NEWCASTLE LUNG GROUP (NLG) INCLUDING NEWCASTLE PULMONARY FUNCTION LABORATORY (NPFL)

Rationale:  Covid 19 is a highly infectious respiratory virus transmitted both by fomites (via touch) and aerosol spread (via inhalation). In unvaccinated subjects in the initial Covid 19 outbreaks in early 2020, hospital admission rates were of the order of 10%, severe illness of approximately 4%, and death in approximately 1%. The rates significantly increase with increasing age and those with comorbid health conditions such as obesity, diabetes, chronic respiratory illness and cardiac disease. Forced expiratory effort and coughing increases the risk of dissemination and transmission of the virus which is of particular concern in our lung function laboratory.

A significant proportion of the clientele seen at Newcastle Lung Group are elderly and have comorbid health conditions, and in particular chronic respiratory disease that places them at particular risk should they contract Covid 19.

As of September 2022, COVID-19 has become endemic, and the COVID-19 variants usually do not cause as severe disease as the initial delta variants

The purpose of this policy is therefore aimed at reducing the risk of transmission of and infection with, Covid 19 within the Newcastle Lung Group practice for both patients and staff, and in particular to those at most risk from Covid 19 infection.

It has been demonstrated that the following reduce the risk of infection and transmission:

• Physical distancing.
• Mask wearing and other personal protective equipment.
• Hygiene measures such as hand washing, hand sanitisation, and wiping down surfaces.
• Limiting the number of person-to-person interactions, and in particular, interactions involving those at higher risk of having Covid 19, or becoming infected with Covid 19.
• Vaccination.

Measures to reduce risk of Transmission and infection - Newcastle Lung group will institute the following:

1. General Measures

• Consultations will be via telehealth in preference to face to face where thought to be appropriate for the clinical problem, and practically able to be performed. This is not possible for patients of Newcastle Pulmonary Function Laboratory where attendance is required for testing.
• Hand hygiene measures for staff and patients with free and easy availability of hand sanitiser within Newcastle Lung Group. Staff will use hand sanitiser between contact with patients.
• Patient numbers will be restricted to eight in the waiting room (4 m² rule).
• Accompanying persons for patients will be discouraged unless this is important for patient care and support.
• Regular wiping down of surfaces–within the lung function laboratory this will occur between each patient.
• Regular sanitisation of objects potentially shared between patients and staff (for example pens)
• Staff and patients will wear facemasks, unless there are medical contraindications to face mask wearing. (Some very breathless patients are unable to tolerate a mask)
• To protect laboratory staff, those staff performing testing within the lung function laboratory will wear N95 masks and gloves during testing or HEPA filtered air fed cords.
• HEPA filters will operate within the lung function testing rooms to try and reduce potential viral aerosol load.
• Staff who are unwell with acute respiratory symptoms will not attend work until they receive a negative Covid test or Covid disease is ruled out.
• All staff will be vaccinated against COVID-19

1. Individualised Risk Assessment:

A risk assessment to identify those at increased risk of transmitting the virus or becoming infected with the virus will be performed before consultation at Newcastle Lung Group and before lung function testing in the Newcastle Lung Function laboratory for each patient. The following are thought to indicate potential increased risk of infection and transmission and patients will be asked if any of these apply to them:

• Recent history of close contact with Covid 19
• Awaiting Covid 19 PCR swab result
• History of acute respiratory illness consistent with viral respiratory tract infection.

(This will include a check of patient temperature at time of consultation)

• Living in an area with high incidence of Covid 19 from which travel and contact with others has been limited by Public Health Orders

If none of these conditions are present, then consultation can proceed with general measures as outlined above.

Where any of the above are identified, and where telehealth consultations are not possible or judged to be inappropriate, then the NLG doctor involved will make an assessment of the urgency/importance of the consultation.

• If consultation or testing is judged to be non-urgent and where a delay in testing or consultation will not adversely affect patient outcome/health then the consultation or testing should be delayed till the above conditions have resolved.
• If the consultation or testing is judged to be urgent or where delay in consultation or testing will adversely affect patient health or outcome, then we will request that the patient undertake Covid 19 PCR testing within 48 hours of the consultation. A negative test will allow the consultation to go ahead.

If the consultation is judged to be an emergency, then the consultation will go ahead though this may involve transfer of the patient to a local hospital or other facility rather than involvement of the NLG, for further care. The NLG doctor involved will make the judgement about the most appropriate medical response.