Infection Prevention and Control Practice Guidance Note infection …… · 2020. 9. 8. · Sputum...

Infection Prevention and Control Practice Guidance Note

Guidance for the management of patients with suspected or confirmed COVID-19 infection – V01

Date Issued

Sep 2020

Planned Review

Sep 2023 IPC-PGN-31 Part of CNTW(C)23 – Infection Prevention and Control Policy

Author/Designation Samantha Cooke – Infection Prevention and Control Nurse

Responsible Officer/ Designation

Anne Moore – Director of Infection Prevention and Control

Contents

Section Description Page No:

1 Introduction 1

2 Background Information 1

3 Mode of transmission 2

4 Standard Precautions 3

5 Diagnosis and Management of Suspected COVID-19 Infection 4

6 Management of patients with suspected/confirmed COVID-19 infection

4

7 Infection Prevention and Control 5

8 References 14

Appendices – attached to Practice Guidance Note

Document No:

Description

Appendix 1 How to obtain combined throat and nose swab for diagnostic sampling

Appendix 2 PPE guidance

Appendix 3 Donning and Doffing PPE

Appendix 4 How to wear a fluid-resistant surgical face mask (FRSM) safely

Appendix 5 AGP PPE

Appendix 6 COVID-19 outbreak notification signage

Appendix 7 Line Lists

IPC-PGN-31

1 Cumbria Northumberland, Tyne and Wear NHS Foundation Trust IPC-PGN-31– Guidance for management of patients with suspected or confirmed COVID-19 - V01-Iss1-Sep 2020 Part of CNTW(C)23 Infection Prevention & Control Policy

1 Introduction 1.1 This Practice Guidance Note (PGN) should be read in conjunction with Cumbria

Northumberland, Tyne and Wear NHS Foundation Trust’s (the Trust/CNTW), CNTW(C)23, Infection Prevention and Control Policy.

1.2 This PGN refers to the diagnosis and management of COVID-19 infection within

the patient population. 2 Background Information 2.1 COVID-19 is a disease caused by a type of virus called a coronavirus. This is a

common type of virus that affects both animals and humans. Coronaviruses often cause symptoms like those of the common cold, but sometimes they can cause more serious infections.

The coronavirus that causes COVID-19 is a new type of coronavirus.

2.2 COVID-19 is able to spread from person to person. The virus seems to spread

when people cough or sneeze, and when people touch objects and surfaces that have the virus on them.

2.3 The incubation period is from 1 -14 days with the median being 5 days. 2.4 At this time, there are no specific vaccines or treatments for COVID-19.

However, there are many ongoing clinical trials evaluating potential treatments. 2.5 Signs and Symptoms of COVID-19 Infection 2.6 Some people can have COVID-19 without any symptoms. If you do develop

symptoms, the most common symptoms can include fever, coughing, shortness of breath, loss of sense of smell, reduced sense of taste, aches and pains, feeling tired, feeling nauseous or vomiting and diarrhoea.

2.7 If any person develops a new, continuous cough, a raised temperature (above 37.8 C) or a loss of sense of taste or smell, they should self-isolate for a minimum of 10 days from the onset of symptoms. Isolation must extend beyond 10 days if high temperature continues. In order for the isolation period to end, the person should be apyrexial (free from fever) for at least a 48 hour period. A cough and loss of sense of smell/taste can last for several weeks after the infection has gone and do not warrant isolation after the 10 day period.

2.8 Case-by-case reviews will be required where any patient is unable to follow

advice on isolation and testing. Clinicians should decide on the appropriate use of the relevant legal framework for each case, with support from medicolegal colleagues as required. Non-concordance with isolation represents a clear risk

IPC-PGN-31


to others and should, in the first instance be conveyed to the patient helping them to understand the clinical reasons for self-isolation and testing.

2.9 If COVID-19 infection is suspected, medical assessment is urgently required. 2.10 Initiation of the Sepsis Tool should be implemented in all cases of suspected

or confirmed COVID-19 infection. A web-based incident report should also be completed.

