Transport of high risk or confirmed patients with

pandemic respiratory infections (MERS, SARS,

SARS-CoV-2 or Novel Coronavirus, Pandemic

influenza)

Transport of a patient

Document ID CHQ-PROC-63005 Version no. 2.0 Approval date 21/08/2020

Executive sponsor Executive Director Medical Services Effective date 21/08/2020

Author/custodian Infection Management and Prevention Service Review date 21/08/2023

Supersedes 1.0

Applicable to All Children’s Health Queensland Staff

Authorisation Executive Director Clinical Services QCH

Purpose

This procedure provides recommendations regarding best practice for transporting a patient with suspected or

confirmed coronavirus including Middle Eastern Respiratory Syndrome (MERS) Coronavirus, Severe Acute

Respiratory Syndrome (SARS), and any Novel Coronaviruses (Emerging diseases) in Children’s Health

Queensland (CHQ).

Scope

This procedure applies to all Children's Health Queensland staff, healthcare students, consultants and

contractors.

Procedure

Movement and transfer of a patient with confirmed or suspected COVID-19

Patients with suspected or confirmed (High -Risk Patient) SARS-CoV-2 or other novel respiratory pathogens

should be managed in negative pressure single rooms. Patients deemed with low risk of SARS-CoV-2 with

acute respiratory symptoms can be managed can be managed in a single room (refer to COVID-19 Personal

Protective Equipment Flowchart to ascertain level of risk of patient). This document details how to move such

patients between areas of the hospital when necessary.

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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It is to be used in conjunction with the CHQ-PROC-63002 - Infection Control Guidelines for the Management

of Coronavirus (MERS, SARS, SARS-CoV-2 or Novel Coronavirus).

Patient movement / transfer

The transportation and movement of patients outside of the negative pressure room should be l imited to

medically essential purposes only.

The use of designated portable X-ray equipment and other important diagnostic equipment may make this

easier.

In situations where it is necessary for the child to be transported outside of their designated room, the patient

and their carer should wear a procedural mask to contain secretions, except when they are receiving oxygen

or high flow therapy. Routes of transport that minimise exposure to staff, other patients and visitors should be

used.

The receiving area should be informed of the patient’s suspected or confirmed diagnosis and the necessary

precautions required prior to the patient being moved.

Maintain a log of contacts for high risk patients. (Appendix 2: CHQ-PROC-63002 – Infection Control Guidelines

for Management of Coronavirus)

Quarantine the transfer pathway including exclusive use of a lift during patient transfer as directed by nursing

staff / treating team

• Call Security on 3068 3222 to isolate lift 18 or 19; note Security will not need to ride in the lift.

• Security do not need to enter the patient’s room. Their role is to ensure the path is clear. In most situations,

two security guards are required:

– One to clear the pathway at origin and to call and quarantine the lift.

– One to clear the pathway at destination.

• This lift does not need to be cleaned after a coronavirus patient has transited through the lift, regardless of

respiratory support.

• CHQ Retrieval Service to lead transfer to the Paediatric Intensive Care Unit (PICU)/Emergency Department

(ED) and home ward to lead transfer to receiving ward/location. The receiving location must always be

informed of an incoming transfer.

– Staff who are transporting the patient should wear contact, droplet with eye protection personal protective

equipment (PPE) in keeping with high risk patients. (To identify level of risk of patient use COVID-19

Personal Protection Equipment Flowchart)

• Medirest porters and Security to attend patient care area for planning prior to patient transfer and assist with

transfer / quarantine of lifts / clearing of the transport route.

– Porters will don contact, droplet with eye protection PPE

– If possible, Security should quarantine the lift from outside. If Security are required to travel in the lift with

the patient, they should also wear contact, droplet and eye protection PPE.

– Please refer to CHQ-WI-63320 – Medirest Transport Guide -COVID-19

• After transfer, PPE should be doffed in accordance with CHQ-PROC-63317- Donning and doffing procedure

(refer to the sequence for donning and doffing PPE).

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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• After a suspect or confirmed case leaves the room, the room should be cleaned with an orange clean with

the cleaner wearing appropriate PPE in line with the risk stratification of the patient, within the time frames

below if a high-risk patient.

Air circulation times in negative pressure rooms post a high-risk patient leaving

ED: 30 minutes

PICU: 30 minutes

9a: 40 minutes

9a Bed 10: 60 Minutes

Theatre 14: 40 Minutes.

ALERT

Please note that the room can be cleaned by the cleaner earlier wearing appropriate

PPE.

