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Within this section you will engage with a number of resources that are essential in understanding COVID -19 Infection Prevention and Control including the use of Personal Protective Equipment (PPE)
By the end of the session the student will be able to:
Understand basic infection prevention and control (IPC) principles, transmission routes and incubation period for COVID-19
Ensure identification of safe practice to protect self and others
Practice the correct donning and doffing techniques for PPE
Demonstrate the correct procedure for swabs and sample collection
Each section below will consider one of the above learning outcomes, please explore each section and complete the tasks.
What you need to do:
What you need to do:
We have collated a range of resources to help you understand essential infection prevention and control principles, to protect yourself and others during your work on the frontline. Some of the resources we would like you to engage with before your in-class teaching session/web-tutorial; some materials we will be using in class/during the web-tutorial; and some are there for you to explore and return to after the in-class session/web-tutorial.
Before the session:
Please look action Section 1 and complete activities 1 and 2
Review the resources in Section 2
Please watch the donning and doffing guides for Aerosol Generating Procedures (AGP) and non-Aerosol Generating Procedures (AGP) in Section 3
During the session/web-tutorial we will be:
Discussing how to protect yourself and ensure you are safe
Strategies for identifying risk and communicating concerns
Practice the sequence of donning and doffing in your pairs (in-class only). Please note: equipment may vary across different Trusts
After the session:
Please review Section 4 and complete activities 3-5 and the final quiz
Revisit Sections 2 and 3
Familiarise yourself with the additional links and resources provided
Section 1: Understand basic Infection Prevention and Control (IPC) principles
Section 1: Understand basic Infection Prevention and Control (IPC) principles
COVID-19 is a type of Coronavirus discovered in 2019 that can cause symptoms, which include a cough, fever and shortness of breath, and can cause severe illness and death in some individuals. It is therefore important to understand the ways in which this virus can be spread from person to person in order to prevent ongoing transmission. The COVID-19 virus is thought to be spread by droplets which become present in the air or on surfaces when an infected person coughs or sneezes. If the virus comes into contact with the mucosa of the mouth or with the eyes the person can become infected. Some procedures in health care, known as aerosol generating procedures (AGPs), can increase the risk of aerosol transmission of the virus. Additional precautions need to be taken with such procedures (please see more information under the section on practicing the correct donning and doffing techniques for PPE).
Recent information published by Public Health England tells us that that COVID-19 viruses are likely to be present in all body secretions and excretions except sweat, so it is important to treat these as potentially infectious. At present there is still relatively little known about COVID-19 transmission and research is required to determine whether it is spread by individuals before they become symptomatic or when they are asymptomatic.
Activity One:
Activity One:
Please watch this video introducing COVID-19, exploring what it is and some of the virus characteristics.
Activity Two:
Activity Two:
Please visit the Public Health England website linked on the right and read the up to date guidance on the transmission, characteristics and principles of COVID-19 infection control.
Section 2: Ensure identification of safe practice to protect self and others
Section 2: Ensure identification of safe practice to protect self and others
In healthcare settings there are things that we can do to reduce the risk of transmission of COVID-19.
These include:
Follow NHS advice on self-isolation and social distancing
Handwashing
Encouraging staff, patients and visitors to follow respiratory and cough hygiene advice
Use of PPE (see detailed information in the section on practicing the correct donning and doffing techniques for PPE)
Environmental and equipment decontamination
Managing infected waste as per local policy
Managing infected linen as per local policy
Following your local organisational policy for uniform. You may be asked to wear scrubs instead of your uniform and these should be left to be cleaned at your workplace if possible.
Activity Three:
Activity Three:
Below are links to six resources. Fold an A4 piece of paper into six squares and then visit each in turn. In each square make some notes of the most pertinent points from that resource and anything you think you may struggle to remember.
