COVID-19

Asymptomatic patients should not be tested for COVID 19 unless:

• On the specific advice of Infection Prevention and Control or Virology during an outbreak
• They are an older adult within 48 hours of being discharged directly from hospital to a care home

Testing arrangements for symptomatic patients remains unchanged from previous advice:

Any patient in any hospital setting who has, or develops, symptoms consistent with any respiratory viral infection should continue to be tested using an appropriate point of care test or laboratory PCR test (on TRAK – select Respiratory virus screen + SARS CoV2).

This applies to adult and paediatric patients on admission or at any point during their in-patient stay.

As of November 2023, NHS Lothian guidance advises a minimum duration of 5-day isolation and additional droplet transmission-based precautions for hospital in-patients who have a laboratory confirmed COVID infection. This is as the 6th November 2023 COVID Speed Read.

Isolation and additional infection control precautions can be stepped down from day 6 onwards (day 1 is the date of symptom onset or first positive laboratory PCR test) once the patient:

• Is showing wider resolution of respiratory viral symptoms and
• Is afebrile and has not required antipyretic medication (e.g. paracetamol) in the past 48 hours.

Patients already receiving regular paracetamol or other similar medication with antipyretic properties for another clinical indication (e.g. pain relief) should be assessed to confirm clinical improvement or resolution of respiratory viral symptoms before stepdown.

This is different to ARHAI National Infection Prevention and Control Manual guidance (which stipulates 10-day isolation), however this risk assessed position has been endorsed by the Pan-Lothian Infection Control Committee and NHS Lothian Senior Management Team.

Staff will no longer have to do a COVID LFD test if they develop symptoms of a respiratory virus, and do not have to demonstrate 2 x consecutive negative tests before returning to work.

Staff who develop symptoms of a respiratory virus (temperature, cough, sore throat, headache, muscle aches) should follow advice on the NHS Inform website.

If you do not feel well enough to come to work or carry out normal activities, you are advised to stay at home and avoid contact with other people. You can return to work when you feel well enough to do so and no longer have a temperature.

Where no test is taken, staff absences due to a respiratory viral infection should be recorded as sickness absence in line with existing policies.

However, it is recognised that some staff will opt to take a test. The current classifications for staff who have tested remain as previously advised. Staff who test positive should be recorded as Special Leave – COVID 19 Positive. Staff do not need to have a negative test result to end self-isolation or return to work after a 5-day period. The day the test was taken is counted as day 0. The day after the positive result is day 1. If after five days they remain unfit to attend work, continue to have a temperature or have long-covid, they should be recorded as Sick Leave – COVID related illness.

See also the 21st September 2023 COVID Speed Read.

As an additional step to help protect vulnerable patients and colleagues, staff who feel well enough to be at work but
who:

• have mild symptoms of any respiratory viral infections, and

• do not have a fever

should consider wearing a Type IIR fluid resistant surgical face mask when providing direct patient care or when
working in close proximity with others until symptoms have resolved. This will help to contain respiratory secretions which are dispersed during normal close contact when speaking to patients and colleagues.

Staff should not re-use face masks whilst symptomatic.

If masks are removed for any reason (such as during meal breaks) a new mask should be applied following hand hygiene.

One mask can be worn continuously during a single ‘task’ for multiple patients (such as carrying out scheduled patient observations or a ward round) before being changed. Masks should be changed when moving from one clinical area to another, or between clinical and non-clinical areas.

It is also important that staff who feel well enough to be at work continue to follow policy and best practice for both cough and hand hygiene:

• Cover the nose and mouth with a disposable tissue when sneezing, coughing, wiping and blowing the nose.
• If a disposable tissue is not available, use elbow to cover the nose and mouth when coughing or sneezing.
• Dispose of used tissues and face masks promptly into a waste bin.
• Change face masks which become damp or contaminated.
• Dispose of used face masks into orange clinical waste bags.
• Wash hands with non-antimicrobial liquid soap and warm water after coughing, sneezing, using tissues, or
  after contact with respiratory secretions or objects contaminated by these.
• Keep contaminated hands away from the eyes nose and mouth.

See the sections on "Staff use of PPE when caring for symptomatic patients" and "PPE use by symptomatic patients" in the "Face mask use" page.

As announced by the NHS Lothian Public Health team, there is a 2023-2024 Winter Vaccination Programme (see also Public Health Scotland announcement). All front-door staff are eligible for dual COVID-19 / influenza vaccinations. More information and booking can be found at https://www.nhsinform.scot/winter-vaccines

(This section has been retained since COVID for information, and in case we need to perform risk assessments again regularly in the future)

During COVID we had to have risk assessments for staff. This needed to be re-done if health circumstances changed.

If you come out as anything above low risk, then let your line manager know so we can do a workplace assessment and a referral to occupational health. It is important that the department knows of any individuals at higher risk so we can adjust rotas accordingly.

Otherwise, staff should come to work ready to be able to work in all areas of the department. For males this means shaving. It is unfair to your colleagues to come to work and not share in the workload. Further there can be unexpected events in amber areas where staff need to be prepared to wear PPE.

Link to the COVID assessment.

As of February 2024, treatment of COVID-19 is outlined here (intranet link)

The ED should not be prescribing any other medication other than steroids - other medications are not emergencies, need careful evaluation of costs/benefits, and should only be prescribed by consultants of admitting ward.