Please refer to the following procedures for high risk and low risk patients and cleaning requirements and PPE:

• CHQ-WI-63324- Medirest cleaning and waste removal (PICU)- COVID-19

• CHQ-WI- 63319 – Medirest Cleaning and Waste Removal (Emergency and ward) -COVID-19

Transferring a patient on high flow nasal prongs

High Flow Nasal Prongs (HFNP) is considered an aerosol generating procedure (AGP). If the patient can be

safely transferred on low flow nasal prongs (LFNP) rather than HFNP this would be preferred. However, some

patients will require HFNP due to their clinical condition. In this setting, IMPS recommend the following:

High risk patients

Remove HFNP and place LFNP if clinically safe. If patient is required to remain on HFNP, ensure all staff

involved in transfer are wearing airborne plus PPE as per the flow chart.

The patient does not need to wear a mask when nasal prongs are in place.

The lift does not need to be cleaned after transfer.

Ensure the parent/carer wears a procedural mask.

Low-risk patients – acute respiratory symptoms:

Remove HFNP and place LFNP if clinically safe. If patient is required remain on HFNP, ensure all staff are

wearing contact, droplet and eye precautions PPE when transferring the patient as per the flow chart.

The patient does not need to wear a mask when nasal prongs are in place.

The lift does not need to be cleaned after transfer.

Ensure the parent/carer wears a procedural mask.

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Low-risk patients – no acute respiratory symptoms

These patients do not have acute respiratory symptoms and should not require HFNP; if HFNP is required

please follow instructions as for low risk patients with acute respiratory symptoms (above).

Discharge of a coronavirus patient under current transmission-based

precautions – confirmed or highly suspected case

When discharging a patient/family who have not yet met the criteria for de-isolation, please take the following

steps.

• Patients and their families should travel home via private vehicle (not public transport, taxi or rideshare

services).

If parent/caregiver is parked in B1

– Call Security to isolate the staff lift 18 for families to enter carpark B1 where hand cleaning and bins are

available for doffing.

– Staff member to don PPE (Contact and Droplet with Eye Protection - gown, gloves, surgical mask and

eye protection).

– If possible, Security should quarantine the lift from outside. If Security are required to travel in the lift with

the patient, they should also wear contact, droplet and eye protection.

– Ensure the patient (if practical) and parent have a surgical or procedural mask on in preparation for

leaving the room and ensure good hand hygiene by parent and patient when leaving.

If patient is being collected

– Instruct the parent to collect their car and bring it to the ambulance bay on Stanley Street.

– Call Security to isolate the staff lift 18 for families to enter carpark B1 where hand cleaning and bins are

available for doffing.

– Staff member to don PPE (Contact and Droplet with Eye Protection - gown, gloves, surgical/procedural

mask and eye protection)

– Staff member and Security to escort the patient to their parent in the car at the ambulance bay and ensure

they are safe to leave.

• When removing PPE, ensure that this is removed in the correct doffing sequence including hand hygiene.

• PPE can be placed in the nearest bin a clinical waste bin is not required.

ALERT

Families who have a positive diagnosis of SARS-CoV-2, are being tested or are in

quarantine/isolation cannot use public transport/taxi or rideshare services.

If they are unable to utilise a private vehicle a QAS patient transport vehicle should be

organised.

Asymptomatic - Families under Quarantine

CHQ recognises that prolonged quarantine can have a detrimental affect on your mental health. With this in

mind CHQ is offering a nature break for family members in quarantine. This will be on level 6 garden space.

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Infection Prevention Requirements for level 6 garden space:

- Their only risk factor is being from a hotspot or requiring quarantine, no other risk factors identified.

- One family to visit the balcony at a time.

- The family members must be asymptomatic to visit the balcony.

- Nurse (USIN/AIN) must maintain social distancing and wear a mask and practice good hand hygiene

when escorting. No other PPE is required.

- Family members must practice good hand hygiene and wear a mask at all times. A new mask is to be

given each time they leave the room.

- For information on how to escort the family member to the garden please refer to Appendix 3.

ALERT

Level 6 garden space only applies to asymptomatic patients in quarantine.

Does not apply to symptomatic patients awaiting COVID clearance, or patients who meet are

quarantined due to reasons other than interstate travel (e.g contact with a COVID positive

person).

