The Intensive Care Society has created this page to provide the critical care community with resources and information on COVID-19.


The Society is collaborating with Government, FICM and other agencies to ensure we provide consistent, up to date and relevant messaging to support your understanding of and management of COVID-19.

Background

As is now well-known, COVID-19 is an airborne High Consequence Infectious Disease (HCID-A) caused by the novel SARS-CoV-2 virus and now spreading globally. Distribution can be seen on the WHO situation report dashboard, updated daily.

Unlike novel flu strains (e.g. H1N1), there is no natural partial immunity in humans, so the combination of rapid spread in a non-immune population and disease severity poses a significant critical care challenge.

In common with our partner organisations, we believe that UK critical care can rise to and meet that challenge. 

Key messages for clinicians

Message from the ICS President:

As the UK moves from the ‘Containment’ to ‘Delay’ phase of the pandemic management plan, it is likely that critical care services will need to adapt to substantial increased demand, as well as potential staff absence due to illness or (potential) community measures such as school closures.

Key principles to bear in mind:

  • As with any major incident, we will likely be working in new ways with expansion/adaptation of physical facilities and flexible working patterns including collaboration with other staff groups

    The following should always apply:

    > Principles of safe care should be delivered across the board in accordance with GPICS, even if staffing ratio recommendations need to be temporarily set aside.
    > Best matching of available skill mix to acuity, with mutual support working across professional boundaries.
    > Adherence to the principles of the joint statement from the professional regulators.
    > ICS and other professional bodies will support rational staffing and flexible working decisions made in line with the above.

  • Escalation should be performed in a managed and systematic way via regional systems.Previous models exist for this from the 2009/10 H1N1 pandemic e.g. crticon – link), and we are seeking to engage NHS England on this topic.

  • In particular, on the topic of potential ‘triage by resource’ (declining a patient on the basis of capacity rather than the usual triage by likely outcome/benefit), the following apply:

    > External: nobody should triage until everybody triages (which should be a national decision).We are a networked service and until the last bed in the last hospital is occupied, there are always options.
    > Internal: no one should make capacity-related admission decisions alone.Trust systems such as ‘three wise people’ should be deployed for mutual multidisciplinary support.

     

Shared Resource - 13 March, 2020

The Society is collaborating with the Royal College of Anaesthetists (RCoA), Faculty of Intensive Care Medicine and the Association of Anaesthetists (AAGBI) to review and revise clinical guidance to provide the UK intensive care and anaesthetic community with up-to-date clinical information, guidance and resources needed to better understand and manage COVID-19.

To support this partnership, a new website has been launched to act as the centralised hub of multi-professional guidance, information and resources to help support the understanding and management of patients with COVID-19.

Click here: www.icmanaesthesiacovid-19.org
Publication of the UK Coronavirus action plan - 3 March, 2020

Following the increase of confirmed cases of COVID-19 in the UK, the Government has published its Coronavirus action plan. This plan sets out what the UK has done so far and what it plans to do next to tackle the outbreak. The exact scale of the response to the outbreak will reflect the nature, scale and location of infection as the situation develops. 

See: UK Coronavirus action plan

Peer-to-peer support/Hot Topics and FAQs

We operate a WhatsApp communications group for multi-professional unit leads. To enrol, please email alexd@ics.ac.uk with your name, position and mobile number, or text your ODN lead for the invite. Please note that for technical reasons, we are limited to 255 members and are already up to 185.

Current hot topics include:

  • 1. PPE and staff protection
  • 2. Use of NIV

 These are both evolving topics, please keep this page under review for updates.

1. Protecting you and your staff 

Cross-infection can be reliably prevented with effective correct location, effective use of PPE, and good working practices. Critical care requires specific consideration, as critical care patients undergo more frequent aerosol-generating procedures and prolonged exposure with 1:1 nursing.

Live and updated information can be found on the Public Health England's guidance: on COVID-19 infection, prevention and control.

We recognise that two models of PPE have been in use in critical care in the UK since the beginning of the outbreak. 

  • Public Health England recommend single-layer PPE for droplet-mediated airborne disease, including COVID-19.Many hospitals, including some HCID centres and some with substantial military/overseas expertise, have implemented and are comfortable with this.

  • Other hospitals, including some HCID centres, have chosen to voluntarily employ enhanced PPE (with complete skin and hair cover) for COVID-19 patients. This is reflected in recent FICM guidance.

There was previously no specific mention of critical care in PHE guidance.  Following approach by the ICM professional bodies, Public Health England have now (6 March 2020) added a critical care section [section 17] to their infection and prevention guidance , which implies that standard PPE is regarded as sufficient in an ICU setting but does not go into greater depth. Further discussion is in progress but this is likely to be around adding explanatory detail rather than a change of direction.   

