COVID 19 Guidance for healthcare staff in acute hospital setting 19th November 2021
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COVID 19 Guidance for healthcare staff in acute hospital setting 19th November 2021 Prof Martin Cormican HSE National Lead for Health Care Associated Infection and Antimicrobial Resistance Josephine Galway Director of Nursing HSE antimicrobial resistance and infection control (AMRIC) team
COVID 19 guidance for healthcare staff in the acute hospital setting
Thank you
For all the work that you do and for keeping the ship a float
Continuous engagement with HSE AMRIC team- for updates and
experiences shared with us
Implementing and following key recommendations/changes as new
evidence emerges/guidance is updated.
Completing information and data requests in these challenging times- BIU
returns, vaccination status on admissions.
COVID 19 guidance for healthcare staff in the acute hospital setting
Before we start our webinar, a quick
reminder
European Antibiotic Awareness Day 18th
November
World Antibiotic Awareness Week 18th – 23rd
November
www.hse.ie/infectioncontrol
We all have a role to play in reducing antimicrobial
resistance and in reducing inappropriate antibiotic #KeepAntibioticsWorking
prescribing.
COVID 19 guidance for healthcare staff in the acute hospital setting
Key messages
• Take care of yourself and learn to treat common illnesses that do not require
antibiotics www.undertheweather.ie
• Antibiotics can cause more harm than good if taken unnecessarily
• COVID-19, influenza, colds are viral infections – antibiotics don't work for virus
infection
• If you do need antibiotics take them as prescribed
• For prescribers; prescribe antibiotics as set out on
www.antibioticprescribing.ie or on hospital/community guidelines and be
aware of the red/green antibiotic prescribing programme.
COVID 19 guidance for healthcare staff in the acute hospital setting
AMRIC plan 2022- 2025
As part of EAAD 2021 the HSE has
launched the AMRIC 4 year plan setting
out how we will deliver the goals set out
in the Government’s plan for AMR,
iNAP2.
The new HSE 4 year plan can be
accessed at this link https://bit.ly/32ce7w0
COVID 19 guidance for healthcare staff in the acute hospital setting
The purpose of guidelines is to support care that meets the needs of the person,
they are not a set of rigid rules and the should always be applied with care and
compassion.
‘Would this seem fair if I was on the other end of this situation?’
Aim to have this at the centre of our practice
COVID 19 guidance for healthcare staff in the acute hospital setting
Caution
DO NOT DROP YOUR GUARD
The vaccine is safe
The vaccine is effective AFTER the immune response
The vaccine is not perfect
There are lot of other infections besides COVID-19
IPC does not go away because you have been
vaccinated
COVID 19 guidance for healthcare staff in the acute hospital setting
COVID 19 guidance for healthcare staff in the acute hospital setting
What we will discuss today
• Overview of COVID-19 position
• IPC checklist for acute hospitals
• Testing/Surveillance
• Vaccination updates and implications
• Visiting Guidance updates and key points
• Other changes from previous versions
• Queries received & live Q&A discussion
COVID 19 guidance for healthcare staff in the acute hospital settingCOVID 19- current position
COVID 19 guidance for healthcare staff in the acute hospital settingCOVID-19 in Ireland - 17th January vs. 18th November 2021
17th January 2021 6th October 2021 18th November 2021
1,492 per 100,000 1,211 per 100,000
14-day incidence 327 per 100,000 population
population population
5-day moving average 6,867 (peak) as of 10th January 1127 4,211
2021
Hospital admissions 1,982 343 611
ICU admissions 193 70 119
Daily cases of COVID-19 cases (20th December 2020 - 4th November 2021)
Cases have been increasing since the
end of JuneCOVID-19 in Ireland - Trends in Cases, Hospitalisations and ICU in Sep-Nov 2021
New cases of COVID-19 has risen in the
month of November from a weekly average of
1,493 at the start of the September to 4,222
new cases on average in the last week.
On November 16th there was a reported 614
patients in hospital with COVID-19. An
increase from a low of 311 at the beginning of
September.
