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Sussex Clinical Commissioning Groups Coronavirus (COVID-19) Infection Prevention and Control Guidance for Primary Care Hot Hubs Date: 03.04.2020

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Sussex Clinical Commissioning Groups Coronavirus (COVID-19) Infection Prevention and Control Guidance for Primary Care Hot Hubs Date: 03.04.2020 Sussex Clinical Commissioning Groups Coronavirus (COVID-19) Infection prevention and control guidance for Primary Care Hot hubs Date: 03.04.2020 Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Sussex Clinical Commissioning Groups What is Coronavirus (COVID-19) • Coronaviruses are a large family of viruses - they cause infections ranging from the common cold to Severe Acute Respiratory Syndrome (SARS) • Coronaviruses circulate between animals and humans; sometimes new variants of the coronavirus emerge - such as COVID-19 • COVID-19 has the potential to spread widely as lack of immunity means everyone in the population is susceptible Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG What are the symptoms of COVID-19 • Symptoms start 5-11 days after exposure • Majority have fever and dry cough (rapid Symptom Proportion of onset) cases • Symptoms last 5-6 days Fever ˃37.5˚c 88% Dry cough 68% • Severe illness starts day 7 Fatigue 38% Sputum 33% . ↑ Shortness of breath Shortness of 19% breath . Lung inflammation Muscle/ joint 15% pain . Pneumonia Sore throat 14% Headache 14% Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG How is COVID-19 transmitted? Exposure to large respiratory droplets & vomit . Coughing/sneezing onto mucous membranes (mouth/eyes) . Need close contact for this to occur (within 1 metre) Contact with respiratory secretions • Transferred by touching mucous membranes • Tissues/surfaces contaminated with respiratory secretions *It is NOT transmitted in air except if patient undergoing a procedure that generates aerosols e.g. airway suction *Aerosol generating procedures increase risk of aerosol spread of infectious agents irrespective of the mode of transmission Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Cough Etiquette Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Infection prevention and Control ‘Hot Hubs’ General guidance • A suitable practice/location is required for Hot hubs for suspected and confirmed Covid-19 patients. • All patients are to be triaged to ensure they meet the case definition • Patients will need at be able to access the sites by private car and not via public transport. • For patients that cannot attend by private car, a home visit will be required. Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Hot Hubs Hot hub Practices should have the following General environment • Car parking for patients • Controlled entry system • Disabled access • Toilet facilities • Natural Ventilation • Adequate storage area for PPE • Free of soft furnishings such as carpets, fabric chairs etc. • Single practices, not attached to other providers or services Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Hot Hubs General environment • Signage • Dirty/clean areas of the practice must be separated by closed doors and have signage displayed warning of the segregated area to control entry. • Non-Hot hub patients should not be able to access the practice, this should be communicated clearly. • To control entry, signage should be displayed warning of the segregated area. • Staff rest area/clean area • Staff must have access to a rest area in a clean area of the practice and access to staff toilet facilities. • This area can be cleaned as routine practice cleaning. Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Hot Hubs General environment • Remove all non-essential items from reception and consulting rooms such as toys, leaflets, magazines and all personal belongings. • Consider removing privacy curtains and window fittings that are not vertical blinds and replacing with window frosting. • Keep air condition units switched off and external windows open for ventilation. • Doors must be kept shut at all times Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Hot Hubs Consultation rooms • Multiple consulting rooms that would be suitable for frequent cleaning (Free of soft furnishings .e carpets, fabric chairs etc.) • Review what equipment is required in consulting rooms and remove, store in cupboards or cover non-essential items • Suitable hand wash facilities in each room. • All equipment used should be disposable where possible • If re-usable equipment is used, it should be decontaminated after each use. • Ensure adequate supplies of equipment are in stock and avoid leaving the room to obtain equipment during a consultation. • Computer keyboards should be able to withstand chlorine decontamination or have a cover that allows this. Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Staffing Hot Hubs • Staff should be risk assessed if it is safe for them to work at the hub and excluded if they are classed as at risk such as – immune-compromised, – underlying health concerns, – over 70 or – Pregnant. • Cohort staff working at this location where possible. • Clinical staff should change in and out of all uniform on site. Uniforms will be laundered by an external company. • All staff to be familiar with good hand hygiene practice. Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Patient attendance ‘Hot Hubs’ • Patients should be triaged and if symptomatic of Covid19 symptoms and able to attend via private car, will be booked into the Covid19 hot hub. • Appointments should be spread-out where possible to avoid patients congregating within the practice. • Clinicians, wearing full PPE, should ideally collect the patient upon entry to the practice and escort them straight to the consultation room. • If patients are required to wait, they should be encouraged to sit spaced from other patients or directed directly into the waiting/consultation room allocated. Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Flow diagram of patient pathway in Hot Hubs 1. Patient is triaged and allocated an appointment at the Hot Hub. 2. where there is car parking facility, the patient will park in the car park and phone the number provided. When the clinician is ready for the patient, they will be contacted and provided with clear instructions on where to go. 3. Clinician to greet patient in reception wearing full PPE (gloves, aprons and fluid repellent face mask). Patient to gel their hands and avoid touching anything such as check-in systems, door handles etc. 4. If clinician is not present, reception staff wearing full PPE to direct patient to sit in the waiting area or direct them straight to the consultation room (avoiding touching surfaces/ handles where possible) 5. The consultation room door must remain closed, air conditioning turned off and external windows open. All equipment used or exposed during the consultation must be disposed of or decontaminated. 6. The patient must be escorted out of the practice by clinician the same way they came in and asked to gel their hands upon leaving. 7. Equipment must be cleaned by either a combined detergent/disinfectant or separate solutions and must be effective against coronavirus (see advice). All surfaces to be cleaned including door handles, cupboards, computer keyboards etc. Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Standard infection control precautions (SICP) SICP are essential to minimise risk of transmission between staff and patients Standards should be in place for: . Hand Hygiene . Personal Protective Equipment (PPE) to protect wearer from exposure to body fluid . Safe disposal of waste and linen . Decontamination/ disinfection of environment and equipment Brighton and Hove CCG | Coastal West Sussex CCG | Crawley CCG | Eastbourne, Hailsham and Seaford CCG Hastings and Rother CCG | High Weald Lewes Havens CCG | Horsham and Mid Sussex CCG Hand Hygiene Hand hygiene is essential to reduce transmission of infection in health and care settings Handwashing must be carried out thoroughly & time sufficient to inactivate the virus i.e. 40-60 seconds Follow the 5 key moments of hand hygiene Alcohol gel ˃60% is effective against COVID-19 Soap and water should
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