24.03.20

IPC Guidance for Covid Hubs

Primary Care Networks should identify a suitable practice/location for suspected and confirmed Covid-19

patients to be cohorted for appointments. These patients will need to access this service by private car and

not use public transport. For patients that are suspected or confirmed positive for Covid19, that cannot

attend by private car, a home visit will be required.

Identifying Respiratory “Hot” hubs in your CCG

Essential

Patients should wait in their cars until called into the building

OR

Hubs should have spacious waiting areas where, if required, patients can sit a minimum of 1 meter

apart. For those sites that have car parks people should wait in their cars until called in for their

appointment

o Patients should be shown where to sit, starting with distances furthest away from each other.

Practices should be free of soft furnishings such as carpets, fabric chairs etc.

Multiple consulting rooms that would be suitable for frequent cleaning, free of soft furnishings and

carpets, with suitable hand wash facilities in each room.

Natural Ventilation

Separate entries for clean/ dirty

An area away from consulting rooms and reception where staff can rest

Adequate storage area for PPE

Disabled access

Toilet facilities

Reception not be used as a thoroughfare by other patients, visitors or staff, including patients being

transferred, staff going for meal breaks, and staff and visitors entering and exiting the building.

Controlled entry system

Considerations

Car parking for patients

Single practices, not attached to other providers or services

Staffing the hub

Staff should be risk assessed if it is safe for them to work at the hub and excluded if they are

classed as at risk such as immune-compromised, underlying health concerns, over 70 or pregnant.

Cohort staff working at this location where possible.

Housekeeping provision at Covid19 will need to cover a regular clean at least daily, 7 days a week.

Staff undertaking this role must be competent and trained in the use of PPE.

Staff should enter/exit the hub via a clean route and change in and out of uniform on site.

If reception staff are used to greet patients they should wear fluid repellent face masks, gloves and

aprons.

This applies to any staff spending periods of time in this area.

All staff to be familiar with good hand hygiene practice.

Appointments

Patients should be triaged and if symptomatic of Covid19 symptoms and able to attend via private

car, will be booked into the Covid19 hub.

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If patients have a facemask at home, they should be asked to wear this to their appointment if

comfortable to do so otherwise these will be provided at the hub.

Appointments should be spread-out where possible to avoid patients congregating in the waiting

area.

Clinicians should ideally collect the patient upon entry to the practice and escort them straight to the

consultation room wearing PPE.

If patients are required to wait they should be encouraged to sit spaced from other patients or

directed directly into the consultation room allocated.

Equipment

Equipment should be disposable where possible

If re-usable equipment is used, it should be decontaminated after each use.

Keyboards should be able to withstand chlorine decontamination or have a cover that allows this.

Ensure adequate supplies of equipment are in stock and avoid leaving the room to obtain

equipment during a consultation.

Decontamination of equipment

Immediately decontaminate equipment with disposable cloths/paper roll and a fresh solution of

detergent, rinse, dry and follow with a disinfectant solution of 1,000 parts per million available

chlorine (ppm av cl) * , leave for correct contact time, rinse and thoroughly dry, following

manufacturer’s instructions for dilution, application and contact time.

Or use a combined detergent/chlorine releasing solution with a concentration of 1,000 ppm av cl*,

leave for correct contact time, rinse and thoroughly dry, following manufacturer’s instructions for

dilution, application and contact time.

If the item cannot withstand chlorine releasing agents consult the manufacturer’s instructions for a

suitable alternative to use following or combined with detergent solution.

Follow manufacturer’s instructions for dilution, application and contact time.

Clean the piece of equipment from the top or furthest away point

Discard disposable cloths/paper roll immediately into the healthcare waste receptacle

Discard detergent/disinfectant solution in the designated area

Clean, dry and store re-usable decontamination equipment

Remove and discard PPE after cleaning.

Perform hand hygiene after removing PPE.

If enough equipment such as stethoscopes and BP cuffs are available, consider decontaminating all

equipment at the end of each session.

Keyboards should be able to be cleaned or have a cover that allows this.

Environment

Remove all non-essential items from reception and consulting rooms such as toys, leaflets,

magazines.

Food and drink must not be in these areas

Review what equipment is required in consulting rooms and remove, store in cupboards or cover

non-essential items.

Consider removing privacy curtains and window fittings that are not vertical blinds and replacing

with window frosting.

Keep air condition units switched off and external windows open for ventilation.

Doors must be kept shut at all times

The environment must be free of soft furnishings and surfaces allow for chlorine cleaning.

24.03.20 PPE

The PPE guidance follows the PHE recommendations which are the same for both primary care and

acute hospital clinicians for the same type of consultations. Order has been submitted 20th March

2020

Examination gloves, fluid repellent aprons and fluid repellent surgical masks must be used for each

patient following the donning and doffing procedure attached (see Appendix One).

