General
QUESTIONS WE HAVE ANSWERED
QUESTION
What is the current guidance for Occupational Therapists practicing telehealth?
ANSWER
There are a number of best practice guidance documents currently available. We have summarised the information and guidance from the Irish COVID-19 Occupational Therapy in Acute Hospitals Interest Group, the Association of Occupational Therapists of Ireland, the World Federation of Occupational Therapists, the American Occupational Therapy Association and Occupational Therapy Australia (OTA).
Question
Can the below tests be administered via telepractice?
- Beery-Buktenica Developmental Test of Visual-Motor Integration
- Detailed assessment of speed of handwriting (DASH)
Answer
Yes, both Beery and the DASH have publisher recommendations for administration via telepractice. Detailed instructions for the DASH can be found here and detailed instructions for the Beery can be found here.
Both tests are published by Pearson. The DASH telepractice information is available on the Pearson UK website but it does not appear on their US website. For the Beery, vice versa, the telepractice information is available on the Pearson US website and does not appear on their UK website.
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Question
What is the impact on return to work for patients with COVID-19 who have been hospitalised?
Short Answer
In Ireland, 3,676 people have been hospitalised because of COVID-19. There is no information on the consequent work status of these individuals. This is also the case on the global stage. There are indications from small scale studies and research on similar diseases (SARS & MERS) that some individuals hospitalised with COVID-19 will experience delayed return to work. Fatigue and breathlessness are the most common post-discharge symptoms. Scientists and professional bodies are calling for occupational therapists and other allied health professionals to prepare for the surge in demand for services but more research is needed to determine the long-term consequences of a COVID-19 hospitalisation and its impact on return to work.
The content of this document is correct as of 08/10/2020.
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Question
When cleaning areas between patients are detergent wipes (e.g. Sanicloths) required or will a general detergent spray and disposable tissue suffice?
When disinfecting areas between patients are disinfectant wipes required or can we use disinfectant spray and disposable tissues?
Short answer
The HSE Health Protection Surveillance Centre guidelines do not stipulate that wipes are required to clean or disinfect areas between patients. Disposable tissues, cloth, or paper towels are sufficient to use in conjunction with the appropriate detergent solution and disinfectant.
The content of this document is correct as of 06/11/2020.
This response was based on HSE Health Protection Surveillance Centre Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. Available here.
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Question
Is there sufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19?
Short answer
No, there is insufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19. Best practice remains maintaining recommended levels of Vitamin D, which may include supplementation of vitamin D in groups at high-risk of deficiency.
The content of this document is correct as of 17/09/2020.
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Question
Could you please provide clarity on the proper disposal of PPE?
What type of bin should be used? Can certain types of PPE be disposed in domestic bins (e.g. masks)?
Short Answer
If PPE is worn with a person who is known or suspected to have COVID-19 then it should be disposed of in a healthcare risk waste bin (yellow). If a healthcare risk waste bin is unavailable, the following procedure should be followed:
- All items of PPE should be disposed of into a plastic bag
- The bag should not be filled more than three quarters full
- The bag should be securely tied and placed inside another second, plastic bag (double bag)
- The bag should be stored securely for 72 hours and can then be disposed of with general domestic waste
If PPE is worn in the absence of a specific known risk of COVID-19 it can be discarded immediately as general domestic waste. There is no distinction made between different types of PPE in terms of disposal procedures.
The content of this document is correct as of 11/12/20.
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Question
1.Can a Classroom Feeding Observation for Dysphagia take place within a Pod?
2.When conducting a Classroom Feeding Observation for Dysphagia do parents of children in the same Pod as the patient need to be informed of, and consent to, the observation?
Short answer
1.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
2.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.
The content of this document is correct as of 18/09/2020.
This response was based on the Department of Education COVID-19 Response Plan for Reopening our Primary and Special Schools, version 2, published in August 2020. Access this document here.
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Question
How can a person who is a ‘close contact’ without their own transport safely travel to a COVID-19 testing centre? Are there any specific arrangements for students or healthcare workers? Can they use public transport, taxi or is there any arrangement with the ambulance centre to support this?
Short Answer
A person who is a ‘close contact’, without their own car, should ask one person that they live with to drive them to the testing centre. If the ‘close contact’ does not live with anyone who has a car they should ask someone who they have been in close contact with very recently to drive them. They should follow the HSE guidance on how to safely travel in a car in such a circumstance. A person who is a close contact should not use public transport, this includes using a taxi service. There are no special arrangements in place for students or healthcare workers.
