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.

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.

QUESTION

• Is there a link between vaccinations for Covid-19 & developing Guillain-Barré syndrome?
• Is one type/make of vaccine a higher risk than others?

SHORT ANSWER

Currently, the available evidence does not support a link between COVID-19 vaccination and an increased risk of developing Guillain-Barré syndrome. Isolated cases of Guillain-Barré syndrome have been reported following COVID-19 vaccination but there is no proven association. There are currently no studies that show that the incidence of GBS that occurs following COVID-19 vaccination is greater than the incidence of GBS that normally occurs. Thus, there is currently no evidence to suggest that COVID-19 vaccines increase the risk of developing the syndrome above the natural incidence in a population. Cases of Guillain-Barré syndrome have been reported for different COVID-19 vaccine types. Continued surveillance of adverse events associated with COVID-19 vaccination and epidemiological studies should provide further clarity.

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The content of this document is correct as of 18/05/2021.

What are the recommended physiotherapy outcome measures to use with Covid-19 patients in an out-patient post-COVID clinical setting?

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.

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.

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.

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

Question

• What is the current best practice when working as a CBT therapist in primary care?
• In light of the new strains of Covid 19 and the most recent information, is it still recommended to wear a face shield and maintain 2 metres distance from the patient?
• What is a safe session duration?

Short Answer

Recent updates of Irish guidance have reiterated that masks must be worn in healthcare facilities when a distance of 2 metres cannot be maintained. However, the guidance does not specifically address if masks need to be worn if persons are greater than 2 metres apart. Surgical masks are recommended for health workers within primary care practices while face coverings are recommended for patients entering a primary care practice. An updated rapid evidence summary by the HSPC indicates that face coverings are preferable to visors/shields to reduce transmission of COVID-19, though the evidence is of low quality. However, there are circumstances where a face covering may not be appropriate and may affect quality of care. In these circumstances a visor/shield may be used provided that it extends from above the eyes to below the chin and from ear-to-ear. The role of room ventilation is increasingly acknowledged and some guidance exists on increasing ventilation though this is dependent on context. Recommendations are not made about safe session duration.

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The content of this document is correct as of 02/02/2021.

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.

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:

1. Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
2. 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.
3. 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.

QUESTION

• To what degree are people with Long COVID presenting with dysphagia and/or voice difficulties? 
• To what degree are mildly symptomatic / asymptomatic patients post COVID presenting with dysphagia and/or voice difficulties? 

SHORT ANSWER

Long COVID has not yet been well-studied and research is underway in this area. Many of the studies of dysphagia and voice difficulties are observational or prospective with small sample sizes and varying lengths of follow-up. Furthermore, the evidence for dysphagia/voice disorders in long-COVID is limited at this point. Studies mainly focus on dysphagia and voice difficulties following acute respiratory distress syndrome (ARDS) and/or the associated respiratory support interventions such as intubation and tracheostomy. The limited evidence suggests people with who have been hospitalised for COVID-19 and particularly, those who have experienced ARDS and undergone associated medical interventions, are at increased risk of dysphagia and/or voice difficulties. There is also preliminary evidence that dysphagia can be addressed through rehabilitation, therefore, reducing long-term effects. In addition, there is insufficient evidence to assess the degree to which mildly symptomatic or asymptomatic patients present with dysphagia and/or voice difficulties post COVID-19.

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The content of this document is correct as of 05/02/2021.

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:

1. All items of PPE should be disposed of into a plastic bag
2. The bag should not be filled more than three quarters full
3. The bag should be securely tied and placed inside another second, plastic bag (double bag)
4. 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.

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.

QUESTION

• What is the evidence for nutrition interventions in COVID-19 respiratory clinics in an acute setting?
• Is there any evidence for specific nutritional care pathways and or interventions in COVID-19 respiratory clinics?

SHORT ANSWER

Very limited information is available as to the inclusion of nutritional interventions in COVID-19 respiratory clinics in an acute setting. Nutritional interventions in COVID-19 outpatient respiratory clinics or settings receive limited attention in guidelines. Guidelines largely place emphasis on acute inpatient management and on movement from acute to community settings. No studies were found that evaluated nutritional interventions in COVID-19 respiratory clinics. Therefore, there is limited evidence to support nutritional interventions in COVID-19 respiratory clinics. Further research is needed.  

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The content of this document is correct as of 09/06/2021.

QUESTION

• How can the nutritional management of those recovering from COVID 19 be best supported and managed in the community setting? Is there any published evidence of nutrition care pathways and or specific interventions for patients Post Covid-19 transferring from acute to rehab, community settings?
• What evidence is available about the specific nutritional considerations in the management of long COVID-19, i.e. nutrition care pathways and/or interventions?
• What is the specific role of the dietitian in the management of post-COVID 19 recovery? What evidence supports the specific need for dietitians to be involved in the multi-disciplinary management of COVID-19?