Please refer to the following PGNs which form part of the Trust’s CNTW(C)29 – Trust standard for the assessment and management of physical health policy:

AMPH-PGN-05 - Sepsis Assessment Tool

in conjunction with

AMPH-PGN-03 – National Early Warning Scores (NEWS2)

NB. In the context of COVID-19, an outbreak refers to two or more cases within an area. In the event that an outbreak of COVID-19 is suspected/confirmed, this PGN should be read in conjunction with Outbreak Management–Major Incidents–IPC-PGN-06.

2.11 It is important to note that patients with a learning disability, autism or dementia

and a co-morbid physical health condition may present with additional, softer signs or early indicators of deterioration, e.g. mood or behaviour changes, becoming unsteady when walking, increasingly tired, sleeping more, restlessness and agitation.

2.12 People with mental health needs, a learning disability, autism or dementia should

receive the same protection and support with managing COVID-19 as other members of the population. This includes, where required, rapid access to acute care.

3 Modes of transmission 3.1 Droplet 3.2 Respiratory droplets carrying infectious pathogens can transmit infection when

they travel directly from the respiratory tract of an infectious individual to susceptible mucosal surfaces of a recipient, generally over short distances. This can be in the form of sneezing, coughing or speaking.

Droplet transmission occurs when a person is in in close contact (within 1 m) with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Transmission may also occur through fomites in the immediate environment around the infected person. Therefore, transmission of the COVID-19 virus can occur by direct

IPC-PGN-31


contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g. stethoscope or thermometer).

3.3 Contact 3.4 Another way to catch the new coronavirus is when you touch surfaces that

someone who has the virus has coughed or sneezed on. You may touch a countertop or doorknob that's contaminated and then touch your nose, mouth, or eyes. The virus can live on surfaces like plastic and stainless steel for 2 to 3 days. To stop it, clean and disinfect all counters, knobs, and other surfaces that are touched several times a day.

3.5 A fomite is defined as an object that becomes contaminated with infected

organisms and which subsequently transmits those organisms to another person. Examples of potential fomites are surfaces, toys, mobile telephones or any inanimate objects.

3.6 Aerosol 3.7 Airborne transmission is different from droplet transmission as it refers to the

presence of microbes within droplet nuclei, which are generally considered to be particles <5μm in diameter, can remain in the air for long periods of time and be transmitted to others over distances greater than 1 m.

3.8 In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed. The following procedures are considered likely to generate aerosols capable of transmitting respiratory pathogens:

Intubation, extubation, open suctioning and related procedures

Cardiopulmonary resuscitation (chest compressions and defibrillation as part of resuscitation are not considered aerosol generating procedures in accordance with guidance from Public Health England)

Induction of sputum

Ventilation of the patient

Continuous Positive Airway Pressure Ventilation (CPAP)

4 Standard Precautions

4.1 Standard Precautions apply to all staff, in all care settings, for all patients when blood, body fluids or recognised/unrecognised source of infection are present. This involves identifying high risk procedures rather than high risk individuals and is intended to protect health care workers from risk such as sharps injuries and bodily fluid spillages and also to protect patients from cross infection.

4.2 Therefore, it is essential that all Cumbria Northumberland, Tyne and Wear NHS

Foundation Trust (the Trust/CNTW) staff are acquainted with precautions to prevent the spread of infection and that these are followed at all times.

https://www.webmd.com/oral-health/rm-quiz-what-do-you-know-about-your-teeth

https://www.webmd.com/eye-health/picture-of-the-eyes

IPC-PGN-31


4.3 All areas within the Trust should ensure that measures are in place so that all

settings are, where practicable, COVID-secure, using social-distancing, optimal hand hygiene, frequent surface decontamination, ventilation and other measures where appropriate.

5 Diagnostic Investigations

5.1 All new admissions into the Trust should be tested for COVID-19 and all those with a negative test result should be repeat screened after a 5-7 day period.

5.2 Where COVID-19 is suspected (patient displaying symptoms of either a new, continuous cough, high temperature and/or loss of sense of taste/smell), a combined throat and nose swab should be obtained for analysis.

Appendix 1 describes the process of obtaining swabs.

5.3 Where an individual declines a test who is symptomatic (or if the test result is negative but the person is symptomatic) then they should be treated as COVID-19 positive and isolated for at least 10 days. It is important to note that consent must be sought from patients prior to screening. Without consent, screening for COVID-19 must not be undertaken.

