At the end of last month Public Health England (PHE) issued interim guidance for primary care on the new coronavirus, now called COVID-19, which originated in China.
A public health campaign has been launched, which includes advice on how people can protect themselves from infection. Following the news that healthcare workers are among some of the latest people to be infected with the virus, PHE has also issued guidance for healthcare workers who have travelled to specific areas (see below).
PHE guidance for primary care
PHE's guidance for dealing with patients, which is being regularly updated as further information becomes available, sets out what GP practices should do if they suspect a patient infected with the novel coronavirus has attended the surgery.
Fever, cough or chest tightness, and dyspnoea are the main symptoms reported by affected patients. PHE's guidance says the novel coronavirus may cause mild to moderate illness as well as pneumonia or severe acute respiratory infection.
It says that if the infection does present in the UK it is most likely to occur in travellers who have recently returned from China, Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan or Thailand and advises clinicians to take an accurate travel history.
If a patient attends the surgery
If GPs undertake a phone consultation with anyone suspected of having the virus, they should not invite them to attend for a face-to-face consultation but instead seek specialist advice from the local health protection team.
However, if a patient has attended the surgery, the following steps should be taken:
- Patients suspected of having the virus should be isolated as quickly as possible and not allowed to use communal toilet facilities.
- If GPs suspect a patient of having coronavirus during a consultation they should leave the room, wash their hands and conduct the remainder of the consultation by phone if necessary. The patient's belongings should remain in the room.
- They should ask the patient to call NHS111 from their mobile phone (if there is no mobile available then they should use the surgery phone).
- If the patient needs to use the toilet they should not use communal facilities. They should be told not to touch anything on their way to the toilet and advised to wash their hands thoroughly.
- Anyone who comes into contact with the patient should wash their hands thoroughly with soap and water and healthcare professionals should obtain specialist advice from a local microbiologist, virologist or infectious diseases physician and inform their local health protection team.
- If a patient is critically ill and requires an ambulance transfer to hospital, the call handler should be informed of the concerns about coronavirus.
- Any other transfer to secondary care should be discussed with the hospital first.
After the patient has left the surgery
The following steps should be taken:
- The room should not be used, the door remained shut with the windows open and the air conditioning off until it has been cleaned with detergent and disinfectant.
- The person cleaning should wash their hands and wear a disposable plastic apron and gloves.
- During cleaning the door should remain closed with the window open.
- All items used to care for the patient and any consumables that cannot be cleaned with detergent and disinfectant should be bagged as clinical waste, including the contents and the bin. Fabric curtains or screens should be removed and bagged as infectious linen.
- Disposable cloths and mop heads should be used to clean and disinfect all hard surfaces and all reusable non-invastive care equipment should be cleaned and disinfected. Cloths and mop heads should be disposed of as single-use items.
- All waste should be quarantined until patient test results are known.
- If the patient spent time in a communal area, this should be cleaned with detergent and disinfectant as soon as possible.
Guidance if health workers have travelled to specified areas
New guidance for staff who work in healthcare has also been issued. If a healthcare worker has travelled to China, Hong Kong, Japan, Macau, Malaysia, Republic of Korea, Singapore, Taiwan or Thailand and returned to the UK in the past 14 days they should:
- Notify their manager immediately
- Notify NHS 111, NHS direct in Wales, NHS 24 in Scotland, or out-of-hours GP service in Northern Ireland.
If they have travelled to Wuhan or had any exposure to healthcare settings in any of the places listed above within the past 14 days, or come into contact with a known case of novel coronavirus, they should self isolate at home and not return from work until at least 14 days after the last exposure.
If they have travelled to any of the areas above, they do not have to stay away from work, but they should seek occupational health advice. They can continue to work as normal while asymptomatic, they should be told about the symptoms of the virus and they should contact NHS 111 if they become to feel unwell.
If they have had symptoms and tested negative and these have resolved they can return to work after 14 days.
Practices may want to review they business continuity plans to ensure they have up-to-date procedures should their practice be forced to close because of an actual or potential case of COVID-19, or if the UK ends up in a pandemic situation.
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