This email is a follow up from the ANZSRS email about COVID-19 and it being managed from a state/territory level. As the WA chairs, we would like to reach out to those hospitals from regional and private laboratories who have limited guidance to changes in management. Here is our 2 cents:
First thing to re-iterate is from the previous ANZSRS email:
"It is important that respiratory laboratories across Australia and New Zealand adhere to their local infection control procedures, the direction of their hospital’s executive along with state/territory and federal government recommendations. Events are unfolding daily and we all must keep aware of and follow the direction of recommendations from experts in the field of disease control and containment".
As we, the WA chairs, are not qualified to give out direct advice, it was thought best to present what other hospitals in WA, Eastern States, Singapore and the UK are doing as examples rather than gospel. They do not represent the exact situation of management in each state or country and are purely examples from different hospital(s)' approaches that may guide other laboratories. Please note that this was as of 18/03/2020. Massive thanks to the heads of lab in WA for sharing their plans and especially Sharon Lagan for extending email contact to over east and Singapore and Sina Panic for extending email contact to the UK. Here are the responses:
A hospital in Singapore:
A hospital in the UK:
A hospital in Victoria:
- continuing routine testing for most of this week
- next week- non urgent patients to be cancelled. Only pre-op/lung cancer
- apparently some labs in Victoria have “stopped all testing for the foreseeable future” and others have continued “business as usual”
A hospital in South Australia:
- same as the hospital in Victoria
- proposal given to management for reduction in non-urgent testing
A hospital in NSW:
- this was one of few labs still operational as others have closed
- as of 17/3, limiting lab staff exposure to <15 min. This means only doing shorter testing eg only spiro pre/post or spiro/DLCO.
- will not test acutely unwell patients
- staff stay home if on non-clinical duties
- mandatory staff temperature screening before starting shift (starts 18/3). Staff get sticker saying they are fit for that day.
- using gloves and wiping all surfaces before and after testing.
- one staff / one pt per room (no visitors/family allowed unless interpreting).
A hospital in WA:
- currently we have ceased all challenge testing and non-urgent exercise tests
- we have ceased all nasal measurements so no nasal NO or SNIP testing to reduce possible contact with mucous membranes
- as per HOD we are asking all patients about recent travel and symptoms and recommending isolation and COVID clinic as appropriate
- we will be moving to a 1 scientist operation in the coming weeks with reduction of OPD visits. We will offer a full service. Any suspect cases will only be tested in the isolation room and we will continue our general infection control guidelines. We use Oxiver TB wipes which is effective against this emerging pathogen.
- any staff with comorbidities will be reducing patient contact, and all other staff will be working from home.
Another hospital in WA:
- reduction of clinics and limiting tests offered
- we have had a large number of pt’s rescheduling, cancelling of their own accord
- [an example of other considerations:] we just had a very bad tempered interpreter demanding a mask to keep her protected whilst she does the job
Another hospital in WA:
- rescheduling challenge and non-urgent CPET tests. Snips off the list too.
- continuing with other PFT testing as usual – although about a third of patients are ringing to cancel or rebook appointments anyway.
- all patients are receiving SMS questions in regards to Covid19 prior to arrival. They are questioned on arrival in the Department and also by the Scientists prior to testing.
- cleaning as usual – Toughie wipe as this is all we have access to at the moment. This is followed by wiping over with 70% alcohol.
- no suspected cases will be tested as we do not have access to sufficient PPE at this point to accommodate a large influx of these, nor the support staff to conduct thorough cleaning of the room.
- the move to cancelling all non-urgent patients has been discussed and will be enacted as soon as it is deemed that the risk to staff and other patients outweighs the need to provide a diagnostic service.
A third hospital in WA:
- social distancing. Seating in patient waiting areas will be modified to maintain a distance of at least 1 metre between seats.
-
temporarily cessation of some respiratory function tests.
- bronchial provocation tests. This test provokes considerable aerosolization of respiratory secretions and may place staff at risk. If a bronchial provocation test is considered to be critical for clinical decisions, it should be conducted by a respiratory scientist wearing full personal protective equipment (i.e. appropriate mask, gown, gloves and goggles or face shield);
- routine Spirometry on sleep clinic patients. Spirometry on sleep clinic patients can be conducted if specifically requested by the physician.
- conduct as many Sleep Clinic reviews as possible by telephone or Telehealth. This includes adoption of a remote monitoring model of care for patients attending the CPAP Therapy Clinic that has been validated by staff.
- strategy meetings & briefings. Department leaders will meet daily to review our COVID-19 strategy and there will be a briefing of all Department staff once a week.
Please note that the circumstances are rapidly changing so while the above might be appropriate for the current date, they may be wildly different in the very near future.
Bill Noffsinger from SCGH is currently working on a google site which can be updated with the latest WA government health/infection control links. Additionally, this will be a platform for heads of WA laboratories to update their latest changes if they can (with the potential for it to be extended to other states too). In the next update email, the site should be ready to be shared and used.
That is all for now.
Stay safe and wash them hands regularly.
Ash and Liz
WA ANZSRS Chairs