5.4. Parental/guardian consent should be sought when considering undertaking a

swab test for children. 5.5 Those testing positive will be included in the new NHS Test and Trace Service

which will help to identify contacts and advise all at risk contacts to self-isolate for 14 days.

5.6 The definition of contact in this instance is any of the following without

appropriate PPE being used during the infectious period (48 hours before symptoms or positive test result if asymptomatic):

Direct Face-to-face contact (e.g. talking) for any length of time; or

Being within 1m for 1 min or longer; or

Being within 2m for 15 mins or longer. NOTE

Where a possible diagnosis may include a bacterial infection, e.g. pneumonia; consideration should be given to obtaining the following:

Sputum for culture and sensitivity and gram staining

Pneumococcal and Legionella urine antigen testing

6 Management of the patient with suspected/confirmed COVID-19

6.1 Treatment of COVID-19 is mostly conservative, and consists of relieving symptoms whilst awaiting recovery.

IPC-PGN-31


6.2 However, in some individuals, COVID-19 can progress from a minor illness where people can be asymptomatic or have mild symptoms to a more severe illness where people can become extremely poorly, requiring immediate assessment/prompt medical review and potential transfer to an acute service.

6.3 Clinical Observations

The following clinical observations should be recorded to ensure any change in the patient’s condition is detected and acted upon immediately and appropriately.

During acute illness blood pressure, temperature, pulse, respirations and oxygen saturation levels should be recorded as a minimum of 4 hourly and more frequently according to the patient’s clinical condition.

Fluid balance should be recorded to ensure the patient remains hydrated.

All observations should be recorded in accordance with the Trust’s policy CNTW(C)29 - Trust Standard for the Assessment and Management of Physical Health, practice guidance note (PGN) AMPH-PGN-03 - National Early Warning Score (NEWS2), Sepsis Assessment Tool AMPH-PGN-05-CNTW(C) 29.

7 Infection Prevention and Control

7.1 Isolation/Cohort Nursing Reference should be made to IPC-PGN-08 –

Isolation of Infected Patients in Hospital

Key principles to be followed wherever possible, including the following:

Advice should always be sought from the IPC team

Symptomatic patients should be segregated from non-symptomatic

patients as soon as possible

Patients with suspected or confirmed COVID-19 should be nursed in a single room

Communal areas should not be shared between COVID-19 and non-COVID-19 positive patients. This is referred to as cohort nursing

Staff should either work with symptomatic or asymptomatic patients (but not both) and this arrangement should be continued for the duration of the infectious period

If several patients are affected, consideration should be given to cohort

areas

IPC-PGN-31


7.2 Personal Protective Equipment (PPE)

Reference should be made to IPC-PGN-02.1 – Standard Precautions

Health Care Workers (HCW) delivering direct care (within 2 metres) to a suspected or confirmed patient with COVID-19 should wear the following PPE:

Disposable gloves

Plastic apron

Eye protection where there is a risk of splashes to the eyes. A risk assessment should be undertaken at the point of care delivery to identify the suitability of wearing face protection

Fluid-resistant surgical face mask (FRSM)

A higher level of PPE is required for those staff undertaking aerosol

generating procedures (AGP’s)

Refer to Appendix 2 for more detailed guidance around the level of PPE to be worn in different scenarios

Appendix 3 demonstrates the correct procedure for putting on (donning) and removing (doffing) PPE.

7.3 Respiratory Guidance

Droplet precautions are designed to minimise the transmission of respiratory organisms from one person to another. Coughing and sneezing produces a ‘respiratory spray’ consisting of large particles (droplets) and smaller particles (aerosol).

7.4 All staff, patients, relatives and visitors are encouraged to follow respiratory hygiene and cough etiquette:-

Use disposable single use tissues and cover nose and mouth when coughing and/or sneezing. Tissue should be disposed of as clinical waste immediately

Wash hands after contact with secretions

IPC-PGN-31


7.5 Respiratory masks

Fluid-resistant surgical face masks

Evidence suggests that fluid-resistant surgical face masks (FRSM) provide a level of protection against large droplets, splashes and contact transmission. This supports the mask being worn by the infected person.

Where possible the infected patient should be encouraged to wear a surgical face mask. However, concordance and the well-being of the patient should be the deciding factor. This should be discussed with the Infection Prevention and Control Team and documented within the patients care plan.