Risk assesses the need for facial visor or goggles if there is a chance of splash/contamination to the

face (see Appendix Two for risk assessment chart).

o If the clinician would prefer to wear goggles all shift, this is perfectly acceptable.

o The same pair of goggles can be worn all shift, and cleaned with the last clean of the room,

after the last patient has left (see cleaning below).

The order to put on (donn) the PPE is hand hygiene, apron, mask, (goggles), gloves.

The order to take off (doff) the PPE is gloves, apron, (goggles), mask, hand hygiene

PPE must be compliant with the relevant BS/EN standards (European technical standards as

adopted in the UK)

Located close to the point of use;

Stored to prevent contamination in a clean/dry area until required for use (expiry dates must be

adhered to);

Single-use only;

Changed immediately after each patient and/or following completion of a procedure or task;

Disposed of after use into the correct waste stream i.e. healthcare/clinical waste (this may require

disposal via orange or yellow bag waste; local guidance will be provided depending on the impact of

the disease).

It is not anticipated that clinicians will be carrying out infectious aerosol-generating procedures

(AGP). AGPs are listed in Appendix Three.

PPE must be worn before the patient presents and removed afterwards. including hand hygiene.

Masks should be removed outside of consulting rooms and disposed of in clinical waste, unless

being worn as part of cleaning PPE, in which case it can be removed at the end of the cleaning

procedure, inside the room.

Cleaning

Staff must wear PPE consisting of gloves, apron and fluid repellent facemask and goggles.

o Keep the same set of PPE on from seeing the patient.

Cleaning equipment should be single use where possible

A detergent should be used combined with disinfectant or separately.

Ensure all surfaces are cleaned following the high to low, clean to dirty process.

All equipment out in the room should be included in the clean. This will include blood pressure cuffs

and sphygmomanometer and the non-disposable parts of otoscopes etc, even if not used in the

previous consultation.

Keyboards should be wipeable or have a wipeable cover, able to withstand bleach. If necessary,

these should be brought in from other surgeries across the CCG.

Frequently touched surfaces should be cleaned regularly to limit environmental contamination

At a minimum daily, a full clean should be completed to include a chlorine disinfection

Follow decontamination guidance for primary care produced by NWL Collaboration of CCGs

(Appendix Four)

Hand hygiene

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All staff and patients should decontaminate their hands with alcohol based hand rub when entering

and leaving areas where care for suspected and confirmed COVID-19 patients is being delivered.

Hand hygiene must be performed immediately before every episode of direct patient care and after

any activity or contact that potentially results in hands becoming contaminated, including the

removal of personal protective equipment (PPE), equipment decontamination and waste handling.

Hand sanitisers should be available at entry/exit points in the practice

Hand hygiene basins should be stocked with liquid soap and paper hand towels ideally from a wall

mounted dispenser

Waste bins should be a pedal style, lidded bin to avoid hand contact

Including wrists in hand hygiene ensures all surfaces are decontaminated.

Waste

Dispose of all waste as clinical waste

Waste should be classified at infectious (Orange bag) and stored securely

Ensure adequate storage for waste is available due to increase from PPE.

Linen

The appropriate use of personal protective equipment (PPE) will protect staff uniform from

contamination in most circumstances.

o Areas of clothing left exposed by PPE are generally lower touch areas and therefore are

lower risk to clinicians, who should be maintaining social distancing.

Uniform should be changed in and out of the practice.

It should enable staff to be bare below the elbows (short sleeved or sleeves able to be rolled up for

duration of shift).

Practices should provide changing rooms/areas where staff can change into uniforms on arrival at

work via a clean entry point.

Uniforms should be transported home in a disposable plastic bag. This bag should be disposed of

into the household waste stream.

Uniforms should be laundered separately from other household linen in a load not more than half

the machine capacity at the maximum temperature the fabric can tolerate, then ironed or tumbled-

dried.

Signage

Dirty/clean areas of the practice must be separated by closed doors and have signage displayed

warning of the segregated area to control entry.

Non-hub patients should not be able to access the practice, this should be communicated clearly.

To control entry, signage should be displayed warning of the segregated area.

Staff rest area/clean area

Staff must have access to a rest area in a clean area of the practice and access to staff toilet

facilities.

This area can be cleaned as routine practice cleaning.

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Flow diagram of patient pathway in Primary Care Covid19 Hubs

Patient is triaged and allocated an appointment at the Covid19 Hub. They will be checked they can

arrive by private car, no non-essential carers/dependents, not to arrive more than 10 minutes

before their appointment and if have a mask and comfortable to do so wear this upon entry to the

practice.

