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Transport of patients/users during COVID-19
This article describes the basic measures that are recommended to reduce the risk of transmission, as well as enhanced measures that are relevant in the event of an increased risk of transmission. The purpose is to protect patients/users and employees against infection, and to limit the spread of infection. The advice is based on the Guide to infection control for public transport (the Norwegian Directorate of Health), with separate assessments for patient transport.
The article describes:
- Transport of patients/users without suspected or confirmed COVID-19
- Ordinary patient transport
- Reinforced measures
- Transport of patients/users with suspected or confirmed COVID-19
Municipalities can introduce stricter measures locally
The local or national infection control authorities decide at what level the various measures are to be applied. Municipalities can introduce stricter measures locally based on the infection situation.
The applicant must state which infection control measures must be implemented before and during transport and whether COVID-19 is suspected or confirmed. The information shall not contain patient information.
- The need for assistance and the need for aids such as a walker, wheelchair or similar must be clarified when ordering transport.
- As far as possible, the need for assistance should be taken care of by a companion/ relative.
Each company is responsible for assessing whether the transport satisfies basic requirements for infection control, and therefore can be offered. Each company must consider how the measures should be adapted to local conditions. In addition, it is important to carry out a risk assessment to identify the risk of infection and other circumstances that may arise as a result of coronavirus. Please also refer to information on the Norwegian Labour Inspection Authority's website.
The transport company must follow national and/or local guidelines for infection control measures and establish routines for how to carry out transport.
- Ensure that all employees are familiar with these routines and have received training in current routines and facilitate the implementation of these.
- Arrange for the infection control measures to be followed by both the driver and the patient/user before, during and after transport.
- Provide information to patient/user.
- Consider establishing separate teams of drivers who receive training in enhanced infection control routines, including the use of protective equipment, for the transport of patients with suspected or confirmed COVID-19.
- Keep a record of drivers who have transported patients/users with suspected or confirmed COVID-19.
- Develop routines for cleaning vehicles.
Each driver has an individual responsibility to familiarise themselves with the current routines for transporting patients/users during the COVID-19 pandemic. The driver must assist patients/users so that they can comply with the infection control advice.
Additionally, each individual driver must;
- Stay at home if they develop symptoms of illness.
- Maintain good hand hygiene and cough etiquette.
- Strive for a distance of 1 metre to the patient/user during transport.
- Do not shake hands with the patient/user or companion.
- Perform hand hygiene before and after assisting the patient/user, in cases where this assistance is needed.
The patient/user should receive information so that they will be able to follow the infection control advice specified by the transport company during the entire journey.
Transport of patients/users without suspected or confirmed COVID-19
The probability of transmission increases with the time spent together. For longer transport stages (for example more than one hour), the need for enhanced infection control measures should be considered, for example, that both the patient and the driver use a face mask.
- Depending on the type of means of transport/car, a distance of 1 metre must be arranged between patient/user and driver during transport. Preferably use a means of transport that maintains a distance between driver and patient/user and any fellow passengers.
- For passenger cars/taxis: The patient/user/companion should sit in the back seat. The distance between the driver and passengers in the back seat is considered sufficient as they do not sit face to face.
Enhanced infection control measures:
- Patients/users/companions and the driver should wear face masks during the journey.
- Passenger cars/taxis: In order to maintain distance, the patient/user/companion should not sit in the front seat.
- Review cleaning routines and assess the need for increased cleaning.
Transport of patients/users with suspected or confirmed COVID-19
A patient/user with confirmed COVID-19 should be transported alone, except for necessary companions. In situations where the infection status is unclear, infection control measures should be equivalent to if the patient / user has confirmed COVID-19.
If possible, transport should be postponed. If transport cannot be postponed, transport and necessary precautions should be clarified in advance and in consultation with the health and care service (hospital / municipal health services / private health provider). Alternative transport in the form of an ambulance can be considered.
Healthcare workers who work in contact with patients with confirmed coronavirus infection are recommended to turn off the Smittestopp app during work hours.
General infection control measures:
- If possible, a distance of 2 metres between driver and patient/user is recommended.
- The driver, patient/user and companion must wear a medical face mask during the entire transport.
- The driver should also wear eye protection (visor or goggles), coat and gloves.
- Ensure that the driver and patient/user can perform hand hygiene before and after transport. Hand hygiene can be performed with hand disinfectants. The use of gloves does not replace the need to perform hand hygiene. Therefore, routine use of disposable gloves is not recommended. Hand hygiene is performed immediately after removing gloves.
Always prepare the following equipment before transport:
- hand disinfectant gel and disinfectant wipes
- face masks
- eye protection (visor or glasses)
- paper towels
- rubbish bags
- Where possible, do not use ordinary cars (5-7 seats). This is based on an assessment that the distance between the driver and patient/user will be too small to prevent transmission.
- Use a bus, minibus or other vehicle where the distance between driver and patient/user is more than 2 metres. As a general rule, no more than one patient/user should be transported at a time, in addition to a companion (if required).
- Keep a distance of 2 metres between the driver and patients/users when entering and leaving the vehicle where possible.
- During transport, set the vehicle's ventilation / air conditioning system so that the air does not circulate inside the car, ventilation with open windows is also possible.
- Patients/users and companions should put on a face mask before entering the vehicle. Face masks can be removed after the patient/user and companion leave the vehicle.
- The driver should open and close the vehicle doors so that the patient/user can avoid touching contact surfaces as much as possible when entering and leaving the vehicle, and during the journey.
Cleaning includes areas that patients/users have been in direct contact with and surfaces near to where the patients/user were sitting (approximately 1 metre).
If bodily fluids such as saliva, urine, or vomit are spilt in the vehicle follow this advice:
- For all contact with spills the person performing the cleaning should consider using protective gear (face mask, eye protection and gloves).
- Wipe up spills using paper towels that are disposed of immediately.
- Dispose of rubbish with general household waste.
- Wipe the area with a clean, damp cloth or disposable disinfectant wipes.
- Perform hand hygiene after taking off gloves.
Clothing, luggage, walking frames and other belongings are assumed to cause little contamination in a vehicle. It is therefore not necessary to clean the luggage compartments, but perform hand hygiene after handling these items.