If a child/family member arrives at the screening stations for OPD or admission and are

symptomatic, they are to be escorted to ED (with a mask on)

Supporting documents

Authorising Policy and Standard/s

• Interim infection control guidelines for the management of Middle Eastern Respiratory Syndrome

Coronavirus

• Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under

Investigation for 2019 Novel Coronavirus (2019-nCoV) in a Healthcare Setting

• Infection prevention and control guidelines for the management of COVID-19 in healthcare settings. –

interim version.

• Queensland Health. Management of deceased persons who are confirmed or suspected COVID-19 cases

• CHQ-GDL- 63327 -The Management of children with COVID-19

• CHQ-PROC-63326 - Respiratory Pandemic sub plan

• CHQ-PROC-63326-1 - Disruption and Disaster Management plan – 9A

• CHQ-PROC-64712 - Visitation and access during COVID-19 pandemic-period

• CHQ-PROC-24703 - Special measures during the COVID-19 pandemic period.

• CHQ-WI-63324 - Medirest cleaning and waste removal (PICU)- COVID-19

• CHQ-WI-63321 - Medirest Food Services Guide COVID-19

• CHQ-WI- 63322 - Medirest Linen Guide - COVID-19

• CHQ-WI-63320 - Medirest Transport Guide - COVID-19

• CHQ-WI- 63319 - Medirest Cleaning and Waste Removal (Emergency and ward) -COVID-19

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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• CHQ-WI-63323 - Personal Protective Equipment (PPE) rationalisation within CHQ – COVID-19

• CHQ-WI- 64713 - Screening controls for visitation and access during COVID-19 pandemic period

Procedures, Guidelines and Protocols

• Please visit the staff portal for details information about PPE and general IMPS information for staff

• COVID-19 Personal Protection Equipment (PPE) Requirements for OPD and ED Assessment and Clinical

procedures

• COVID-19 Personal Protection Equipment Flowchart

• COVID-19 Masks and uses

• COVID-19 Risk screening flowchart (Inpatient/Outpatient)

• All COVID-19 screening outside of emergency

• COVID-19 - Personal Protection Equipment Chart Guide.

Consultation

Key stakeholders who reviewed this version:

• Clinical Nurse Consultant – Infection Management and Prevention Service

• Director of Infection Management and Prevention Service

• Infectious Diseases Consultant – COVID-19 Fellow

• Director of Clinical Support

• Executive Director Medical Services.

Definition of terms

Term Definition Source

Aerosol generating

procedures

Any medical procedure that can induce the

production of aerosols of various sizes, including

small (<5 µm) particles

WHO 2

Cohorting Placing together in the same room patients who

are infected with the same pathogen and are

suitable roommates

NHMRC 6

Negative pressure room A single-occupancy patient-care room used to

isolate persons with a suspected or confirmed

airborne infectious disease. Environmental

factors are controlled in negative pressure rooms

to minimise the transmission of infectious agents

that are usually transmitted from person to person

by droplet nuclei associated with coughing or

aerosolisation of contaminated fluids.

NHMRC6

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Term Definition Source

Personal Protective

Equipment (PPE)

A variety of barriers used alone or in combination

to protect mucous membranes, skin, and clothing

from contact with infectious agents. PPE includes

gloves, masks, respirators, protective eyewear,

face shields, and gowns.

NHMRC6

Audit/evaluation strategy

Level of risk Medium

Strategy Monitor for trigger incidents

Observation of cleaning and PPE use

Incidents involving transport of patients with suspected confirmed Coronavirus

Audit/review tool(s)

attached

Nil

Audit/Review date As required in preparation and during pandemic responses

Review responsibility IMPS CNC

Key elements /

Indicators / Outcomes

Correct use of PPE

Rapid and appropriate isolation/cohorting

Procedure revision and approval history

Version No. Modified by Amendments authorised by Approved by

1.0

24/06/2020

CNC, Infection Management

and Prevention Service

Director – Infection

Management and Prevention

Service

Executive Director Clinical

Services - QCH

2.0

21/08/2020

CNC, Infection Management

and Prevention Service

Divisional Director Clinical

Support

Executive Director Clinical

Services - QCH

Keywords Infection Control, MERS, Middle Eastern Respiratory Syndrome, Coronavirus, Novel, SARS,

Wuhan, suspected, confirmed, Coronavirus,63002, COVID-19, SARS-CoV-2, 63005

Accreditation

references

NSQHS Standards (1-8): Standard 3 – Preventing and Controlling Healthcare Associated

Infections.