Clinician will greet patients in reception wearing full PPE (gloves, aprons and face mask) and ask

the patient to gel their hands and avoid touching anything such as check-in systems, door handles

etc.

If clinician is not present, reception staff wearing full PPE should ask the patient to gel their hands

upon entry. Direct patient to sit spaced apart from other patients in the waiting area or direct

them straight to the consultation room (avoiding touching surfaces/ handles where possible)

The consultation room door must remain closed, air conditioning turned off and external

windows open. All equipment used or exposed during the consultation must be disposed of or

decontaminated.

The patient must be escorted out of the practice by clinician the same way they came in and

asked to gel their hands upon leaving.

Equipment must be cleaned by either a combined detergent/disinfectant or separate solutions

and must be effective against coronavirus (see advice). All surfaces to be cleaned including door

handles, cupboards, keyboards etc.

24.03.20

Appendix One: Donning and Doffing Procedure

Use safe work practices to protect yourself and limit the spread of infection

Keep hands away from dace and PPE being worn.

Change gloves when torn or heavily contaminated

L:imit surfaces touched in the patient environment

Regularly perform hand hygiene

Always clean hands after removing gloves

NB Masks and goggles are not routinely recommended for contact precautions. Consider the use

of these under standards infection control precaution or if there are other routes of transmission.

The type of PPE used will vary based on the type of exposure anticipated, and not all items of

PPE will be required.

The order for putting on PPE is Apron or Gown, Surgical Mask, Eye Protection (where required)

and Gloves.

The order for removing PPE is Gloves, Apron or Gown, Eye Protection, Surgical Mask.

Eye/face protection should only be removed by handling head band or ear pieces.

1. Putting on Personal Protective Equipment (PPE).

Perform hand hygiene before putting on PPE

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2. Removing Personal Protective Equipment (PPE)

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Appendix Two: Risk Assessment for Eye Protection

When/where should eye/face protection be used?

Eye/face protection must be worn during activities/procedures where there is a risk of blood, body fluids,

secretions or excretions splashing into the eyes/face, and during AGPs and theatre.

Eye and face protection (including full-face visors) must:

Be worn to protect patients from the operator as a source of infection, eg when performing surgical

procedures or epidurals or inserting a central vascular catheter (CVC).

Be well-fitting and fit for purpose, fully covering the mouth and nose (manufacturers’ instructions

must be followed to ensure effective fit and protection).

Be removed or changed:

o at the end of a procedure/task

o if the mask’s integrity is breached, eg from moisture build-up after extended use or from

gross contamination with blood or body fluids

o in accordance with manufacturers’ specific instructions.

Not be impeded by accessories such as piercings or false eyelashes

Not be touched when being worn.

Regular corrective spectacles are not considered eye protection

How do we decontaminate the goggles?

See the local decontamination guidelines to see how to decontaminate the reusable goggles.

24.03.20

Appendix Three:

COVID-19 – Environmental Decontamination for Primary Care

The same processes as those used for cleaning up blood spills should be employed for

decontaminating rooms which have been used by suspected cases.

Once the patient has been transferred from the primary care premises:

The room should not be used until environmental cleaning is completed;

The room door should remain shut;

The windows should be opened and air conditioning switched off;

The responsible person for cleaning should be familiar with the processes and procedures.

Wipes are not suitable for this process.

Preparation

Firstly – remove or put away any items from your chosen isolation room that are not

essential. Anything that is on a surface when a suspected case spends time in the room

that cannot be decontaminated as stated will have to be disposed of.

In order to cut down the cleaning needed put all equipment away between consulting sessions.

Your isolation room should not have any fabric/non-wipeable chairs, or fabric curtains. If you have

carpet, it should be able to withstand a chlorine clean.

You will need extra PPE (aprons and gloves) but these need to be kept in a closed cupboard to

remain ‘clean’. Any gloves on a rack or aprons on a roll will need to be destroyed.

You will need:

Cleaning equipment:

o disposable mops, cloths.

Clinical waste bags

Made up solutions of detergent & disinfectant, or a combined product such as Actichlor

Plus.

o Option 1:- Use a combined detergent/disinfectant solution (chlorine) at a dilution of

1000 parts per million (ppm);

o Option 2:- A neutral purpose detergent followed by disinfection (1000 ppm av.cl.);

o Follow manufacturer’s instructions for: -

Dilution,

Application

Contact times;

Necessary PPE:

o Plastic apron, gloves, fluid resistant mask and goggles/face visor x 2 (for use with

chlorine containing product.);

Collect all equipment to have ready before you go in.

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Perform hand hygiene prior to putting on PPE. The order you put on the PPE is apron,

mask, goggles and then gloves.

o You will need to wear mask and goggles/visor as you are using a chorine based

product and there is a risk of splashing, NOT because of the risk to you from COVID-

19.

