COVID-19 Guidelines & Resources

SCGH ED COVID-19 Guidelines

SCGH ED COVID Response Video Update:
- Charlie’s COVID Chronicles #1 – 27th March 2020 update from Dr James Rippey – with thanks to Tor Ercleve, Nicole Hoskins, Nick Martin, Susie Mills and Megan Rayner (password protected – see your emails)

Triage:
- Triage screening questions – to categorise patients
- Triage Patient Placement for Initial Assessment
  - ILI / Respiratory Sx’s – into Triage Lobby for initial assessment
  - Non-ILI / Respiratory Sx’s – into main ED WR / FT WR / Clean Resus or Assessment Bed

ED Patient Placement:
- ED COVID Triage Sieve
  - ED COVID Patient Flow Video Explanation
    - password protected – see your emails – suggest 1.5 – 2 x speed adjustment
- ED COVID Graded Escalation Plan (internal)

Aerosol Generating Procedure Rooms (AGPRs = ISO/FT) Criteria
- AGPRs to be used for patients who require Aerosol Generating Procedures,OR are have a high risk of producing aerosol generation of virus (high secretions with cough) – See ED COVID Triage Sieve (right sidebar)
- Aerosol Generating Procedures:
  - Intubation
  - Nebulisers
  - NIV
  - Suctioning

COVID Testing Criteria
- WA COVID Clinic Testing Guidelines, OR
- WA Health Care Worker Testing Guidelines (as per latest SitRep – internal),
  - “any healthcare worker with direct patient contact has a fever (≥38°C), or history of fever (eg. night sweats, chills) AND an acute respiratory infection (e.g. shortness of breath, cough, sore throat)” – as of 24/03/2020, OR
- If outside testing criteria AND high clinical suspicion for an admitted patient, then d/w COVID Consultant via switch x91 (consultant to consultant in hours) – they can discuss with ID needed

Imaging Pathways:
- Radiology:
  - Chest Imaging
  - Non-Chest Imaging
  - COVID Risk Assessment Stamp – for imaging requests
- Critical Care Ultrasound in COVID
  - Lung Ultrasound Report
  - Instructional Video of Lung Ultrasound in COVID Patients
  - Cleaning the Ultrasound Machine – see: WA DOH – Coronavirus Disease-19 (COVID-19) Infection Prevention and Control in the Hospital Setting

COVID Patient Admission Communication:
- Call COVID Consultant via Switchboard on x91
- Booking Slip under Dr Kosky, Respiratory Medicine
- COVID Assessment Team (COAT) Rounds (Resp / ICU / Anaesthetics) start ~11:30 arrive in ED ~12:00 to meet ED Duty Consultant

Suspected / Confirmed COVID Patient Investigation & Management:
- Investigations (note: these are not routine suggestions and should be considered on a case by case basis after d/w a senior clinician):
  - CXR
  - U&E / FBP / LFT’s / Blood Cultures
  - ECG
  - COVID / ILI PCR (?also consider Rapid Flu test – for disposition planning)
  - Consider risk stratification biochemistry (not to be ordered in ED) – D-dimer / LDH / PCT / Trop / BNP
- Mx Bilateral Pneumonia / Pneumonitis (specifics should be discussed with ED / COVID Consultant / ICU / Anaesthetics as appopriate)
  - Consider covering with broad spectrum IVAB’s (ie. ceftriaxone / azithromycin), OR Tamiflu (if influenza positive)
  - Cautious use of IV Fluid Therapy
  - Early Goals of Care Discussions (see WA DOH: Goals of Care in the COVID-19 environment)
  - Oxygen to maintain SAO2 ~88-90%
    - Oxygenation Escalation Pathway
    - COVID Patient Intubation Guidelines – call Special Anaesthetic Service (SAS) x71242
      - If SAS not available:
        SCGH ED Intubation & Ventilation Guidelines for COVID-19 patients

Transport of COVID Patients:
- Into the ED – See ED COVID Triage Sieve
- Out of the ED

ED Patient Flow:
- Ambulance…
- Medical / Surgical Inpatient Flow – Contact…
- Mental Health Escalation Plan…

Discharge Advice Sheets:
- WA Health self-quarantine advice sheet general
- Discharge Advice for Patients with URTI / ILI Symptoms Advice – ie. fit for discharge, no recognised risk factors for COVID, not tested for COVID, hence cannot exclude COVID

SCGH ED Infection Prevention & Control Practices

Relevant Policy Documents:
- SCGH – Coronavirus (COVID-19) Interim Infection Prevention and Control Policy (internal)
- WA DOH – Coronavirus Disease-19 (COVID-19) Infection Prevention and Control in the Hospital Setting
- Communicable Diseases Network Australia (CDNA) National Guidelines for Public Health Units – Coronavirus Disease 2019 (COVID-19)

Staff
- Hand Hygiene
  - 5 Moment for Hand Hygiene
  - How to wash your hands PROPERLY!
- Personal Protective Equipment (PPE):
- Cleaning of Clinical Areas
  - Who to call?
  - Room cleaning times?

Patient
- What Precautions (CDNA Australia COVID-19)
  - No AGPR’s / Not high secretions = Contact / Droplet Precautions
  - AGPR’s / High secretions = Airborne Precautions
- Patient Oxygen Delivery System / Flow and Corresponding PPE for Patient & Staff

SCGH ED Health Care Worker Occupational, Health and Safety Advice

Medical Staff Wellness Amongst the COVID-19 – Download link for Powerpoint presentation by SCGH ED Consultant Dr Jason Scop

Health Care Worker with Respiratory Tract Illnesses (RTI’s)
- If you experience “flu-like” symptoms you can call the dedicated WA Health Staff COVID-19 Call Centre on 1800 955 765
- If COVID testing (see latest SitRep for indications), then isolate until test results (Self-quarantine and testing for COVID-19)
  - Negative
    - as for SCGH ILI Policy (see below)
  - Positive (as per Coronavirus Disease 2019 (COVID-19) – Communicable Diseases Network Australia (CDNA) National guidelines for Public Health Units)
    - the person has been afebrile for the previous 48 hours;
    - resolution of the acute illness for the previous 24 hours
    - be at least 7 days after the onset of the acute illness;
    - PCR negative on at least two consecutive respiratory specimens collected 24 hours apart after the acute illness has resolved
- If not COVID testing, then SCGH ILI Policy:
  - Influenza confirmed:
    - “should not return to work until either 72hours since commencing oseltamivir treatment, or 7 days have elapsed since onset of symptoms”
  - URTI / ILI:
    - “exclude from duty until afebrile and acute symptoms have settled (~3- 5 days)”

Health Care Workers Considered Close Contacts of Confirmed COVID-19 Case
- See latest: Coronavirus Disease 2019 (COVID-19) – Communicable Diseases Network Australia (CDNA) National guidelines for Public Health Units

The following HCWs must not care for a suspected or confirmed case of COVID-19 (as per SCGH Infection & Control Policy: Coronavirus (COVID-19) – Interim Policy):
- pregnant women
- individuals with chronic respiratory conditions including asthma, COPD
- mobidly obese
- persons with chronic illness predisposing to severe disease such as:
  - cardiac disease, excluding simple hypertension
  - diabetes mellitus
  - chronic renal disease
  - haemoglobinopathies
  - immunosuppression, including that caused by cancers, medications or by HIV/AIDS infection
  - chronic neurological conditions

SCGH Other Departmental COVID-19 Plans