Coronavirus

COVID-2019
Healthcare Associated Infections (HAI)
Clinical Excellence Commission
(updated June 2020)

TO BE UTILISED AND UPDATED BY LHDs

 CONTENT
• What is SARS-CoV-2
• Update on Outbreak
• NSW Health Response
• Testing
• Infection Prevention and Control
• Additional Resources

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What is Coronavirus & COVID-19
• Coronaviruses are a large family of viruses, some cause illness in humans, and
others cause illness in animals, such as bats, camels, and civets.
• Human coronaviruses cause mild illness, such as the common cold
• Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused
by a coronavirus, called SARS-associated coronavirus (SARS-CoV)
• Previous Coronaviruses have included SARS- CoV and MERS-CoV
• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain
of coronavirus that has not been previously identified in humans. 

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Human Coronavirus Origins
The most likely ecological reservoirs for
coronaviruses are bats, but it is believed
that the virus jumped the species barrier to
humans from another intermediate animal
host.
This intermediate animal host could be a
domestic food animal, a wild animal, or a
domesticated wild animal which has not yet
been identified.

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Coronaviruses
Coronaviruses belong to the Coronaviridae
family in the Nidovirales order
Corona represents crown-like spikes on the
outer surface of the virus; thus, it was named as
a coronavirus
Coronaviruses are enveloped viruses, minute in
size (65–125 nm in diameter) and contain a
single-stranded RNA as a nucleic material, size
ranging from 26 to 32kbs in length

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COVID-19
The virus that causes COVID-19 is known as SARS-CoV-2
It appears to have first emerged in Wuhan, China, in late 2019.
The outbreak has since spread across China to other countries around the world. By the end of
January, the new coronavirus had been declared a public health emergency of international
concern by the WHO.
The most commonly reported symptoms include a fever, dry cough and tiredness, and in mild
cases people may get just a runny nose or a sore throat.
In the most severe cases, people with the virus can develop difficulty breathing, and may
ultimately experience organ failure. Some cases are fatal.

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COVID-19 Timeline

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COVID-19 Worldwide 29 June 2020

10,072,616

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COVID-19 cases and tests reported in NSW, up to 20 June
2020

10
Total number of COVID-19 cases by age group and health status NSW 2020

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Coronavirus (COVID-2019)
February 2020 NSW Health responded to an outbreak of a coronavirus (COVID-
2019), first reported in China in December 2019.
The WHO has declared that the official new name for the virus that also formerly
went by the names “2019 novel coronavirus” or “2019-nCoV” is now to be known
as “SARS-coV-2” which causes COVID-19.
This name change is to differentiate it from other coronavirus outbreaks that
include the common cold, but also the severe acute respiratory syndrome (SARS-
CoV) and Middle East Respiratory Syndrome (MERS-CoV) which have previously
afflicted the world.

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Australian National Response
The Australian Government’s health response to the COVID-19 outbreak aims
to:
• minimise the number of people becoming infected or sick with COVID-19
• minimise how sick people become and the mortality rate
• manage the demand on our health systems
• help you to manage your own risk and the risk to your family and community

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Australian Department of Health
Government and private agencies are working together to support the
Australian Government response
• regularly reviewing response
• moving resources into activities that are working well
• scaling back activities that are not working

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NSW Health Response
Infection with COVID-19 is a notifiable condition
under the NSW Public Health Act, so all cases
and suspected cases must be reported by doctors
and pathology to NSW Health
NSW Health have implemented a range of
measures to promptly identify cases of COVID-19
infection and prevent transmission in NSW
 Leading & Coordinating a Statewide
Response

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NSW Health Response to COVID-19
Should a person in NSW be confirmed to have COVID-19 infection, NSW Health has procedures in place to identify people
they have been in close contact with. Those people are provided with advice about self-isolation to minimise spread of the
infection. NSW Health response included:

• establishing a NSW COVID-19 Clinical Council and 30 Clinical Communities of Practices across key clinical specialities
to support the response to COVID-19

• providing advice to GPs, pharmacists, emergency departments, and the broader health system on the situation as it
evolves to enable possible cases to be rapidly identified, diagnosed and managed

• developing diagnostic tests through public health laboratories to rapidly diagnose cases

• offering testing at public COVID-19 clinics throughout the state

• managing any cases with appropriate infection prevention and control and public health measures to minimise the risk
to health care workers and the community

• providing regular updates to the community, through media briefings, media releases and social media including in
community languages

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Case definition – confirmed case
A person who:
i. tests positive to a validated specific SARS-CoV-2 nucleic acid test;
OR
ii. has the virus isolated in cell culture, with PCR confirmation using a validated
method;
OR
iii. undergoes a seroconversion to or has a significant rise in SARS-CoV-2
neutralising or IgG antibody level (e.g. four-fold or greater rise in titre).
https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F8001F91E2/$File/COVID-19-SoNG-v3.3.pdf