Health Care Workers are required to wear a FRSM at all times when at work in line with national guidance. National guidance is subject to change and updated information will be available on the Trust Intranet.

All masks should be disposed of as clinical waste after use.

Appendix 4 shows how to wear a FRSM safely.

7.6 FFP3 Respirator (filtering face piece class 3)

The following procedures are considered to generate aerosols of respiratory secretions from infected patients, and therefore may present a significant infectious risk.

IPC-PGN-31


Open suctioning, intubation ,extubation

Cardiopulmonary resuscitation (chest compressions and defibrillation as part of resuscitation are not considered AGP’s in accordance with guidance from Public Health England)

Induction of sputum

Non-invasive ventilation

Continuous Positive Airway Pressure Ventilation (CPAP)

7.7 Nebulisation of medication is not classed as an aerosol generating procedure and is therefore not considered to represent a significant infection risk.

An FFP3 respirator should be worn in conjunction with fluid repellent gown, gloves, and full face and eye protection during the above procedures. See Appendix 5

FFP3 respirators filter at least 99% of airborne particles. The HSE states that all staff who are required to wear an FFP3 respirator must be fit tested for the relevant model to ensure an adequate seal or fit (according to the manufacturers’ guidance). Fit checking (according to the manufacturers’ guidance) is necessary when a respirator is donned to ensure an adequate seal has been achieved.

It is important to ensure that facial hair does not cross the respirator sealing surface and if the respirator has an exhalation valve, hair within the sealed mask area should not impinge upon or contact the valve.

Aerosol generating procedures should only be performed when essential and should be in well ventilated single rooms, with the doors closed

Environmental cleaning should be undertaken of the patients room as soon as it is possible without the use of a respirator after the procedure

7.8 Environmental Decontamination

Due to factors that determine the survival time of the virus, it is impossible to provide a definitive survival time.

Evidence suggests that this may be from a few hours to several days. In general, data supports longer virus survival on hard (non-porous) surfaces than on softer (porous) items.

Hard surfaces should be cleaned using a chlorine based product (Chor-Clean) in the patients room and ward area. Particular focus should be on frequently touched surfaces e.g. hand rails, door handles, toilet areas, tables etc.

IPC-PGN-31


Patients should be encouraged to practice good respiratory hygiene and be provided with disposable tissues to cover the mouth and nose when coughing. Tissues should be disposed as clinical waste

Hands should be washed thoroughly with soap and water after coughing and sneezing and after using a disposable tissue

Patients rooms should be kept clean and clutter free

Cleaning of infected patients rooms should be prioritised

A terminal clean should be undertaken of affected areas in discussion with the IPC Team. Reference should be made to the Terminal Clean Method Statement 49

7.9 Hand Hygiene

Reference should be made to IPC-PGN-04.1 – Hand hygiene and the use of gloves.

Hand hygiene is absolutely essential in order to reduce the transmission of COVID-19. All staff, visitors and patients should decontaminate their hands thoroughly with soap and water or alcohol-based hand sanitiser when entering and leaving areas where patient care is being delivered.

Hand hygiene must be performed immediately before every episode of direct patient care and after any activity/task or contact that potentially results in hands becoming contaminated, including the removal of personal protective equipment (PPE), environmental/equipment decontamination and waste handling.

All hand hygiene dispensers should have adequate supplies of soap and paper towels and should be accessible to staff, patients and visitors.

Hand hygiene must be performed in the following instances:

On entering and leaving a clinical area

Immediately before/after each direct patient contact/care

After any activity / contact that potentially results in hands becoming contaminated

Before/after handling food

Before/after wearing gloves

Before preparing/dispensing medications

Between different procedures for the same patient (i.e. mouth care, catheter care)

IPC-PGN-31


After visiting the toilet

When hands feel unclean or are visibly dirty

An effective hand washing and drying technique plays a key role in standard infection control practice to prevent cross infection.

Use of hand sanitiser

Hand sanitiser is available to complement hand hygiene practice and can be used to decontaminate socially clean hands. It is not an alternative to hand washing and should only be used when hands are visibly clean and free from dirt, soil and organic material.

7.10 Transfer of patients to acute settings

Reference should be made to IPC-PGN-17 - Transfer of patients.

