affected area should be managed as infectious linen.
- When a bed is vacated and the linen removed, new linen should not be put in place until the ward or bed bay has been terminally cleaned and is ready to re-open to admissions and transfers.
3.8.7 Staff
- Ward staff should be provided with regular updates and support regarding outbreak management.
- The number of staff entering the ward should be restricted as far as possible. The number of staff on wards rounds should be reduced to essential staff only. Non-essential patient assessments by staff external to the ward should be postponed until the outbreak is closed where possible. .
- Staff should be cohorted to the symptomatic patients and any contacts and avoid caring for other unaffected patients on the ward wherever possible.
- Regular symptom vigilance must be in place at all times and arrangements made for staff to leave the ward if symptoms develop during a shift.
3.8.8 Management of staff exposed to a confirmed case of COVID-19
3.8.9 Closure of the ward/unit
- If cases have limited patient contacts which can all be isolated or cohorted in a closed bed bay or single rooms, the IMT may decide that it is appropriate to keep the ward open taking account of bed availability and any specialist services provided in the affected ward. This must be reviewed regularly (at least twice daily) and where there is any other symptom onset identified in staff, patients or visitors outside of the affected bay, the ward should be closed to admissions and transfers.
- Where all contacts and subsequent cases are unable to be isolated or cohorted, the ward should be closed to admissions and transfers wherever possible.
3.8.10 Other control measures which may be considered by the IMT
- Visiting restrictions
- Education sessions for staff if knowledge gaps identified
- Wider screening of patients and staff during the outbreak period
3.8.11 Conversion of outbreak ward to COVID-19 ward
During the ongoing COVID-19 pandemic when COVID-19 admissions are high and where bed capacity in the board is extremely limited, the board may consider converting the outbreak ward into a COVID-19 ward to allow confirmed COVID-19 cases to be transferred/admitted to the area and utilise bed capacity within the ward. This is an operational decision which must be carefully considered, documented and undertaken as a last resort.
In choosing to convert the outbreak ward to a COVID-19 ward, IMTs alongside hospital management must weigh up the risk associated with transferring contacts to other wards and the demand for patient beds to accommodate emergency admissions.