In the interim, our guidance is as follows:


  • By local decision and at discretion, units may additionally choose to utilise enhanced PPE, in which case they should follow the available guidance for this, with particular attention once again to correct donning and doffing, in particular of headwear [https://www.ficm.ac.uk/sites/default/files/resppolicyhcidlevel3ppe_donningdoffing.pdf – credit: FICM/Sheffield].

  • Strategic PPE stockpiles are based on PHE guidance. We recommend that units using enhanced PPE should plan ahead for transition and re-training in the event of stock exhaustion of enhanced items.

  • In an ICU setting, checklists and buddy supervision should be used for donning and doffing until all staff are fully confident, and units should be staffed accordingly for as long as sustainable. We recognise this may evolve over time.

  • Equal attention should be given to adequate daily environmental cleaning, and safe sample and waste management.

  • FFP3 masks should be fit-tested according to manufacturer recommendation (note that this varies by manufacturer, and supplies are likely to change over time).

There is 2007 CDC guidance on facial hair and best mask fit.  In general, shaving is recommended during this epidemic. We acknowledge that some people have cultural and religious needs, and they are recommended to seek advice from religious leaders for appropriate guidance for their own and patient safety.

Staff who do not pass fit-testing for whatever reason should be at the back of the queue for managing COVID-19 patients. Some units have procured powered air protective respirators (PAPR), but should note that HCIDs such as Royal Free have rejected these as there is no reliable way to decontaminate the external parts.

2. NIV and HFNO  

The latest PHE guidance [section 5.4] recognises these as aerosol-generating procedures (AGP). Unlike other AGPs, these are continuous rather than intermittent, and may therefore pose additional risk.

In collaboration with the HCIDCs, we have previously recommended avoiding these in COVID-19 patients and moving to early intubation in deteriorating acute respiratory illness. The benefits of delay with NIV are unclear, and the risks of aerosol generation are recognised.

We are engaging with the British Thoracic Society with regard to scenarios such as pre-existing complex respiratory illness and those with treatment ceilings.

In the interim, the principles in the opening statement apply: clinicians should prioritise the best interests of the patient, and work with colleagues to provide shared and robustly documented decision-making for difficult decisions.

ICS position 

The Society is not currently planning to develop guidance relating to COVID-19 at this time.

First and foremost, our priority is to make sure critical care units across the UK are fully up to date and informed on how to safely treat and care for their patients. 

The ICS will work in any way it can with UK agencies and stakeholders to provide a critical care perspective to support preparedness and management of the situation as it develops. The Society has already worked with the High Consequence Infectious Disease (Airborne) Network to produce FAQs on preparing your unit for COVID-19. 

Getting your unit prepared for COVID-19 (11 February, 2020)

The Society has worked with the High Consequence Infectious Disease  (Airborne) Network to develop an COVID-19 FAQ applicable to all ICUs, with thanks to Dr. Chris Meadows and the National HCID (Airborne) Network of Adult Critical Care Units.

In implementing the FAQ advice, the ICS additionally recommends units to:

(a) Clearly establish which team in your Trust (Infectious Diseases, Microbiology, Virology or Infection Control) carries responsibility for communicating with Public Health England, and how to access them in- and out-of-hours for escalation and advice.
(b) Train and prepare for effective PPE use, including safe, reliable, supervised donning and removal, as well as sample and waste management.
(c) Adopt a buddy system when managing suspected cases: roster additional staff outside the room for PPE supervision and runner duties.

Read our: 2019-nCoV (now COVID-19), critical care FAQ and advice. Published on 11 February, 2020

Please note that information relevant to Infection Prevention and Control (IPC) is subject to frequent update, and should be monitored regularly.

We also recommend you regularly check Public Health England: COVID-19: infection prevention and control guidance

IPC guidance for secondary care will shortly be updated to include specific Critical Care advice.

        
ICS COVID-19 Guidance and Resource Library 
        
 
The Society is working hard to bring you guidance and resources to help support you with the management of patients with suspected and confirmed COVID- 19.

Access the guidance and resource library here. 


 
        ICS wellbeing Resources
   
As COVID-19 intensifies, so does the need to make sure you take the time to look after your wellbeing. 

We have been working with Dr Julie Highfield to bring you resources and advice on how to sustain wellbeing during COVID-19 and beyond.

Check out our wellbeing library to download your resource pack now.

Please share amongst your colleagues, teams and networks so we can help make sure we look after one another. 

       
 
       
Calling all departmental leads
        
   
We the current department lead WhatsApp contact group is now full.

We are aware that there are still leads awaiting to gain access to this group and we are working hard to source a new platform to allow us to expand the amount of people we can allow in. To be notified of when this platform becomes available, please contact alexd@ics.ac.uk who will add you to the list. 

We thank you for your patience 
 
 

 

       
UK information and key websites for more detailed advice
       
   
 
 
 Infection Control Advice 
 
   
 
   Useful JICS articles