The content of this document is correct as of 10/11/2020.
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QUESTION
Do I need to wear a mask if maintaining a 2m distance in a treatment room while delivering face-to-face CBT in Primary Care?
Short answer
The National Public Health Emergency Team (NPHET) has recommended that healthcare workers use a surgical mask for all patient care activities when a safe distance (2m) cannot be maintained. This implies that when a 2m distance can be maintained a mask is not necessary. However, the NPHET guidance does not state this explicitly and does not address the issues of room size/occupancy or duration of contact. The European Centre for Disease Prevention and Control considers maintaining a 2m distance in a closed environment, such as a treatment room, as low-risk for exposure to COVID-19. The HSE Health Protection Surveillance Centre state that in low-risk circumstances, where wearing a mask may impact on patient care, a clear face visor is an acceptable alternative.
The content of this document is correct as of 30/09/2020.
These documents were used to answer this question:
- Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
- Health Protection Surveillance Centre (2020). Guiding principles for Infection Prevention and Control when returning to routine General Practice during pandemic COVID-19 v2.1. HSE: July 2020.
- European Centre for Disease Prevention and Control (2020). Public health management of persons having had contact with cases of novel coronavirus in the European Union. ECDC: February 2020.
Dr Liz Kingston, member of the RapidInfo4U Panel of Experienced Clinicians and Lecturer at the University of Limerick, with a clinical speciality in infection prevention and control, was consulted to answer this question.
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Question
- What is the evidence to support high flow nasal oxygen in COVID-19 management?
- Does high flow nasal oxygen result in increased droplet dispersion and aerosol generation in COVID-19 patients?
Short Answer
High flow nasal oxygen for the management of COVID-19 is a controversial topic due to a lack of high-quality research into its efficacy and its potential as an aerosol-generating procedure. Systematic reviews commissioned by the World Health Organization found that high-flow nasal cannulas may reduce the need for invasive ventilation and the escalation of treatments over conventional oxygen therapy in COVID-19 patients. However, they caution that this potential advantage must be weighed against the currently unknown risk of droplet and aerosol transmission: there is currently no research evidence directly examining the consequent dispersion of COVID-19 virus for this procedure. A number of actions can reduce any potential risk: deliver HFNO in negative-pressure rooms and/or ensure proper ventilation; use an increased area of precaution; ensure staff have protective PPE; and place surgical masks on patients receiving the HFNO.
The content of this document is correct as of 04/12/20.
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QUESTION
- Is there any evidence to suggest chest physiotherapy is an aerosol-generating procedure?
- Does the evidence compare different types of chest physiotherapy treatment techniques – and whether certain treatments may be more aerosol generating than others? (i.e. positive pressure devices, oscillating devices, cough assist, breathing techniques, patient coughing, suction etc).
SHORT ANSWER
There is insufficient evidence to state that chest physiotherapy is an aerosol-generating procedure. However, absence of evidence is not evidence of absence. International and national professional physiotherapy bodies have endorsed guidelines for physiotherapy management during COVID-19 which state that chest physiotherapy interventions are potentially aerosol-generating procedures and strongly recommend using airborne precautions when delivering these interventions. Furthermore, a recent systematic review classified chest physiotherapy interventions as potentially aerosol-generating and recommended, for the purposes of selecting personal protective equipment, that such procedures be treated as aerosol-generating.
The content of this document is correct as of 04/12/20.
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Question
What is the latest evidence regarding conscious proning of COVID-19 patients?
At what level of oxygen is it best to commence proning?
When should you stop proning as the patient is improving?
Short Answer
The current evidence for conscious proning is of poor quality and fails to answer several key questions required to inform clinical practice, including the optimum conditions for commencing and ceasing proning. There are multiple RCTs underway that will address these gaps in knowledge over the coming months.
The content of this document is correct as of 27/11/2020.
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Question
1.What is current guidance for cleaning a room after a hands-on physiotherapy session?
2.What are the current recommended products for effectively cleaning surfaces?
3.Do I have to wait a certain amount of time to clean my treatment room after a session?
Short answer
1.Clean with detergent and water followed by rinsing and drying. If a surface is suspected or known to have been contaminated by infectious material a disinfected should be used after cleaning.
