Clinical care information, flowcharts and matrix

CALHN staff are to follow the CALHN management of COVID-19 (SARS-CoV-2) policy PRC05409 –COVID-19 (SARS-CoV-2) - Management Guide, available from eCentral.

Contact tracing

• CALHN COVID-19 Initial Contact Tracing Management and Outbreak management - includes After Hours V6 | 14 June 2024 

Management of COVID-19 positive cases

• COVID-19 positive patient placement | 22 December 2023

Surgery

• CALHN COVID-19 risk stratification for Tech Suite workflow RAH | 31 May 2024
• CALHN COVID-19 risk stratification for TQEH theatre – EMERGENCY | 31 May 2024

Allied Health COVID-19 guidelines

• Hydrotherapy COVID-19 Safety Guidelines | 23 November 2023
• Inpatient HRC Therapy COVID-19 Safety | 23 November 2023
• Outpatient Allied Health Group sessions - COVID-19 | 23 November 2023

CALHN COVID-19 testing and clearance flowcharts

• CALHN COVID-19 Testing and Clearance Flowcharts V8 | 27 June 2024

COVID-19 PCR test added to RAT surveillance schedule | 23 June 2023

All patients being admitted must have a RAT on admission (even if they are waiting in ED).

For patients presenting for a procedure or surgery, who are well and asymptomatic on presentation, screening with a Rapid Antigen Test (RAT) is no longer required.

For patients receiving care in settings such as haemodialysis, day cancer services and medical infusion services, please continue your current screening processes for these more vulnerable groups of patients.

If the patient presents with respiratory symptoms or develops signs or symptoms consistent with COVID-19 during admission perform Respiratory Pathogen PCR and RAT at the same time, isolate in a single room and commence Enhanced Respiratory Precautions (ERP). ERP cannot be lifted until both results are available.

If the patient becomes a close contact during admission, then place in isolation with ERP for 3 days from exposure and undertake RAT and PCR testing as per close contact requirements listed in the flowsheet.

Any advice regarding patient management can be directed to the relevant site IPCU (during business hours). After hours, contact ID on call via Switch.

All patients who are at low risk of COVID and have had initial negative testing, require ongoing testing during inpatient stay:

• RAH / TQEH: RAT on admission and alternate days thereafter or as directed
• HRC / RHC: RAT on admission to ward and repeat RAT alternate days thereafter
• Glenside: RAT on admission to ward and repeat RAT alternate days thereafter or follow testing advised by medical lead

RAT and PCR testing post COVID-19 infection

Non-infectious viral shedding may occur for several months following COVID-19 infection. Testing of immunocompetent patients following clearance by either RAT or PCR is not recommended for a period of 35 days post-infection.

Should an inadvertent test be conducted and come back positive within the 35-day period this patient should still be considered cleared of COVID if all other criteria for clearance are met. This means there is no need to re-instate precautions or to transfer to a COVID ward/hospital in the event of a positive test under these circumstances.

Surgical patients

Where a patient presents for surgery or a procedure and they are symptomatic, please consider the clinical impact of delaying the procedure and order a rapid Gene-Xpert 4-Plex PCR (in addition to a 12-plex PCR) to assist in clinical decision making. The rapid 4-Plex is available at TQEH and RAH and takes approximately 90 minutes. It can be ordered by any medical practitioner.

Please ensure that appropriate transmission-based precautions are taken to care for the patient should the procedure or surgery need to proceed due to clinical urgency.

Any staff queries can be directed to Clinical Worker Health via Health.CALHNClinicalWorkerHealthService@sa.gov.au.

Clearance

• Stipulated days have passed since symptom onset (refer to flowcharts)
• Fever has resolved for >72hrs
• Patient is not severely immunosuppressed or in ICU
• Respiratory symptoms have fully resolved (day 10)

Patients meeting these criteria can be cleared and released from isolation (at 2359 hours) and document clearance criteria met in EPAS. No screen is necessary at the receiving sites as part of the Intra-CALHN patient transfer process.

If you have any questions, please contact the Infection Prevention and Control Unit via Health.CALHNInfectionPreventionandControlUnit@sa.gov.au.

Mental health

• CALHN COVID-19 Mental Health workflow for query or positive | 26 August 2021

Clinical Ethics committee

Staff can access information about the Clinical Ethics Committee from the CALHN intranet.

Medical records and coding

Staff can access information about medical records and coding from the CALHN intranet.