Since 12^th March 2020, we’ve all become very aware of the government’s announcement that we’ve moved from the ‘contain’ phase into the ‘delay’ phase of the ongoing coronavirus (COVID-19) outbreak. But what does this mean for your practice, and how do we raise the quarantine flag to warn other seafarers if we become compromised?

Another well-documented requirement is to heartily sing a sea shanty for at least 20 seconds when washing our hands. Washing with soap and water is deemed to be the most important thing we can do to protect ourselves from germs.

Should you cough or sneeze, then do so into a tissue, put it in a bin and then rewash your hands. Let’s hope you don’t have a regular cough, otherwise that’s a lot of handwashing (and singing).

Another really important aspect in all of this is communication, and let’s hope that the latest PI Coronavirus Poster, which is free to download, has been placed at all entrances to the practice to stop any COVID-infected people in their tracks.

Lastly, talk through the plan with your team and consider what’s needed, especially the location of an isolation room which is close to the entrance and preferably not one with any soft furnishings or carpet as this, of course, will be much harder to clean.

But what if they do turn up?

I guess it’s easy to have missed those ‘one or two’ recent headlines about COVID-19, but if you’re unlucky enough to have that bewildered infected patient or a confused staff member turn up at the practice, this is what you should do:

• If they’re a staff member, suggest they follow the current national guidance on quarantining for 14 days; they should go home and not be so daft in future.
• If they’re a patient, immediately place them in your (hopefully) non-carpeted room, away from other patients and staff, and then withdraw from the room yourself. Place a “DO NOT ENTER” sign on the door, then… wash your hands thoroughly with soap and water whilst heartily singing a sea shanty for 20 seconds or more – any sea shanty will do, it doesn’t matter which one.
• Avoid carrying out a physical examination of any suspected case. The patient should remain in the room with the door closed, with their belongings and any waste in the room with them. The patient, plus any accompanying family members, should remain in the room with the door closed.
• Advise others not to enter the room. If a clinical history still needs to be obtained or completed, this can be done by telephone.
• If entry to the room or contact with the patient is unavoidable, such as in an emergency, wear PPE and keep exposure to a minimum.
• Ask the patient to call NHS 111 from their room, preferably on their own mobile. If this isn’t possible, of course use the GP surgery landline.
• Should the patient need to use the toilet, they should be allocated one, but instruct the patient to wash their hands thoroughly after using the toilet and, yes, they must be mighty in their singing. The toilet will then need to be closed, again using a sign, and then not used until it’s been cleaned and disinfected following the decontamination guidance.
• Following this, the patient must return directly to the isolation room.

Patient transfers

Should the patient be deemed to be quite or very unwell and, as such, requiring an urgent ambulance transfer to a hospital, inform the ambulance call handler of the concerns about COVID-19.

In all other instances, the case must be discussed with the receiving hospital so that they’re aware that COVID-19 is being considered and the method of transport agreed. Under no circumstances should a patient with suspected COVID-19 use public transport or a taxi to get to hospital.

After the patient’s departure, the room should be closed and should not be used until further advice is provided by the local HPT and following a ‘deep clean’. Windows should be opened and the air conditioning switched off, until it has been cleaned with detergent and disinfectant.

Once this process has been completed, the room can be used once more.

Get ready to rumble?

The responsible person undertaking the cleaning with detergent and disinfectant should be familiar with these processes and procedures, and all equipment must be available before entering the room.

Give your hands a good clean [cue song]; this is just in case you haven’t cleaned them recently. Following this, put on a disposable plastic apron, mask and gloves as per PPE-donning advice within the Infection Prevention and Control Policy.

The decontamination process

Use disposable cloths, paper roll and disposable mop heads to clean and disinfect all hard surfaces, floors, chairs, door handles and fittings in the room.

Either of these two cleaning options are suitable:

• Combined detergent disinfectant solution at a dilution of 1,000 parts per million (ppm)
• A neutral purpose detergent followed by disinfection at 1,000 ppm

Being aware of the Safety Data Sheet (SDS) within your COSHH folder, follow any instructions for dilution, application and contact times for all detergents and disinfectants.

Clean all equipment systematically from the top or furthest away point. Any cloths and mop heads used must be disposed of as single-use items.

Next steps

All waste from this contaminated area should be appropriately disposed of. Cleaning cloths and PPE are to be placed in orange infectious clinical waste bags and disposed of in the clinical waste bins.

To celebrate a job well done, perform a sing-song whilst giving your hands a good rub-a-dub-dub… Group singing at this stage should be encouraged.

Information and policies to support you

There’s so much information just now on ‘all things coronavirus’ on every media platform, some useful, some not. There’s a great deal of useful guidance and advice on the forum and also there are PI policies that already refer to this topic.

• The Infection Prevention and Control Policy details the correct method of wearing your PPE, disposal of infectious waste, cleaning bodily fluids plus much more
• The Cleaning Standards and Schedule Policy provides a table listing all areas and to what standard they should be cleaned
• Much of this advice has come from the government’s COVID-19: Interim Guidance for Primary Care. The bit about singing sea shanties may have been a little fabricated by me.

Good luck to you all and stay safe.

Mat Phillips

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