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Clinical criteria
Fever (≥37.5°C) or history of fever (e.g. night sweats, chills)
OR
acute respiratory infection (e.g. cough, shortness of breath, sore
throat)
OR
Loss of smell or taste

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Probable case

A person who has detection of SARS-CoV-2 neutralising or IgG

antibody AND has had a compatible clinical illness AND meets one
or more of the epidemiological criteria outlined in the suspect case
definition

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Suspect case
Clinical and public health judgement should be used to determine
the need for testing in hospitalised patients and patients who do not
meet the clinical or epidemiological criteria.

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Epidemiological criteria
In the 14 days prior to illness onset:
• Close contact with a confirmed or probable case
• International or interstate travel
• Passengers or crew who have travelled on a cruise ship
• Healthcare, aged or residential care workers and staff with direct patient
contact
• People who have lived in or travelled through a geographically localised area
with elevated risk of community transmission, as defined by public health
authorities

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COVID-19 Close Contact definition

A close contact is defined as requiring:

• face-to-face contact in any setting with a confirmed or probable case, for
greater than 15 minutes cumulative over the course of a week, in the period
extending from 48 hours before onset of symptoms in the confirmed or
probable case, or
• sharing of a closed space with a confirmed or probable case for a prolonged
period (e.g. more than 2 hours) in the period extending from 48 hours before
onset of symptoms in the confirmed or probable case

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Infection Prevention and
Control Strategies

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Role of Clinical Excellence Commission

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General principles for infection prevention and control to
prevent or limit transmission of COVID-19
• Early recognition of patients who have suspected, probable or confirmed
COVID-19
• Physical distancing during COVID-19 outbreak
• Respiratory hygiene and cough etiquette
• Management of patients with acute respiratory symptoms and/or suspected or
proven COVID19
• Application of Standard Precautions for all patients at all times
• Implement Transmission-Based Precautions based on risk assessment

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Isolate and apply infection prevention & control precautions
• Standard precautions, including hand hygiene (5 Moments) for all patients.
Patients and health workers should observe respiratory hygiene and cough
etiquette.
• Transmission-based precautions for patients with suspected, probable or
confirmed COVID-19:
- Contact and droplet precautions for routine care of patients.
- Contact, droplet and airborne precautions for respiratory aerosol
generating procedures (AGPs).

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Aerosol-generating procedures (AGPs)
Aerosol generating procedures (AGPs) are defined as any medical and patient
care procedure that results in the production of airborne particles (aerosols) less
than 5 micrometres (µm) in size which can remain suspended in the air, travel
over a distance and may cause infection if they are inhaled.
Examples of
AGPs can be found on Coronavirus Disease 2019 (COVID-19)
CDNA National Guidelines for Public Health Units

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COVID-19 transmission
Generally, SARS CoV-2 is spread by larger respiratory particles of liquid
referred to as droplets. These larger droplet particles tend to fall on adjacent
surfaces (e.g. floor, tabletop) relatively quickly and do not travel long distances.
Travelling over long distances on air currents is generally not a significant factor
in the spread of this infection.

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Precautions for COVID-19
Contact and droplet precautions
 Addition of airborne precautions for respiratory AGPs
 Hand hygiene
 Environmental cleaning
 Cleaning of shared patient care equipment

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On presentation or admission to hospital the patient should be:
o given a surgical mask to put on, and
o placed in a single room (ensuring air does not circulate to other
areas)
o placed in a negative pressure room (in the event of AGPs being
performed).
o If transfer outside the room is essential, the patient should wear a
surgical mask during transfer and follow respiratory hygiene and
cough etiquette.

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Contact and droplet precautions:
• For close contact <1.5meter between health worker and patients the
following PPE is safe and appropriate and should be put on before entering
the patient’s room:
o An apron or a long-sleeved impervious gown

o surgical mask

o Safety glasses or face shield

o disposable nonsterile gloves when in contact with patient (hand hygiene

before donning and after removing gloves)

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Personal protective equipment for AGPs
• P2/N95 respirators are used for airborne precautions when respiratory
AGPs are conducted on patients with suspected, probable or confirmed
COVID-19 and must be discarded following the AGP along with
• Fluid resistant long-sleeved or isolation gown
• Eye protection - safety glasses or face shield
• Disposable nonsterile gloves when in contact with the patient (hand hygiene
before donning and after removing gloves)

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P2/N95 Mask Fit Check
Unless used correctly, i.e. with fit-checking, a P2/N95 respirator (mask) is
unlikely to protect against airborne pathogen spread.
An air-tight seal may be difficult to achieve for people with facial hair.
Fit checking with a range of P2/N95 respirators must occur to assess the most
suitable one to achieve a protective seal. If a tight seal cannot be achieved,
facial hair should be removed.