NHS advice on how to avoid spreading COVID-19
NHS Hand washing advice
Best Practice Hand Washing Guide
Public Health England guidance advises the washing of forearms
Catch it, Bin it, Kill it
Management of blood and body fluid spillages
Decontamination of reusable equipment
Please see the Public Health England document on reducing the risk of transmission of COVID-19.
UPDATED INFO FOR MAY 2020
Nurses should consider using eye protection (goggles/visor) if a patient is coughing and there is increased risk of drop transmission to the eye mucosa. This is for non-AGPs.
“Health and social care workers should consider the need for contact and droplet precautions based on the nature of care or task being undertaken. Risk assessment on the use of eye protection, for example, should consider the likelihood of encountering a case(s) and the risk of droplet transmission (risk of droplet transmission to eye mucosa such as with a coughing patient) during the care episode. Sessional use of FRSMs and eye protection is indicated if there is perceived to be close or prolonged interaction with patients in a context of sustained community COVID-19 transmission.”
There is updated guidance on COVID-19 testing:
1. Upper respiratory tract sample(s): single swab used for throat then nose into one pot of viral transport medium; a viral nose swab and a viral throat swab combined into one pot of viral transport medium, or a nasopharyngeal aspirate in a universal transport pot. Bacterial or charcoal swabs are not suitable.
2. Lower respiratory tract sample (sputum) if obtainable, in universal container
Additionally, if the patient is admitted to hospital, take a sample for acute serology:
· 5mL serum tube or plain (no additive) tube; for children <12 years, 1mL is acceptable
Important points about sample-labelling and request forms include:
· label each sample with ID, date of birth and type of sample
· use the specific form for requesting COVID-19 acute respiratory disease testing (E28), one form for each sample
· do not place paperwork (request forms) in the primary container for Category B transport
· request form must include a contact phone number for sharing of results
· samples without appropriate paperwork will not be tested or testing will be delayed
NMC statement on personal protective equipment during the covid-19 Pandemic.
INFORMATION FOR MIDWIFERY STUDENTS
Dear Students, we would encourage you to familiarise yourself with the updated RCM infographic included - click the link to the right called 'PPE: what to wear in maternity care'
As midwives we sometimes find ourselves in emergency situations. An example of this may be a category 1 caesarean section. If this scenario was to occur, it is vital that you have the correct protective equipment to keep yourself, your colleagues and the woman safe.
An FFP3 mask is a special type of mask which MUST be fit tested (there are no types of FFP3 that do not need fit testing.) This is a procedure that takes between 15-20 minutes and cannot be hurried or performed in an emergency situation. It is therefore vital that you have had the mask fit testing ideally at the start of placement, especially if attending labour ward, and definitely before attending theatre. Elective caesareans can quickly be converted to general anaesthetic procedures and if that is the case and you have not been fit tested for an FFP3 mask you will need to stop caring for that woman and remove yourself from theatre. FFP3 masks are also used for any caesarean which could result in a postpartum haemorrhage, including high risk caesareans such as placenta accreta. Any emergency caesarean leaving from labour ward in most trusts are now being treated as a Covid-19 procedure, please be mindful of this.
Most trusts are currently working to the standard PPE shown in the info-graphic, as being acceptable for routine cares. There may be slight changes for example STH request two pairs of gloves to be worn when attending theatre. If the trust is working on an enhanced PPE to that shown in the infographic please work to their guidelines.
Please pay particular attention to the use of visors. These are now to be used at any episode of care involving potential exposure to bodily fluids, care at any stage of labour and caring for anyone with either suspected or confirmed Covid-19. Spontaneous rupture of membranes is a high risk event. Therefore visors should be worn throughout labour care.
If you are concerned about any aspect of the trust protective equipment policy or supply. Please discuss this with your mentor and Sheffield Hallam academic advisor or course lead as a matter of urgency.
Section 3: Practice the correct donning and doffing techniques for PPE
Section 3: Practice the correct donning and doffing techniques for PPE
This section will focus on essential preventative measures you need to follow as healthcare professionals working in areas that may have patients with COVID 19. Please have a good look at the information within this section in preparation for the teaching session.