2.A neutral detergent with water for cleaning and a chlorine-based product, such as sodium hypochlorite, for disinfecting.
3.HSPC cleaning protocols do not stipulate that a certain amount of time should be left between seeing a patient and cleaning. HSPC guidelines state that COVID-19 virus droplets produced by an infected patient will land on surfaces “within minutes” of production. They do not state how many minutes precisely. Research has found that large droplets fall within 1 second while smaller droplets can take up to 9 minutes to fall to the ground.
The content of this answer is correct as of 02/10/2020
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GUIDELINES
For HSE document on recommendations for the use of Personal Protective Equipment see here.
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The HSE preliminary guidance on Facial Hair and respiratory protection in the Healthcare Setting in the Context of COVID-19 can be seen here.
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The HSE has published rights-based guidance on implementing Infection Prevention and Control measures and mitigating risk in disability services.
The guidance addresses introducing appropriate infection prevention and control measures, while ensuring that this does not have the effect of restricting the rights and independence of people with disabilities.
View the guidance here.
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The HSE Library has created an evidence summary document to answer the question: What is the impact of the coronavirus pandemic on the mental health of elderly nursing home residents? To view the summary click here
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HSE guidance for health and social care workers in relation to COVID-19 infection prevention and control when conducting home and residential setting visits. This guidance has been developed by the HSE’s Health Protection Surveillance Centre.
Click here for guidance
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The HPSC is Ireland’s specialist agency for the surveillance of communicable diseases & is part of Health Service Executive. They have compiled a range of guidance for healthcare workers on their website here
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The HSE National Health Library Summaries of Evidence are compilations of the latest research evidence and key reference information related to Covid-19.
Each Summary of Evidence contains a comprehensive representation of all available research evidence and key reference sources and provides collated information on a topic of interest, displayed in a way that it is easy to follow and understand. They aim at supporting our healthcare professionals to make informed decisions.
To go to the Library click here
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The International Alliance of Academies of Childhood Disability (IAACD) mission is to improve the health and well-being of children, youth and adults with childhood-onset disabilities around the globe.
COVID-19 continues to cause major disruptions in service provision, participation, and overall well-being of children and young people with disabilities and their families worldwide. As such, the IAACD has recently created a COVID-19 Task Force with the main goal of learning and understanding the impact of COVID-19.
Click here to visit the IAACD COVID-19 Task Force website
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Statements re COVID-19 and people with intellectual or developmental disabilities:
People with disability Australia
Centre of Research Excellence in Disability and Health
University of New South Wales, Australia
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CONTENT FROM SCIENTIFIC JOURNALS
Wade, D. T. (2020). Rehabilitation after COVID-19: an evidence-based approach. Clinical Medicine.
This article discusses the principles of rehabilitation including a simple screening process; use of a multidisciplinary expert team; four evidence-based classes of intervention (exercise, practice, psychosocial support, and education particularly about self-management); and a range of tailored interventions for other problems.
Click here for article
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The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?”
The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified:
- Details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health.
- Suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation.
- Guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function.
Click here for article
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Wade, D. T. (2020). Rehabilitation after COVID-19: an evidence-based approach. Clinical Medicine.
The large number of COVID-19 patients needing rehabilitation coupled with the backlog remaining from the crisis will challenge existing services. The principles underpinning vital service reconfigurations needed are discussed.
Click here for article
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The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.
Click here for article
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In response to the COVID-19 pandemic, governments around the world instituted various public-health measures. This project aimed to highlight the most significant similarities and differences in key mental-health indicators between four Western and Northern European countries, and identify the population subgroups with the poorest mental-health outcomes during the first months of the pandemic.
This paper demonstrates that the pandemic and associated country lockdowns had a major impact on the mental health of populations, and recommends certain subgroups should be closely followed to prevent negative long-term consequences. Younger individuals and individuals with a history of mental illness would benefit from tailored public-health interventions to prevent or counteract the negative effects of the pandemic. Individuals across Western and Northern Europe have thus far responded in psychologically similar ways despite differences in government approaches to the pandemic.
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CT imaging of asymptomatic cases with COVID-19 pneumonia has definite characteristics. It is essential to pay attention to the surveillance of asymptomatic patients with COVID-19. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspicious, asymptomatic cases with negative nucleic acid testing.
