Evidence Check - System capacity and evaluation
Infrastructure, hospital capacity, human resources, supplies, monitoring, surveillance, prediction, evaluation, post-pandemic
Test, trace, isolate and quarantine
Added: 14 Oct 2021
- Modelling studies have found that test, trace, isolate and quarantine can prevent transmission, reduce the reproductive number, decease years of life lost and hospital bed use and reduce mortality.
- The elements of these programs found to be effective include a strong test component. To be strong requires high testing rates, timely contact tracing, high quarantine compliance, timely self-isolation of symptomatic individuals and quarantine of their household contacts. It also means comprehensive case finding, repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances. Effective elements also include an extended quarantine period and the use of digital tools for contact tracing and self-isolation.
- Internationally, many jurisdictions have implemented test, trace, isolate and quarantine (TTIQ)strategies. These can have differing lengths of time in isolation, testing requirements andexceptions for vaccinated people.
Public health measures and COVID 19 vaccine rollout
Added: 30 Sep 2021
- Modelling studies from different countries caution that even with a high vaccine coverage, some level of public health, travel and social measures may still be needed to minimise the risk of localised transmission and deaths.
- The World Health Organization updated their interim guidance on considerations for implementing and adjusting public health and social measures in the context of COVID-19 in June 2021. They advise that some countries may consider relaxing some measures for individuals who are either vaccinated or have had a confirmed SARS-CoV-2 infection in the past six months. Depending on transmission level, measures that could be relaxed include waiving quarantine and/or allowing indoor congregation with other vaccinated or recovered people.
- The Canadian Government have guidance on adjusting public health measures in the context of COVID-19 vaccination. They describe a risk-based approach at an individual and community level.
Workforce reconfiguration evidence check
Added: 4 Jun 2020
Updated: 29 Sep 2021
- Workforce reconfigurations of split teams, or creating smaller ‘sub teams’ and establishing social distancing protocols within teams have been described for a range of specialties including general surgery, oncology, radiology, cardiology, emergency departments and dialysis units.
- A modelling study describes a desynchronisation strategy with two medical teams working on alternate seven day periods. The findings of the strategy is that it’s associated with reduced infection rates among the healthcare workforce.
- Different approaches tried in various settings have been described in the literature including the following. • An account from the University of Washington on the use of separate and sub-teams (inpatient care, operating care, and clinic care teams) to ensure continuity of care and minimise exposure of healthcare workers. • The University of Wisconsin has used a restructuring ‘team of teams’ framework that focuses on network of networks approach to enable communication, staffing redesign, synchronising work cycles and clinical and educational changes to minimise staff exposure to COVID-19. • Hospitals in Singapore have used sub-teams which function separately and do not come into contact with each other to ensure emergency surgery can continue if one team if quarantined or infected, and a fixed-team based strategy in the emergency department, where several nursing and doctor sub-teams were created, resulting in longer shift hours but longer rest periods between rostered days. • Many of the specialties have halted inter-hospital and cross-institutional rotations of medical staff to reduce interactions, where previously staff were scheduled to cover several hospitals within a hospital network.
Furloughing staff following exposure to COVID-19
Added: 17 Sep 2021
- Recommendations for quarantine have been made throughout the course of the pandemic for people who have COVID-19, have either been exposed or potentially exposed to COVID-19 and those who have travelled. Recommendations are generally based on a risk assessment which considers exposure type and, more recently, vaccination status.
- Workforce reconfigurations, such as splitting teams, have been described for a range of specialties in order to minimise staff exposure.
- This evidence brief focuses on furloughing (leave of absence from work) and self-isolation of healthcare workers following exposure to COVID-19 and the implications for staffing levels. It is based on small descriptive studies and recommendations from healthcare organisations.
Ethics and duties of treating COVID-19 patients
Added: 27 Aug 2021
There is little practical guidance for healthcare institutions that are deciding whether or when to exclude healthcare staff from providing care or allow them to opt out from providing care in order to protect themselves.
- Many perspective and opinion articles outline that healthcare professionals have a have a duty or obligation to provide care to patients due to the specialised skills obtained during their training.
