covid-19_interim_guide_for_infection_prevention_and_control_ipc_risk_assessment_for_personal_protect

COVID-19 Interim guide for infection prevention and control (IPC) risk assessment for personal protective equipment (PPE) use in community healthcare settings – Omicron update 02 MARCH 2022 This guide assists health and disability care workers in selecting the appropriate PPE following a risk assessment for COVID-19. The guidance is consistent with international evidence and practice and replaces previous advice PPE is considered as part of Standard Precautions which are a set of IPC measures required for all healthcare interactions. A risk assessment is required before every interaction or every session with a patient/client/resident by the health and disability care worker (HCW) to determine what PPE is required.

The risk assessment considers the risk of the patient/client/resident having COVID-19, the environment the task is to be undertaken in, and the risk of exposure to blood or body fluids. It determines the PPE required and if additional respiratory protective PPE may be needed.

Risk assessment for COVID-19 Before every interaction, consider the following risk factors: • • • • • •

Does the person or any other household member have confirmed COVID-19 infection?

Does the person have any COVID-19 symptoms?

Is the person a household contact of a COVID-19 case or still under an isolation order?

Has the person been notified by Public Health and asked to self-isolate?

Has the person travelled internationally in the last 10 days?

Is an adequate contact history able to be obtained from the person? If not, a more precautionary approach is needed.

What circumstances increase the risk • Prolonged face-to-face contact < 2metres from person.

• Will the interaction occur in a well-ventilated space?

• Is the person and any others with them in the room able to wear a medical mask?

• Is there widespread community transmission in your region/area?

• Does the person require an aerosol generating procedure*? * Aerosol generating procedures – Ministry of Health

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Infectious period

The person with COVID-19 infection is generally infectious from 48 hours before the onset of symptoms, then for 10 days after the onset of symptoms, and for 72 hours after symptoms have stopped. Some people with severe illness may be infectious for longer. If there are whānau/family or others in the household, their period of infectivity also needs to be considered.

About COVID-19 – Ministry of Health

General COVID-19 IPC measures to reduce the risk of exposure in community healthcare settings To reduce the risk of exposure to COVID-19, the health and disability care worker should: • •

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Be fully vaccinated for COVID-19 including a booster dose when eligible.

Triage a person prior to any face-to-face encounter: o if possible, defer the visit if a person is identified as having a risk factor o determine if a virtual appointment is possible, or delay care until no longer increased risk Practice physical distancing where possible – when close contact is required, minimise the duration of the interaction.

Perform regular hand hygiene.

Encourage the person, and any other who needs to be in the room, to wear a mask*.

Consider the ventilation of the environment in which the interaction will take place: o if home visiting, where possible, open the windows to improve ventilation before and during visit. o if occurring in a community healthcare facility, open the windows to improve ventilation if possible. Ensure any mechanical ventilation system is appropriate for use. o use of other IPC measures – reduce number of people in room or premises, use of physical barriers, floor markings to maintain physical distancing.

use and disposal of PPE correctly.

* Aged and other residential care residents are not required to wear a face covering when in their home.

Select personal protective equipment by referring to the COVID-19 Interim guide table for PPE selection to protect primary and community health and disability care workers – Omicron update below.

Sessional (continuous) use of PPE

Definition: A session refers to a period of time where a healthcare worker is undertaking duties in a specific care setting/exposure environment for a set period of time.

Sessional (or continuous) use of PPE refers to the wearing of PPE for a ‘session’ of care activities without needing to don and doff the respiratory protection, eye protection and gown (unless soiled) between each task. The duration of a session will vary depending on the task or activity being undertaken but will typically not exceed 4 hours.

It is still expected that the respiratory protection, eye protection, and gown, along with the gloves will be removed when staff go for meal/rest breaks.

New, or cleaned reusable PPE will be donned when the HCW returns to their clinical/practice/work area.

Eye protection (allocated individual eye protection e.g., face shields/goggles) worn during a session is acceptable. A single-use face shield can be worn by the same staff member for a number of sessions, provided it is cleaned between sessions by wiping with a disinfection wipe. For a face shield with a foam band, do not immerse in a solution which will saturate the foam. Do not share a face shield with another staff member

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COVID-19 Interim guide table for PPE selection to protect primary and community health and disability care workers - Omicron update Complete a risk assessment before every interaction or every session with patient/client/resident to select appropriate PPE. All health and disability care workers1 must be fully vaccinated (plus booster dose).

COVID-19 Omicron Phase settings PATIENT/CLIENT/RESIDENT Their risk of having COVID-19 LOWER RISK of COVID-19 infection • No COVID-19 related symptoms2 and not a household contact of a confirmed case MODERATE RISK of COVID-19 infection • COVID-19 related symptoms,2,3 but not a household contact of a confirmed case3 OR • No COVID-19 related symptoms but a household contact OR required to self-isolate4 HIGHER RISK of COVID-19 infection • COVID-19 related symptoms2 and identified by the contact tracing service as a household contact until test results are available (if clear then care as moderate risk)3 • Confirmed COVID-19 case during infectious period3

Sporadic cases Phase One

Increasing cases* Phase Two

Widespread cases* Phase Three

Medical mask

Medical mask

Medical mask

HEALTH AND DISABILTY CARE WORKER (HCW)1 Recommended PPE

Medical mask5 6 and eye protection Wear a gown7 or apron and gloves if exposure to blood or body fluids is likely

P2/N95 particulate respirator8, and eye protection Wear a gown7 or apron and gloves if exposure to blood or body fluids is likely

P2/N95 particulate respirator8 and eye protection. Gown7 and gloves for close contact clinical or home support care

* Consider

local and regional variation for case numbers which may reduce or increase risk/PPE selection for HCW. All healthcare workers in Urgent Care and General Practice should wear a P2/N95 particulate respirator for all close interactions with patients presenting with an undifferentiated infectious diagnosis across all phases of the Omicron outbreak.

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PATIENT/CLIENT/RESIDENT/PARTNER IN CARE/WHĀNAU Advice for when to wear a mask All persons present with the HCW would be requested to wear a mask Aged and other residential care residents are not required to wear a mask Exemptions to mask wearing may apply

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HCW include: Home and Community Support and Disability Service workers, Aged Care, General Practice, Urgent Care, Community Services.

COVID-19 related symptoms refer to Ministry of Health case definition, test for COVID-19.

Defer face to face interaction whenever possible until COVID-19 test results are available, or patient/client/resident is no longer infectious.

Required to self-isolate under the Health Order (Section 70) or requested by the Medical Officer of Health.

If intervention requires an aerosol generating procedure, then the HCW should wear a P2/N95 particulate respirator8.

If the care environment is not able to be ventilated i.e., no windows, doors, fresh air or HVAC system and close interaction for longer than 15 minutes is anticipated, the HCW should have access to a P2/N95 particulate respirator.

7. Long sleeve fluid resistant gown.

8. Any worker who is required to wear a P2/N95 particulate respirator should have undertaken the requisite fit testing and be trained in fit checking 1

Fit checking and Fit testing We are aware that access to fit testing services remains constrained. In situations where fit testing has not yet been carried out, and a P2/N95 respirator is recommended for use, a fit-checked/user seal checked P2/N95 respirator should be worn. View the fit checking guidance: Interim guidance for P2/N95 particulate respirators in the absence of fit testing, please refer to the below link in which you will find the information:

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COVID-19: Infection prevention and control recommendations for health and disability care workers 4