Guidance

[Withdrawn] COVID-19: actions required when a case was not diagnosed on admission

Updated 14 March 2020

This guidance was withdrawn on 29 March 2020

The information on this page is now out of date and has been replaced with information in the guidance for health professionals collection.

It is expected that providers of secondary care will follow recommendations on identifying possible cases of COVID-19, isolate and follow appropriate infection prevention and control measures from the outset.

However, there may be occasions when COVID-19 was not considered to be a possible diagnosis initially, particularly as case definitions evolve.

Healthcare workers (HCWs) are vital for the functioning of the health system to ensure that we can treat patients appropriately. In addition, managers have a high level of skill in assessing whether individual staff are developing symptoms that would require exclusion from work. HCWs themselves are educated about prevention of the nosocomial spread of disease. It is a well-established practice for individuals not to come to work with respiratory tract infections.

1. Staff exposures

1.1 Staff caring for COVID-19 patients

HCWs who come into contact with a COVID-19 patient while not wearing personal protective equipment (PPE) can remain at work. This is because in most instances this will be a short-lived exposure, unlike exposure in a household setting that is ongoing. HCWs should:

• not attend work if they develop symptoms while at home (off-duty), and notify their line manager immediately
• self-isolate and immediately inform their line manager if symptoms develop while at work

If the HCW has not had any signs of improvement and has not already sought medical advice, they should call NHS 111 or 999 in an emergency and seek appropriate medical review.

The current recommended PPE that must be worn when caring for COVID-19 patients, including for when aerosol generating procedures (AGP) are being performed, is described in the infection prevention and control guidance

These are guiding principles and there may need to be an individual risk assessment based on staff circumstances, for example for those who are immunocompromised.

1.2 Healthcare workers with exposures through other settings, including travel

HCWs who have returned from travel overseas (including to countries or areas previously specified), or have exposure to confirmed cases within the community, can carry on working in their usual role as long they are well. If they are unwell they should follow the steps listed above.

2. Staff return to work criteria

Symptomatic staff can return to work:

• on day 8 after the onset of symptoms if clinical improvement has occurred and they have been afebrile (not feverish) for 2 days
• if a cough is the only persistent symptom on day 8, they can return to work (post-viral cough is known to persist for several weeks in some cases)

3. Patient exposures

Patients who have been exposed to a confirmed COVID-19 patient do not require isolation. If symptoms or signs occur in the 14 days after exposure, such as influenza like illness (ILI), pneumonia, acute respiratory distress syndrome (ARDS), a new cough or fever, the relevant diagnostic tests, including the COVID-19 test, should be performed.

On discharge, patients should be given written advice to stay at home and referred to the stay at home guidance if less than 14 days has elapsed since their exposure.

For patients admitted from the Emergency Department (ED), if they shared an exposure window with the patient and a shared waiting area, once discharged home from A&E, they should be advised to monitor for symptoms until the end of a 14-day observation period and, if they become unwell, to refer to the stay at home guidance.

4. Visitors

In general, hospitals should minimise visitors of patients to only essential visitors that are required for patient welfare, particularly for those with unexplained respiratory illness.

Visitors of patients in neighbouring bays of a confirmed COVID-19 patient are unlikely to meet the required contact time or distance of <2 metres for 15 minutes. They should be informed that a COVID-19 diagnosed patient was present on the ward when they visited their relatives, and be given written advice about what to do if they develop symptoms and who to contact.

5. Cleaning

Infection prevention and control (IPC) leads should ensure that all aspects of the patient pathway have been mapped, and that appropriate decontamination measures have been taken. Further guidance on decontamination of healthcare settings is available.