The receiving area and paramedic staff (where required for transfer) should be made aware of the patients COVID-19 status where this is suspected or confirmed.

A risk assessment should be undertaken to consider:

a) The risk to the patient during transfer

b) The risk to others

c) Precautions required during transfer

IPC-PGN-31


7.11 Visitors to the clinical area

Where a clinical area is affected by a known or suspected outbreak of COVID-19, visitors should be advised to protect themselves and other carers/relatives.

All visitors should be:-

Discouraged from visiting symptomatic patients where this is feasible and does not adversely affect the social/emotional needs of the patient

Made aware of the risks around visiting an area where there are suspected or confirmed cases of COVID-19

Strongly advised to clean their hands thoroughly with soap and water or hand sanitiser before and after visiting patients

Avoid physical contact with the symptomatic patient and be at least at a two metre distance from possible cases

Recommended to wear a single use fluid-resistant face mask when in contact with the patient. However - this may not be possible and discussion with the Infection Prevention and Control Team is essential to discuss risk factors.

Symptomatic visitors should not visit the ward until they have completed the advised isolation period and are no longer symptomatic of COVID-19. The Infection Prevention and Control Team will provide guidance and support.

Appendix 6 – COVID-19 Outbreak Notification. This notice should be clearly displayed on the entrance to the ward to notify all visitors if there is an outbreak of COVID-19 (can be amended as necessary).

7.12 Health Care Workers

Infected health care workers can act as a source of transmission to both patients and staff who may be at increased risk of complications associated with COVID-19. A health care worker can spread COVID-19 to others even if they are not symptomatic themselves.

Health Care Workers who become symptomatic should remain at home and self-isolate for at least 10 days and can return to work after that time provided they feel clinically well. A post-viral cough can last for several weeks after infection and would not mean that someone is to continue in isolation after the recommended period.

A risk assessment of all staff working with patients with COVID-19 should be undertaken to identify those health care workers who themselves are in clinical risk groups. Alternative working arrangements should be considered to ensure protection of vulnerable individual’s .This includes pregnant members of staff.

IPC-PGN-31


The use of bank and agency staff should be avoided in areas where there are suspected or confirmed cases of COVID-19. However where this is unavoidable, attempts should be made to block-book staff to minimise risk of virus transmission to other areas.

Where staff are required to respond to an area affected by COVID-19 for emergency response purposes, all precautions should be taken to prevent and limit the spread of infection including (but not limited to) thorough hand hygiene, the use of appropriate PPE and social distancing to be maintained where possible.

7.13 Waste Management

Reference should be made to CNTW(O)24 - Waste Management Policy.

All waste generated by a suspected or confirmed case of COVID-19 should be disposed of as hazardous clinical waste

PPE must be worn when handling clinical waste 7.14 Laundry Management

Reference should be made to IPC-PGN-12 - Management of Used Hospital Laundry.

All linen generated from a patient with suspected or confirmed COVID-19 should be treated as infected linen. This includes personal clothing

PPE must be worn when handling linen

Linen should be placed in a sealed seam soluble bag and placed within a red linen bag, fastened securely and labelled with ward/department of origin

All linen i.e. towels and bed linen should not be laundered in the ward washing machine, but sent to the central laundry

Personal clothing if washed in the ward washing machine should be placed in a red bag and laundered after all other personal items belonging to other patients have been laundered

7.15 Patient Equipment

Reference should be made to IPC-PGN-10 - Disinfection and Decontamination practice guidance note.

Any item of equipment used in providing patient care must be considered to be contaminated and has the potential to spread infection

Wherever possible single use disposable medical devices must be used

IPC-PGN-31


Single use items must be disposed of appropriately as clinical waste

Reusable equipment must be cleaned and decontaminated after patient use in line with manufacturer’s guidance or Trust policy.

Equipment should as far as possible be allocated to the affected patient/s and remain in place until asymptomatic

7.16 Environmental Cleaning

Environmental cleaning/disinfection is intended to remove or significantly reduce the numbers of the virus on contaminated surfaces, therefore breaking the chain of infection.

Cleaning and decontamination should only be performed by staff trained in the use of the appropriate PPE; in some instances, this may need to be trained

Clinical staff rather than domestic staff, in which case, clinical staff may require additional training on standards and order of cleaning.