This will be a potentially dangerous environment and so you must fully protect yourself and avoid any likely cross contamination. When caring for your patients you need to wear the right Personal Protective Equipment (PPE) taking account of the sort of procedures you might be doing or witnessing. For example if a patient has a tracheostomy and you will be close to them whilst an open suction procedure of their airway takes place this is classed as an aerosol generating procedure, but if you are involved in altering the position of a patient to prevent skin pressure this would usually be a non-aerosol generating procedure. PPE must be available for you in every area where there may be patients with COVID 19; putting this on is donning and taking it off is doffing.
Please note that the information below is taken from national guidance and it is advised that you also check your local Trust guidelines.
Donning and doffing procedures can be categorised into (taken from up to date Public Health England’s full guidance on PPE )
1. Aerosol generating procedures (AGP)
These include:
intubation, extubation and related procedures, for example manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract)
tracheotomy or tracheostomy procedures (insertion or open suctioning or removal)
bronchoscopy and upper Ear Nose and Throat (ENT) airway procedures that involve suctioning
upper gastro-intestinal endoscopy where there is open suctioning of the upper respiratory tract
surgery and post mortem procedures involving high-speed devices
some dental procedures (for example, high-speed drilling)
non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive Airway Pressure Ventilation (CPAP)
high Frequency Oscillatory Ventilation (HFOV)
induction of sputum (cough)
high flow nasal oxygen (HFNO)
2. Non-aerosol generating procedures
Activity Four:
Activity Four:
Please explore the links to Public Health England guidance on the correct procedures below for each and be confident that you understand and can replicate these procedures. Commit these to memory anyway you feel you learn best ie. write a list, draw a diagram, make up a song.
Aerosol Generating Procedures (AGP)
Aerosol Generating Procedures (AGP)
Donning Video
Donning Video
Donning Guide
Donning Guide
Doffing Video
Doffing Video
Doffing Guide
Doffing Guide
Non Aerosol generating procedures (AGP)
Non Aerosol generating procedures (AGP)
Donning & Doffing Video
Donning & Doffing Video
Donning Guide
Donning Guide
Doffing Guide
Doffing Guide
Section 4: Demonstrate the correct procedure for swabs and sample collection
Section 4: Demonstrate the correct procedure for swabs and sample collection
Except for sweat, all body secretions and excretions are thought to be infectious for COVID-19. It is therefore essential to follow local and national guidance for the correct sampling, labelling and packaging of all potentially infectious samples in healthcare settings. Taking samples from a patient known or suspected to have COVID-19 presents an infection risk to anyone handling the sample. Below you will find a video detailing how to process and send a sample for testing in a Public Health England Laboratory. Some Trusts may offer in-house testing for samples and it is important to ensure that all potentially infectious samples are labelled as per your local policy.
Activity Five:
Activity Five:
Watch the video below and look at the paper guide, be happy that you can remember these and complete steps detailed below.
Packing Diagnostic Samples
Packing Diagnostic Samples
Packing Samples Guide
Packing Samples Guide
The principles in this video are relevant to all samples taken from a patient with suspected or confirmed COVID-19 but local policy may differ. It is generally recommended that you:
· Take printed labels and bags with you to the patient’s room or bay so that these can be stuck to the sample without having to remove the sample from the patient’s room or bay, as this will increase the risk of infection spread. If your local Trust policy requires you to write on the sample do this before you enter the room or bring a pen with you that will be left in the room.
· Ensure that lids are tightly in place on the sample.
· Decontaminate the sample pot or bottle once the sample has been taken away from the patient, but still in the patient’s room. If you have another member of staff with you, they can do this.
· Change your gloves.
· Place the sample in a zip-lock bag and seal.
· Once you have left the room immediately place the sample and bag within a second bag.
· Ensure that forms or stickers are with the sample as per local policy. It is often advised that these are outside the second bag.
Check your understanding of the above information
Check your understanding of the above information
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