On the 16th of November there was a reported
114 patients with COVID-19 in ICU. An
increase from September’s low of 52.ECDC: COVID-19 Situation in EU/EEA https://www.ecdc.europa.eu/en/covid-19/country-overviews
Ireland: Hospital Acquired COVID-19 - Up to Week Ending November 7th 2021 Number of cases of hospital acquired COVID-19, outbreaks in hospital and confirmed cases in hospital staff have increased in recent weeks Number of Hospital Acquired COVID-19 Number of currently opened Outbreaks Number of new confirmed cases in hospital cases staff
COVID-19 in Ireland - Optimistic vs Pessimistic Case Number Predictions
Cases 12,000
Hosp 2,500
ICU 400
Cases 5,000
Hosp 1,000
ICU 150Key Messages: Uncertainty about disease trajectory
Entire healthcare system significantly stretched due to number of cases of COVID-19
and morbidity associated with other seasonal viruses
Provision of Intensive care under considerable pressure, with an increasing need for
supportive care outside intensive care settings
Unvaccinated people have no protection from the virus. Unvaccinated people can pick
up the virus from vaccinated people and unvaccinated people who have recovered from
COVID-19 have less protection than vaccinated people and can still be reinfected
Delta Vaccinations alone will not control case numbers, public health measures such `self-
Variant isolating with symptoms and reducing our contacts remain critical to control cases
numbers
Vaccination remains protective in reducing serious illness but waning immunity
necessitates a booster campaign for specific groups to ensure at risk groups are
protected
Prevention of illness requiring intensive care is much easier than treating
someone once they enter intensive careThe Basics
• Control of introduction
• Vaccination
• Limiting traffic
• Checking for symptoms (everyone)
• Testing
• Control of spread
• Vaccination
• Standard precautions
• Transmission-based precautions
• Streaming/distance/ventilation
• Control of harm
• Vaccination
• Early detection and response to spread
• Care of the person before and after
COVID 19 guidance for healthcare staff in the acute hospital settingChecklist for acute hospitals
COVID 19 guidance for healthcare staff in the acute hospital settingChecklist for acute hospitals
• self-assessment tool to support a hospital group and hospital in
reviewing their processes and assuring themselves and others that
key measures are in place
• Critical measures to prevent the risk of introduction and spread of
COVID 19
• Review critical measures regularly
COVID 19 guidance for healthcare staff in the acute hospital settingChecklist for acute hospitals Updates to checklist to include: • Vaccination of eligible hospital inpatients (Memo from ND Acute Operations 09.11.21) • Surveillance testing of all overnight admissions for SARS-CoV-2 including fully vaccinated patients (Memo from ND Acute Operations 15.11.2021)
Testing and surveillance testing
• Diagnostic testing- clinical suspicion of COVID 19
• In hospital contact testing guidance sates
• “testing of fully vaccinated contacts is not required in all cases. If performed
based on risk assessment testing may be at less frequent intervals”
• at present the risk level favours testing contacts at frequent intervals
• Surveillance testing: Testing of all overnight admissions for SARS-CoV-2
including fully vaccinated patients (adults, children and parents/guardians
accompanying children and staying overnight in multi bedded accommodation)
• Sampling methods- no change
• Test methods – as per hospital laboratory service
COVID 19 guidance for healthcare staff in the acute hospital settingInterpreting CT value
Guidance says
Note that it is appropriate to report a test as not-detected or equivocal if
the Ct value is so high that it is not possible to be confident that the
result confirms detection of virus (decisions on reporting based each
laboratories test system, experience and judgement)
COVID 19 guidance for healthcare staff in the acute hospital settingVaccination Memo from ND Acute Operations 09.11.2021 A process to identify all patients who are eligible for booster vaccination and offer them the booster vaccine promptly once their clinical condition permits vaccination. A process to identify patients who are immunocompromised and eligible for extended primary vaccination and offer them an additional dose of vaccine promptly once their clinical condition permits vaccination. Continue to identify patients that have not been vaccinated and offer them vaccination promptly once their clinical condition permits vaccination.
COVID 19 guidance for healthcare staff in residential care facilities COVID 19 guidance for healthcare staff in the acute hospital setting
Booster Programme Overview (as of 17 Nov) - continued
Housebound Healthcare Workers
Housebound process extended to those Estimated Population size: ca.305,000
eligible for third primary vaccination &
Booster (80+) Commenced weekend 6-7 Nov
Programme will then be extended to those Vaccinated through VCs with Pharmacy support
eligible aged 60+ from this week, ca. 100,400 administered to date
Majority of eligible will have been offered an
appointment or vaccinated by end of Dec
Eligible – become eligible about 6 months after completion of primary course
(can administer from 5 months after)
If you had second dose of a two dose schedule on 31 August you don’t become
eligible until 31st of January 2022Boosters now also for 50 and older +
Booster Programme Overview (as of 17) Nov)
18 and older with high-risk conditions
Over 65s in Long Term Residential Facilities Over 80s
Estimated Population size: ca. 25,000 Estimated Population size: ca.161,000
Administered ca.24,000 doses GPs administered ca.132,200 doses
>65s substantially completed w/c 25th October. Target to complete in November.
