Social distancing to protect staff and patients from Covid is no longer ‘routinely required’ in GP practices under new infection prevention and control (IPC) guidance.
The new guidance published by the UK Health Security Agency (UKHSA) last week said that healthcare settings including GP practices should risk assess whether ‘standard infection control precautions’ such as hand hygiene and PPE are needed.
This could include screening, triaging and testing patients for Covid infection.
But the guidance added that ‘transmission-based precautions’ such as physical distancing are ‘not routinely required’.
IPC guidance is issued jointly by UKHSA, the Department of Health and Social Care (DHSC), NHS England, Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland and NHS National Services Scotland.
In a letter sent to trusts and CCGs outlining the changes, NHS England said that the updated guidance ‘takes into account UKHSA’s latest assessment of the scientific evidence’ as well as ‘feedback from local providers on the ongoing impact on capacity that IPC measures are having’.
It added: ‘In line with the flexibility afforded for local risk-assessment within the UK IPC guidance, and advice from UKHSA, the following should also be noted:
- ‘Returning to pre-pandemic physical distancing in all areas, including in emergency departments, ambulances and patient transport, as well as all primary care, inpatient and outpatient settings. This should be done in a way that maintains compliance with all relevant Health Technical Memoranda and Health Building Notes.
- ‘Returning to pre-pandemic cleaning protocols outside of Covid-19 areas, with enhanced cleaning only required in areas where patients with suspected or known infection are being managed.‘
The changes ‘signal a step in the transition back to pre-pandemic IPC measures’, NHS England said.
It added that providers must implement instructions set out in an IPC manual for England that it published alongside its letter last week ‘as soon as possible’.
NHS England stressed that all patients, staff and visitors should continue to practise good hand and respiratory hygiene including the continued use of face masks.
All current ‘triaging and cohorting arrangements’ outlined in the IPC guidance will also continue to apply, it said.
The IPC guidance also reiterated that all staff should be ‘vigilant for any signs of respiratory infection and should not come to work if they have respiratory symptoms’.
It comes as doctors have called for wider Covid restrictions to be reintroduced as vaccine uptake wanes.
And a Pulse survey revealed last month that the majority of GPs in England think Covid restrictions were removed too soon.
New IPC guidance for GP practices
Patients attending for an appointment or admission who have been screened (and have answered ‘no’ to all screening questions), triaged (and have no clinical signs or symptoms of respiratory infection) and tested (with a negative result) as per country or local testing strategies only require the application of standard infection control precautions (SICPs) at the point of care.
The application of SICPs during care delivery is determined by an assessment of risk to and from individuals and includes the task, level of interaction and/or the anticipated level of exposure to blood and/or other body fluids. Transmission-based precautions (TBPs) as outlined in this guidance are not routinely required. However, the application of IPC measures must be assessed, and risks mitigated as outlined under the hierarchy of controls.
The elements of SICPs are:
- patient placement and assessment for infection risk (screening/triaging/testing)
- hand hygiene
- respiratory and cough hygiene
- safe management of the care environment
- safe management of care equipment
- safe management of healthcare linen
- safe management of blood and body fluids
- safe disposal of waste (including sharps)
- occupational safety: prevention and exposure management
[Transmission-based precautions (TBPs)] are applied when SICPs alone are insufficient to prevent transmission of an infectious agent. TBPs are additional infection control precautions required when caring for a patient with a suspected or confirmed infectious agent. TBPs are categorised by the route of transmission of the infectious agent.
These include –
Physical distancing: In health and care settings, physical distancing is the recommended distance that should be maintained between staff, patients and visitors unless mitigations are in place such as the use of PPE. WHO continues to advise that a physical distance of at least 1 metre should be maintained between and among patients, staff, and all other persons in healthcare settings. This distance should be increased wherever feasible, especially in indoor settings. Physical distancing is recommended to remain at 2 metres where infectious respiratory patients are cared for.
Patient placement: Where patient treatment or appointment cannot be deferred, patients with symptoms of respiratory infection should be triaged to a segregated waiting and assessment area with physical distancing at 2 metres. This may be achieved by:
- creating separate waiting and reception areas or use of physical barriers. Patients should be instructed to stay in these areas and not visit public areas such as cafes. Signage should be used as appropriate
- staggering clinic times for patients with and without respiratory symptoms, ensuring disinfection of communal areas between clinics
This story first appeared on oour sister title, Pulse.