On entering the room

Keep the door closed;

Windows should be open to improve airflow and ventilation (not if internal window);

Bag all used items and any consumables that can’t be cleaned in a clinical waste bag;

Remove any fabric curtains / screens and bag as infectious linen;

Remove any disposable couch curtains and dispose as clinical waste;

Cleaning process

If using a combined detergent/disinfectant solution, you will only need to do the following

procedure once. Leave for the correct contact time, rinse and dry thoroughly.

If you are using separate detergent and disinfectant solutions, you will need to use the detergent

solution first, following the steps below. Rinse and dry off and then repeat with the disinfectant

solution, leaving for the correct contact time, rinsing and drying thoroughly.

Surfaces

Work from high to low.

Use disposable cloths or paper roll to clean and disinfect all hard surfaces, chairs, door handles,

sinks, drawer handles and reusable non-invasive care equipment in the room including the

undersides. Consider all high touch surfaces such as door handles/push panels, light switches,

desk tops, taps and the couch. Remember to clean the blinds, which should be a vertical design.

Close any sharps containers and wipe the surfaces with your chosen products, prior to disposal.

When using a cloth and bucket do not ‘double dip’ used cloths into the bucket containing cleaning

solution or into the container of unused, pre-soaked clean cloths

Cleaning cloths such as microfibre cloths should be folded and rotated in a manner to utilise all

surface areas of the cloth, including the front and back, and used in such a way to avoid cross

contamination whilst maximising efficiency.

Use a figure-of-pattern to ensure all surfaces are covered but that dirt is not redistributed.

Floor

Use a disposable mop head.

Mop the floor in 1-2 metres square sections

Mop edges with straight strokes and use a figure-of-eight pattern on the remainder of the section,

turning the mop frequently. The floor should be fairly dry on completion.

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Move to the next section and repeat the process.

Cloths and mop heads used must be disposed of as single use items.

Cleaning and disinfection of reusable equipment

Clean and disinfect all reusable equipment systematically from the top or furthest away point;

Clean and disinfect any reusable non-invasive care equipment in the room prior to their removal

such as:

Blood pressure monitors;

Digital thermometers;

Glucometers.

Carpeted flooring and soft furnishings

Carpeted floors that cannot withstand chlorine-releasing agents:

Consult the manufacturer’s instructions for a suitable alternative to use following or

combined with detergent cleaning.

When you have finished decontaminating the room

Put mop head and cloths/paper roll into clinical waste

o If mop heads are launderable, put into sealed bag for laundering

Remove PPE into clinical waste:

o The order you remove PPE is:

o Gloves;

o Hand hygiene;

o Apron;

o Goggles/Visor (if you are using re-useable goggles, put these on top of the bucket of

solution)

o Mask;

Perform hand hygiene;

Don clean aprons, gloves and clean visor/goggles;

o If you need to clean your goggles, do so now with a with a detergent/disinfectant

wipe, such as Clinell Universal Wipe. Pick up goggles with one hand, start cleaning

all surfaces with wipe in other hand, put down on the work surface and clean last

parts with the hand in the clean glove. Let dry.

Put new glove on over dirty glove. Wipe mop handle with a new detergent/disinfectant wipe.

Leave handle in room;

Using hand towel, open door – this is because your glove is dirty but the door handle is

clean;

Remove clinical waste and bucket with chlorine solution;

Empty waste cleaning solution into sluice or toilet. Do not pour down outside drain;

Dry bucket with disposable paper towel;

Wipe all surfaces (inside and out) with detergent/disinfectant wipe. Leave to dry inverted in

cleaner’s cupboard;

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Remove and discard PPE as clinical waste;

Take clinical waste to outside secure clinical waste area;

Perform hand hygiene.

4.7 Cleaning of communal areas

If a suspected case has visited the toilet, or spent time in the waiting area or toilet

facilities:

o Repeat above process for surfaces and floor;

o Fabric curtains will need to be washed commercially using a sluice setting;

o Magazines, books and leaflets, if not covered, should be disposed of;

o Toys that cannot be cleaned must be disposed of.

References

Ecolab (no date) Safety Data Sheet Actichlor Plus. 116238E. Available from : https://en-

uk.ecolab.com/offerings/aldehyde-free-concentrated-cleaners-and-disinfectants/actichlor-plus

Public Health England (2020) COVID-19: interim guidance for primary care. Available at:

https://www.gov.uk/government/publications/wn-cov-guidance-for-primary-care/wn-cov-interim-

guidance-for-primary-care

Public Health England (2020) COVID-19: infection prevention and control guidance. Available from:

https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-

control