Some facilities will need to be revisited due to Home Vaccination service been expanded
outbreaks. to accommodate Boosters for housebound
70 - 79 year olds 60 - 69 year olds
Estimated Population size: ca.336,000 Estimated Population size: ca. 475,000
Commenced w/c 1 Nov Commenced w/c 1 Nov
Vaccinated through GPs, ca. 130,500 To be vaccinated through VCs; to date ca. 23,800
administered to date have been administered
Majority of those eligible will have been offered Majority of those eligible will have been offered
an appointment or vaccinated by end of Nov an appointment or vaccinated by end DecBoosters give over 90% protection against symptomatic COVID-19 in adults
over 50
November 15th 2021
● 2 weeks after receiving a booster dose protection against
symptomatic infection in adult aged 50 year and over was 93.1%
in those with AstraZeneca as their primary course and 94% for
Pfizer-BioNTech
https://www.gov.uk/government/organisations/uk-health-security-agencyEffectiveness of Pfizer vaccine up to 6 months - US study
Oct 4th, 2021
Vaccine Effectiveness (VE) against infection
Vaccine Effectiveness (VE) against
decreased with increasing time since
hospitalisation, showing no significant waning.
vaccination,.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltextVisiting Guidance
COVID 19 guidance for healthcare staff in the acute hospital settingRequirement for COVID-19 vaccination pass for visitors Recommendation on testing of asymptomatic adults accompanying children and staying overnight in multi-bed areas with other children and adults Clear statement that essential service providers and important service providers should be vaccinated Guidance on access for home birth midwife/doula
Safety pause
COVID 19 guidance for healthcare staff in the acute hospital settingPatient and staff safety
Important reminder:
At the start of each shift, all staff should be asked to confirm that they
do not currently have symptoms of viral respiratory infection, such as
fever, cough, shortness-of-breath, recent loss of taste or smell or
myalgia.
COVID 19 guidance for healthcare staff in the acute hospital settingLimiting exposure of staff
Where face to face discussion facilitates
decision making for patient care such
meetings should take place with
appropriate precautions, the space
selected should facilitate the anticipated
number of attendees, physical distancing
and adequate ventilation can be observed.
Social interaction between staff in the
healthcare setting should comply with all
relevant public health and IPC guidance.
COVID 19 guidance for healthcare staff in the acute hospital settingAll the success we cannot see
Acute hospitals receive many of the most infectious COVID-19 patients into buildings
that house the most vulnerable of people with unavoidable intense traffic from the
community they serve and intense close personal interaction
We count every case of hospital acquired COVID-19 and every outbreak
Look at all the discharges someday and count all the people for whom you have
supported clean, safe and compassionate careWorld Toilet Day 19th November 2021
*3.6 billion people do not have access to a safely
managed sanitation service (WHO/UNICEF 2021)
We should all care more about toilets.
If you have one, thank it.
Life without a toilet is dirty, dangerous
and undignified.
Public health depends on toilets.
COVID 19 guidance for healthcare staff in the acute hospital settingDear colleagues
Follow on note
During the webinar for acute hospitals on today November 19th there was a question
regarding the status of people in the 9 months post diagnosis of COVID-19 that I did
not have full details on the following is to clarify
Under the Government policy the following applies:
People who are fully vaccinated are required to restrict movements for 5 days and to
self-test three times in the event that they are identified as a close contact of a case in
the household where they live.
People who are in the 9 months after diagnosis of COVID-19 infection are not required
to restrict movements or self-test in the event that they are identified as a close contact
of a case in the same household
MartinQuestions and answers
COVID 19 guidance for healthcare staff in the acute hospital settingThank you for joining this webinar
This recording will be published on www.hpsc.ie
COVID 19 guidance for healthcare staff in the acute hospital settingYou can also read