- The capacity for a health professional to protect themselves during a pandemic whilst caring for infected patients, depends on their ability to practise universal precautions.
- While some authors assert that doctors cannot, with integrity, refuse to serve the victims of an infectious outbreak, there are instances where some argue that healthcare professionals may be excused from their duties.
- If excused from some duties, healthcare professionals may still be expected to contribute in other nonclinical ways.
- Specific specialties may need to help manage the surge of respiratory failure when required.
- In the United Kingdom, parliament has introduced indemnity protection for nurses. There was a rapid deployment of returning nurses and student nurses to a range of traditional and novel roles, including retraining for nurses to work in intensive care settings.
Extended use or reuse of personal protective equipment (PPE) evidence check
Added: 18 Jun 2020
Updated: 27 Aug 2021
- Single-use personal protective equipment (PPE) is intended to be discarded after each encounter or procedure. During times of supply disruption or extraordinary demand, such as airborne disease outbreaks, extended use and reuse protocols have been implemented to conserve PPE.
- Extended use refers to the practice of wearing the same PPE for repeated close contact encounters with several patients, without removing it between those encounters. Extended use is suited to situations where multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards.
- Reuse refers to the practice of using the same PPE for multiple patient encounters but removing it (‘doffing’) after each encounter.
- The evidence on reuse is primarily focused on masks and respirators and there is limited information available on extended use or reuse of other types of PPE.
- The World Health Organisation (WHO) and US Centres for Disease Control and Prevention (CDC) suggest considering PPE decontamination methods, which not only demonstrate effective reductions in pathogen burden, but also preserve the structural and functional integrity of the mask without causing any residual chemical hazard to the wearer.
- Occupational health and safety guidance for infection prevention and control recommends that PPE is considered in the context of broader, more effective hazard reduction approaches, such as elimination, engineering and administrative measures, including cohorting patients or bundling patient care activities in hot and cold zones.
- Reviews found evidence supporting extended use of respirator (N95 or equivalent) over intermittent reuse, as extended use involves less touching of the respirator and therefore, less risk of contact transmission.
- The NSW Clinical Excellence Commission (CEC) recommends that reprocessing of single-use PPE not be undertaken without prior written approval from the NSW Ministry of Health and local PPE Governance Committees
Rapid antigen testing
Added: 19 Aug 2021
- Rapid antigen tests are one of four main types of COVID-19 tests.
- The other test types are nucleic acid amplification tests (PCR), rapid molecular tests (e.g. XpertXpress) and antibody tests.
- The strengths of rapid antigen tests are: Timeliness, with most taking 15-30 minutes from test to result. Sample type used (usually a nasal swab or saliva) which are more acceptable to people. No requirement for specialist equipment (although some use immunofluorescence). Relatively low cost, with most costing $5-$20 per test.
Added: 13 Apr 2021
- Most countries, except Canada and the United States, have differential quarantine measures or requirements based on travellers’ country of departure and travel history (that is places visited in the 14 or 21 consecutive days prior to entering the destination country).
- Exemption from mandatory quarantine is available in Australia, New Zealand, the United Kingdom, Singapore, France, Italy, Greece, Spain, Iceland, Cyprus and Norway for travellers arriving from a specified country or category of countries of low risk. Other conditions to exemptions may apply, such as a negative COVID-19 polymerase chain reaction (PCR) test upon arrival or within 24 hours, 48 hours or 72 hours prior to arrival.(1-11)
- Shorter quarantine duration than travellers arriving from the specified high-risk countries is available in Singapore and France if travellers arrived from certain categories of low-risk countries.
- Quarantine at home, or a suitable place instead of quarantine hotel or dedicated facility for the whole or part of the duration is available in the United Kingdom, Singapore, Italy, and Norway if travellers arrived from specific categories of countries.
- Exemption from mandatory quarantine is currently available in the United States, France, Greece, Spain, Norway, Iceland and Cyprus and from 5 July 2021 in Canada if a traveller is fully vaccinated as defined by the destination country. Other conditions to exemptions may apply, such as a negative COVID-19 PCR test upon arrival or within 24 hours or 72 hours prior to arrival.
Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health.