IPC Guidance in health and care settings - Spring 2023

The global pandemic and Influenza season is still ongoing and there have been considerable risks to patients and staff over the winter period. Although the situation is slowly improving, there is a need to start the transition to business as usual and to move to standard IPC precautions.

Moreover, whilst Trusts continue to respond to potential respiratory infections within healthcare, NHS England and United Kingdom Health and Security Agency (UKHSA) acknowledge the changes required within the IPC guidance in order to support the move to the England and Scottish National Infection Prevention Control Manual over the coming weeks and months.

Nationally, whilst disease prevalence has started to fall, it is necessary that Trusts do all that they can to further reduce the risk and ensure all IPC measures are reviewed in line with local risk assessment to determine necessary and proportionate measures.

The changes noted below are the minimum standards set for the ambulance sector in line with the NHSE national guidance to avoid any unnecessary variation in IPC practice.

Face Masks

• Mask wearing, fluid repellent surgical mask (FRSM) or equivalent, for all staff and patients/escorts/carers is now optional in the clinical setting (unless in high risk identified areas, or where local risk assessments deems it necessary).
• Face masks must still be worn where it is indicated following a dynamic risk assessment i.e., infections transmitted via the droplet route e.g. respiratory viruses, outbreak on station, or where the hierarchy of controls cannot be applied or where staff wish to do so.
• FRSMs must be worn by staff when knowingly, routinely or primarily undertaking duties with immunocompromised or immunosuppressed patients when a risk assessment deems it necessary. This includes PTS staff that are providing prescheduled care to immunosuppressed patients.
• Whilst FRSMs are no longer mandated in the non-clinical setting, staff may continue to do so. This should be based on risk assessment and local situational awareness e.g., masks in Control Centres, high sickness levels, outbreaks on station etc..

Physical Distancing

There is no longer a requirement to undertake physical distancing in any setting. However, the following principles should be adhered to:

• Patients who are known to be positive with an infectious disease must be isolated from other patients.
• All other patient groups may be transported together, and no physical distancing is required however, Fluid Resistant Surgical Masks (FRSM) may be worn by both patients and staff if a risk assessment deems it necessary.
• Risk assessments should be undertaken locally to determine transport arrangements for vulnerable patients i.e., immunosuppressed / immunocompromised. This includes PTS conveyances of known immunosuppressed persons.
• Escorts / carers may be permitted to travel and masks are optional however they should be advised on good hand and respiratory hygiene and not to travel if they are feeling unwell or have symptoms of infectious illness including for example COVID-19, norovirus.

Ventilation

• Air should not be recycled in the cab and where there are delays (i.e. ED handover, crews must ensure that the ventilation systems are running and set to extract, doors opened periodically).
• Across Trust premises, it is best practice to undertake manual ventilation and open windows regularly to allow fresh air in.

PPE Levels

Standard infection control precautions (SICPS):

Applies to all asymptomatic patients. Staff should apply patient screening/triaging as appropriate and adhere to good IPC standard precautions in all areas, applying transmission-based precautions (TBP) (in addition to FRSM wearing) as required, based on the level of exposure and the risk assessment consideration of additional PPE should be taken.

Decontamination

Environmental Cleaning:

Environmental cleaning for non-clinical areas should be part of business of usual processes. Wiping down workstations before and after use will remain in place as good practice. Enhanced cleaning may be re-instated in the event of an outbreak and in line with any other escalation measures.

Cleaning and Decontamination:

Vehicles must continue to be cleaned as per the vehicle cleaning schedule, including in between patient cleans must be undertaken following transportation of all patients. Enhanced cleaning should be undertaken for suspected or confirmed infection cases and/or where AGPs have been undertaken within the vehicle.

Published 25th April 2023