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The Importance of P2/N95 Respirator Fit Check

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Infection prevention & control principles
• Environmental Cleaning using a hospital grade and TGA approved disinfectant.

• Waste Management follows routine clinical and non-clinical waste processes

• Utensils follows routine cleaning process

• Linen Management follows normal processes.

• Hand Hygiene using ABHR and/or hand washing.

• Respiratory hygiene and cough etiquette principles apply

• PPE Transmission based precautions

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PPE
• Staff education for donning and doffing PPE is undertaken for staff managing cases

• Opportunity to ensure training of staff is up to date - Limited stocks of PPE should not be used
for training and other models of training should occur
Removing PPE
There are a variety of ways to safely remove PPE without contaminating your clothing, skin, or
mucous membranes with potentially infectious materials.
See two examples below:
Example 1 Example 2
1. Gloves 1. Gown and Gloves (in a
2. Gown or Apron combined motion) Hand
3. Goggles or Face shield 2. Goggles or Face shield Hygiene
4. Mask or Respirator 3. Mask or Respirator

Perform hand hygiene immediately after glove removal, before removing face protection, before
removing mask/respirator and after removal of any contaminated item

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Facility Preparedness for COVID-19
 Staff needed (and suitability) to be trained in high level PPE for COVID-19
 Training schedule and staff training in high level PPE –combined precautions
 Consumables required available, easy to locate and accessible to staff.
 Emergency Department trained and up to date with PPE competency and combined
precautions
 Intensive Care/Critical Care Department trained and up to date with PPE competency and
combined precautions
 Pandemic plan in place - reviewed and updated

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INVESTIGATION - arrange for COVID-19 testing if
recommended by risk assessment

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Coronavirus Disease 2019 (COVID-19) CDNA National Guidelines for Public Health Units
Advice for health workers, staff, healthcare
students and volunteers in NSW
• NSW Health recommends that any HW, healthcare student or volunteer with respiratory
symptoms or unexplained fever (≥37.50C) should be tested for COVID-19 and immediately
self-isolate. They should not return to work duties until they have been tested and cleared
from COVID-19 infection
• Symptoms of COVID-19 include fever (≥37.50C), cough, sore/scratchy throat and shortness
of breath. Other reported symptoms of COVID-19 include loss of smell, loss of taste, runny
nose, muscle pain, joint pain, diarrhoea, nausea/vomiting and loss of appetite.
• The HW, healthcare student or volunteer must also follow the home isolation guidance for
people suspected to have COVID-19. There are a number of COVID-19 Testing Clinics
throughout NSW. General Practitioners and Emergency Departments can also perform
COVID-19 testing

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Advice for health workers, staff, healthcare students and
volunteers in NSW

• If a HW, healthcare student or volunteer is tested positive for COVID-19 they

must follow the NSW Health Release from Isolation criteria before returning to
work.
• If a HW, healthcare student or volunteer has tested negative for COVID-19
and continues to experience respiratory symptoms or unexplained fever, they
should be medically assessed prior to returning to work duties
• If a HW has been informed that they are a close contact for COVID-19 by
either the healthcare facility or local Public Health Unit, they must inform their
manager or supervisor.

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RESOURCES – copy and paste below link into your browser
NSW HEALTH
https://www.health.nsw.gov.au/Infectious/diseases/Pages/coronavirus.aspx
NSW HEALTH DIRECT LINE
• 1800 022 222
CLINICAL EXCELLENCE COMMISSION
• http://www.cec.health.nsw.gov.au/
• http://www.cec.health.nsw.gov.au/patient-safety-programs/infection-prevention-and-control/n
ovel-coronavirus-2019-ncov

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OTHER RESOURCES – copy and paste below links into your browser
CLINICAL EXCELLENCE COMMISSION RESOURCES
Link to High Consequence Infectious Diseases (Videos)
http://www.cec.health.nsw.gov.au/patient-safety-programs/infection-prevention-and-control/high-
consequence-infectious-diseases

CDNA National Guidelines for Public Health Units

https://www1.health.gov.au/internet/main/publishing.nsf/Content/7A8654A8CB144F5FCA2584F
8001F91E2/$File/interim-COVID-19-SoNG-v2.0.pdf

Link to Videos on PPE

 http://www.cec.health.nsw.gov.au/keep-patients-safe/COVID-19/personal-protective-equipment
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{ Insert local contacts and resources }

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