The frequency of cleaning the care environment in designated COVID-19 care areas should be increased - for example, single rooms, cohort areas and clinical rooms must be decontaminated at least twice daily

Cleaning must precede the process of disinfection. Organic matter (patients secretions, excretions ) must be removed for the disinfection process to be effective

The cleaning process should avoid producing an aerosol

After cleaning with neutral detergent, a chlorine-based disinfectant (Chlor-Clean) should be used, in the form of a solution at a minimum strength of 1,000ppm available chlorine

The main patient isolation room should be cleaned at least twice daily. Body fluid spills should be decontaminated promptly

Dedicated or disposable equipment (such as mop heads, cloths) must be used for environmental decontamination. Reusable equipment (such as mop handles, buckets) must be decontaminated after use with a chlorine-based disinfectant as described above. Communal cleaning trollies should not enter the room

Horizontal surfaces, particularly in patient bedrooms, frequently touched surfaces and immediately around the patient’s bed should be cleaned regularly

IPC-PGN-31


To facilitate effective cleaning the patients bedroom should be kept as clutter free as possible

Where there is a COVID-19 outbreak, carpets should not be hoovered or cleaned with a wet carpet machine in order to reduce likelihood of disturbing viral particles.

7.17 Crockery and cutlery

There is no need to use disposable plates or cutlery. Crockery and cutlery can be washed by hand using household detergent and hand-hot water after use or in a dishwasher.

8 References

Public Health England. 2020. COVID-19: infection prevention and control guidance. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/886668/COVID-19_Infection_prevention_and_control_guidance_complete.pdf

Health and Safety Executive. 2020. Respiratory Protective Equipment.

https://www.hse.gov.uk/respiratory-protective-equipment/index.htm

Public Health England. 2020. Supporting patients of all ages who are unwell

with coronavirus (COVID-19) in mental health, learning disability, autism,

dementia and specialist inpatient facilities.

https://www.england.nhs.uk/coronavirus/wp-

content/uploads/sites/52/2020/04/C0290_Supporting-patients-who-are-unwell-

with-COVID-19-in-MHLDA-settings.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/886668/COVID-19_Infection_prevention_and_control_guidance_complete.pdf



https://www.hse.gov.uk/respiratory-protective-equipment/index.htm

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0290_Supporting-patients-who-are-unwell-with-COVID-19-in-MHLDA-settings.pdf



IPC-PGN-31


Appendix 1

Process for taking swabs for COVID-19 testing

1) Label the green tube legibly with the patient’s name and date of birth, (specimen tube

must have two unique name identifiers on it, or it will not be tested).

2) If using one collection swab, use the same swab for the throat and nose. You must

swab the throat first.

3) Use swab to collect the throat specimen by swabbing the patient’s posterior pharynx

and tonsillar area (avoid the tongue, gums and teeth).

4) Insert the swab gently inside the nostril until you feel resistance. This is usually

around the 2.5cm mark.

5) Rotate the swab 5 times against the inside of the nose.

6) Carefully remove the swab and insert it into the other nostril and repeat the same

process.

7) Insert the swab into the tube after following the steps above. The swab shaft extends

past the top of the tube, snap it at the breaking point so that the top of the swab

shaft is just below the top of the tube allowing the end with the swab tip to

remain in the liquid. The swab tip must be immersed in the liquid.

IPC-PGN-31


Appendix 2

IPC-PGN-31 Appendix 3


Appendix 3

IPC-PGN-31


Appendix 4

Appendix 5 IPC-PGN-31


IPC-PGN-31


Appendix 6

Infection Prevention and Control

Notice to visitors

We are currently experiencing an outbreak of a

respiratory illness.

In order to reduce the potential spread of this infection

we request that you:

Follow any instructions provided by ward /

department staff

Please ensure you thoroughly wash your hands

when entering and exiting the department

Keep visiting to a minimum

Deter children from visiting

Do not visit if you are feeling unwell yourself

Thank you for your cooperation.



Appendix 7



Date post:	06-Dec-2020
Category:	Documents
Upload:	others
View:	4 times
Download:	0 times

Infection Prevention and Control Practice Guidance Note infection …… · 2020. 9. 8. · Sputum...

Documents