covid-19_interim_guide_for_ipc_risk_assessment_for_ppe_use_in_community_healthcare_settings_-_3_dece

COVID-19 Interim guide for Infection Prevention and Control (IPC) risk assessment for personal protective equipment (PPE) use in community healthcare settings 3 DECEMBER 2021 This guide assists healthcare workers in selecting the appropriate PPE following a risk assessment for COVID19. The guidance is consistent with international evidence and practice and replaces previous information under the ‘Alert Level’ system.

Standard Precautions are a set of IPC measures required for all healthcare interactions. A risk assessment is required before each interaction by the health and disability care worker (HCW) to determine what PPE is required. The risk assessment considers the patient/client/resident, the environment, the task to be undertaken and determines the risk of exposure to blood or body fluids and if personal protective equipment (PPE) is required.

Risk assessment for COVID-19 Before every interaction, consider the likelihood that the person may be infected with COVID-19: • • • • • • •

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 close 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 (excluding travel by air from a country/area with which NZ has quarantine free travel)?

Does the person require an aerosol generating procedure?

Is an adequate contact history able to be obtained from the person?

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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: • •

• • • •

Be fully vaccinated for COVID-19.

Triage a person prior to any face-to-face encounter: o Consider deferring the visit if a person has new onset of clinical symptoms or they are COVID19 positive. o Determine if a virtual appointment is possible, or delay care until no longer infectious.

Perform regular hand hygiene.

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

Practice physical distancing where possible – when close contact is required, minimise the length of the interaction.

Consider 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.

* Aged residential care residents are not required to wear a face covering Select personal protective equipment by referring to the COVID-19 Interim guide for PPE selection to protect primary and community health and disability care workers below.

Infectious period The person with COVID-19 infection is generally infectious for at least 10 days after the onset of symptoms, or a positive test result. If there are whānau/family or others in the household, their period of infectivity also needs to be considered. Seek advice from the public health team.

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COVID-19 Interim guide for PPE selection to protect primary and community health and disability care workers Complete a risk assessment before every interaction with the patient/client/resident to select appropriate PPE. All health and disability care workers1 must be fully vaccinated.

COVID-19 Protection Framework setting PATIENT/CLIENT/RESIDENT Their risk of having COVID-19 LOWER RISK of COVID-19 infection • No COVID-19 related symptoms2 and not a close contact of a confirmed case MODERATE RISK of COVID-19 infection • COVID-19 related symptoms,2,3 but not a close contact of a confirmed case3 OR • No COVID-19 related symptoms but a close 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 close contact until test results are available (if clear then care as moderate risk)3

Sporadic cases

Increasing cases

Widespread cases

HEALTH AND DISABILTY CARE WORKER (HCW) 1 Recommended PPE Medical mask encouraged

Medical mask in clinical or care area

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

Medical mask at all times Medical mask5,6 and eye protection Wear a gown7or 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

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Confirmed COVID-19 case during infectious period3

PATIENT/CLIENT/RESIDENT Advice for when to wear a mask • • • • •

If LOWER RISK follow the regional COVID-19 Protection Framework advice If MODERATE RISK wear a medical mask or face covering If HIGHER RISK wear a medical mask Aged residential care residents are not required to wear a face covering Exemptions to mask wearing may apply

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HCW include: Home and Community Support 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 respirator 8.

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.

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