SHORT ANSWER

Guidelines make recommendations as to how nutrition in those recovering from COVID-19 can be managed in the community. The guidelines predominantly address how to manage malnutrition during intensive care unit (ICU) stay but increasingly also address nutrition management on movement to acute ward and from hospital discharge to community settings. There is limited evidence of the impact of nutrition management approaches on COVID-19 recovery. The guidelines draw from broader literature and expert consensus. Broader evidence of the impact of nutrition on the immune system and health suggests nutrition is a key aspect of recovery from COVID-19. Furthermore, there is evidence to support the role of nutrition in recovery from respiratory illness and ICU stay.

The guidelines emphasize screening for malnutrition, developing a tailored nutrition care plan and ensuring ongoing nutritional support on discharge. Regular review and monitoring is encouraged to reduce nutritional risk. The nutritional considerations in long COVID-19 are not easily distinguished from the considerations in COVID-19 recovery overall, except that they are prolonged in duration. The findings of long-term effects reinforce the recommendations for continued nutrition support until the nutrition risks have been addressed. Further research is needed to understand the impact of nutrition and dietetics interventions in recovery from COVID-19.

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The content of this document is correct as of 31/05/2021.

QUESTION

• What malnutrition screening tools are best for use with patients recovering from Covid-19 in acute and community settings?
• Has any data been published to show that these are effective in screening accurately for malnutrition?
• Is there any potential for under-over diagnosis been reported with existing screening tools?

SHORT ANSWER

Clinical guidelines endorse use of validated tools for screening patients with or recovering from COVID-19. These guidelines also endorse the GLIM two-step approach where screening is first conducted to identify those at high risk of malnutrition and further assessment is conducted for those identified at risk of malnutrition. Guidelines and literature on malnutrition screening tools are often focused on acutely ill COVID-19 patients. MUST is commonly recommended for use in the community setting but guidelines suggest that various validated tools can be used.

The effectiveness of malnutrition screening tools considers a range of factors: how sensitive and specific the tools are as well as how well they perform compared to other validated measures and how well they predict patient outcomes. Within COVID-19 patients, the literature is limited. Many of the tools were found to have high sensitivity including the NRS-2002, MNA-SF, and MUST. This suggests that the tools are unlikely to miss those at risk of malnutrition. MUST may be slightly less sensitive but may be more specific – that is, it would be less likely to incorrectly identify someone as being at risk of malnutrition. However, the COVID-19 and broader literature on the utility of the nutrition screening tools is considered low quality and studies provide mixed estimates of their effectiveness.

Nutritional biomarkers have also been suggested to provide valid estimates of malnutrition. An additional consideration is the extent to which screening tools can be used remotely in the community setting. Practices for remote screening have been developed and recommended but the effectiveness of these approaches requires further evaluation.  

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The content of this document is correct as of 31/05/2021.

question

What is the impact of achieving adequate nutrition in the rehabilitation phase post COVID-19 infection?

Short Answer

At this time, there is no evidence on the impact of adequate nutrition in the rehabilitation phase post COVID-19. There is also limited evidence for the impact of adequate nutrition in the prevention and treatment of COVID-19. However, given the broader evidence on the impact of nutrition on recovery from infectious diseases, guidelines highlight the need to assess malnutrition in COVID-19 patients and to develop an appropriate plan to ensure necessary energy, protein, vitamin and mineral intakes.

Question

How long do taste changes or loss remain post COVID-19? What is the impact of same?

Short Answer

Research indicates that about 1 in 3 COVID-19 patients will experience taste changes or loss and that for the majority this dysfunction will last 7 to 14 days. It is not yet clear how long it will take those patients with persistent taste dysfunction to recover. Research to date has included only short-term follow-up protocols, following patients for four to eight weeks. As with everything in the COVID-19 era evidence is constantly accruing and more research is needed to determine both the average length of recovery time for persistent taste dysfunction as well as the impact of such a dysfunction overtime on the patient. Existing literature on taste dysfunction (unrelated to COVID-19) has found that loss of taste can be detrimental to both the physical and mental health of a patient. There are currently no treatments recommended by researchers for loss of taste produced by the COVID-19 virus

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.

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.

Question

Essential oils have been use for decades for the treatment of minor ailments. Each particular essential oil has their specific properties from antiviral, antimicrobial, anti-fungicide, antibacterial and so on. Is there any evidence that essential oils ease respiratory symptoms or respiratory distress for patients with COVID-19 if used alongside or in conjunction with medical treatment?

Short Answer

Research on the antiviral properties of essential oils are at the early stages. Recent reviews have found no trials that evaluated the clinical efficacy of essential oils on respiratory symptoms caused by coronavirus in humans. Additionally, current studies fail to provide adequate information on the toxicity of essential oils and safe dose information.

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The content of this document is correct as of 28/01/2021.

Are visors a safe alternative to face masks for patients who cannot communicate with healthcare professional who is using a face mask?

QUESTION

Is there a mandatory requirement to set aside vacant rooms to be utilised in the event of a COVID-19 outbreak in a residential care facility?
Will there be financial provision or grant to the centre to cover the cost of having vacant rooms for this purpose?