Click here for article
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As the architect of racial disparity, racism shapes the vulnerability of communities. Socially vulnerable communities are less resilient in their ability to respond to and recover from natural and human‐made disasters compared with resourced communities. This essay argues that racism exposes practices and structures in public administration that, along with the effects of COVID‐19, have led to disproportionate infection and death rates of Black people. Using the Centers for Disease Control and Prevention’s Social Vulnerability Index, the authors analyze the ways Black bodies occupy the most vulnerable communities, making them bear the brunt of COVID‐19’s impact. The findings suggest that existing disparities exacerbate COVID‐19 outcomes for Black people. Targeted universalism is offered as an administrative framework to meet the needs of all people impacted by COVID‐19.
Click here for article
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Approximately 10% of people experience prolonged illness after COVID-19
This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of COVID-19 that was managed in the community or in a standard hospital ward. Broadly, such patients can be divided into those who may have serious sequelae (such as thromboembolic complications) and those with a non-specific clinical picture, often dominated by fatigue and breathlessness.
Click here for article
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OTHER REPUTABLE REPOSITORIES & USEFUL CONTENT
A repository has been developed in the HSCP Hub on HSELanD to support the Health and Social Care Professions to deliver services in the context of the COVID-19 pandemic. It is intended that this central repository will enable a sharing of HSCP resources, both COVID and non-COVID related resources, to reduce duplication of effort for HSCP frontline staff and managers.
Log in to HSELanD to access.
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HSE Health & Social Care Professions Blog: HSCP Share
This blog is a way to connect, communicate and enable collective dialogue across the 26 disciplines and 16,000 staff of the Health & Social Care Professions of the Health Services. It is a new format for connecting Health and Social Care Professionals with one another.
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The HSE Health Protection Surveillance Centre published this document: Guidance on Infection Prevention and Control for the Health Service Executive 2020 in September 2020
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The HSE National Health Library and Knowledge Service (NHLKS) Summaries are compilations of the latest research evidence and key reference information related to Covid-19. They are developed by the NHLKS Evidence team in response to questions received by healthcare professionals via their online evidence request form.
Click here to view the summaries
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To inform national efforts in response to COVID-19, HIQA is developing evidence summaries to answer specific research questions posed by the National Public Health Emergency Team.
View the summaries here.
CHAIN (standing for Contacts, Help, Advice & Information Network), is a successful online mutual support network for people working in health and social care. More info here.
CHAIN has a sub-section on research into COVID-19, available here
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CHAIN (standing for Contacts, Help, Advice & Information Network), is a successful online mutual support network for people working in health and social care. More info here.
The CHAIN rehabilitation subgroup has developed a range of resources on rehabilitation and COVID-19, available here
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CHAIN (standing for Contacts, Help, Advice & Information Network), is a successful online mutual support network for people working in health and social care. More info here.
The CHAIN rehabilitation subgroup has developed a range of resources on rehabilitation and COVID-19, available here
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CHAIN (standing for Contacts, Help, Advice & Information Network), is a successful online mutual support network for people working in health and social care. The Network originated more than 20 years ago in the NHS Research & Development programme and has since grown into a not-for profit international online community of over 15,800 people who are willing to share their knowledge and experience with each other.
CHAIN is multi-professional and cross organisational, and is designed to connect like-minded health and social care practitioners, educators, researchers and managers. It covers the whole of the UK and is now international, with satellites in Australia, Canada, Scandinavia, Italy, Spain and members in 40 other countries worldwide.
CHAIN has developed a huge range of COVID-19 resources, available here
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The HSE has developed a range of posters with instruction for the use of Personal Protective Equipment. See full range of posters here.
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Video resources for Infection Prevention and Control produced by the HSE’s health protection surveillance centre are available here.
The World Health Organisation has developed a mobile learning app specifically for health workers and is designed to enable them to expand their life-saving skills to battle COVID-19. It delivers mobile access to a wealth of COVID-19 knowledge resources developed by WHO, including up-to-the-minute guidance, tools, training, and virtual workshops to support health workers in caring for patients infected by COVID-19 and in protecting themselves as they do their critical work.
For more information or to download the WHO app click here
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RapidInfo4U is part of the Irish Government’s national coordinated research and innovation response to the COVID-19 pandemic. RapidInfo4U is funded by a Health Research Board COVID-19 Pandemic – Rapid response funding award and managed by the Health Implementation Science and Technology cluster at the University of Limerick.
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