ISO 9001:2015 Quality Management Systems: (4-10)

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Appendix 1Routes of transfer of a patient with confirmed or suspected

Coronavirus

Calling lift 19

Call Security with ETA to isolate lift 19, meet at arrival point and assist with quarantine of route to be used to

move patient throughout QCH to destination

Location of lifts 18 and 19

Lifts 18 and

19

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SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Route to be used for

ED to lift 18 or 19

CHQ Recovery Service (CHQRS)/helicopter landing services route lift 19 to ED isolation

rooms

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Route to be used for

PICU discharges to 9a (lift 18 or 19 to 9a rooms)

ED transfers to 9a (lift 18 or 19 to 9a rooms)

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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PICU

Route to be used for

Staff lifts/lift 19 to theatre/Post-Anaesthetic Care Unit (PACU)

Theatre/PACU to staff lifts/lift 19

Staff lifts/lift 19 to PICU directly

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SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Route to be used for

PICU admissions (includes Medical Emergency Team (MET) calls) from ED, QCH inpatient

wards or CHQRS (lift 19 to Riverside PICU)

PICU discharges to inpatient wards (PICU to lift 19)

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SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Appendix 2 Patient transport checklist

COVID-19 (suspected high-risk or confirmed) Patient Transport Checklist

Set up/Preparation

Consult and confirm with receiving team that they are ready to receive patient and bedspace/location.

Allocate key roles:

• 2 clinical staff for escort

• 1 porter

• 1 parent

• 1 escort (Security available 24/7 on 3068 3222 need minimum 10min warning)

Check relevant route outlined in Policy Appendix 1

Don PPE (if not already on as per policy appendix). Security need wear Contact, Droplet and Eye

protection.

Patient barrier (surgical or procedural mask for patient, unless intubated or receiving low or high flow

oxygen)

Equipment check:

• Monitor/Suction

• Oxygen

• Facemask, filter, breathing circuit/Air Viva

• Respiratory support device (Airvo, ventilator) DO NOT TRANPORT INTUBATED PATIENTS via

bag and mask ventilation. They must be attached to ventilator to reduce AGP.

• Resuscitation guide/medications

• Relevant Documentation/chart

Clinical RECAP prior to moving (ABCDEF)

Patient safe to leave

Check parent/carer has surgical face mask

Transfer

Confirm destination ready (Contact receiving location TL/Shift coordinator to confirm ready. In PICU

use vocera to alert all staff to close patient bedside doors and curtains)

“This is [identify self and location]. We are ready to transfer [patient name] who is a suspected/

confirmed COVID-19 patient. Is the receiving team ready and in PPE?”

Transport via shortest route as per policy Appendix 1

Clean escort (Security) walks 2 metres ahead and summons lift if needed

Destination

Handover patient PRIOR to transfer to ward support Monitoring

• O2/Respiratory Support

• IV fluids/infusions

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Clinical handover

Transport team /Equipment cleaning:

• Clean equipment in the patient room with Clinell wipes

• Move equipment out of patient room (due to size of equipment i.e stretcher push equipment

directly out of patient room into hallway instead of Anteroom). Staff member remains in patient

room

• Stay in patient room and doff as per policy, except mask

• Move to Anteroom or outside patient room and complete doffing (mask removal)

• Put on white gown and gloves and wipe down equipment with Clinell again.

Transport team debrief

CHQ-Proc-63005 – Transport of high risk or confirmed patients with pandemic respiratory infections (MERS,

SARS, SARS-CoV-2 or Novel Coronavirus, Pandemic influenza)

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Appendix 3: Transportation of the quarantine family – Asymptomatic.

CHQ has a designated AIN/USIN that can accompany the family member to certain areas around the

hospital. Areas for escorting include:

- Break space level 6 garden for a nature break.

- An entry and exit point of main QCH complex.

- Carpark within QCH building

- From the screening door to an OPD when available and no one is available at the screening station.

- Ward to one of the above locations.

ALERT

Assistance with transport is only for non-clinical use. All clinical transfers an RN/EN must

transfer the patient.

Availability

Monday – Friday 0800-1600

Weekends – Safety AIN 0900-1500 (timing by negotiation)

After Hours – emergency relief only – Safety AIN (timing by negotiation)

Important Information:

- Security is not required for escorting of a patient in quarantine who is asymptomatic.

- When a patient leaves the QCH complex the USIN/AIN does not need to continue the escort even if

they are under quarantine. They are to cease accompanying the patient, they are now under the

direction of public health quarantine orders.

Please refer to Asymptomatic - Families under Quarantine for information about the level 6 garden space.