15 August 2022

COVID-19 Framework for System Alert and Response (SAR)

The WA Health COVID-19 Framework for System Alert and Response (SAR) (PDF 598KB) has been developed to inform WA’s public health services’ processes and interventions in response to changing risks of COVID-19 transmission in the community.

The role of the SAR is to assist hospitals and health services manage the risks of COVID-19 transmission in a consistent and coordinated manner, while at the same time ensuring provision of appropriate care and safety for patients, staff and visitors.

You should continue to refer directly to these webpages and frequently check for updates. The SAR Framework is designed to be a live resource meaning it will be reviewed and updated regularly by the Department of Health. This will be in line with the latest advice from the WA Health Chief Health Officer, and emerging state, national and international best practice and evidence.

The SAR has been collaboratively developed by the Department of Health, Health Service Providers, and key subject matter experts, including public health, infection diseases and other clinical leaders from across the WA Health system.

It includes an agreed, minimum set of guidance on topics such as:

  • use of personal protective equipment (PPE)
  • arrangements for elective surgery, outpatient services and specialist day services
  • public dental services in the community
  • patient testing and screening requirements, for different care settings such as unplanned and planned care
  • health care worker screening
  • student and volunteer access
  • visitor access

Alert levels

Alert levels can be applied to all of Western Australia, or to specific geographical regions.

There are five risk levels, with each rating reflecting the risk of COVID-19 transmission in the community and how a health service should respond and prepare to reduce that risk. 

All decisions to change risk ratings are made by the Western Australian Department of Health.

Determining alert levels and risk ratings

Regular monitoring of key community, public health and health system COVID-19 indicators will help inform the WA Chief Health Officer and Department of Health in their review and determination of the appropriate alert level for each region.

The decision to change an alert level is made by WA’s Chief Health Officer. If it is decided a risk rating should be changed in a particular region, the Department of Health will enact and communicate the decision to health services. This website will also be updated to reflect changes.

The SAR has been developed to be flexible and provide clear escalation and de-escalation guidance for public health services in Western Australia and facilitate rapid decision making by the Chief Health Officer.

Current alert level

The map below shows the current alert level in place across Western Australia.

 

Alert level Location Date the risk rating was applied
COVID-19 transition (blue) Goldfields
Kimberley
Mid West
Pilbara
Perth / Peel
South West
Great Southern
Wheatbelt
15/08/2022

Responses at different alert levels

See advice on appropriate health service procedures and activities at Blue alert.

PPE guidance

The following applies at all alert levels unless additional PPE guidance is recommended at a particular alert level:

  • Standard precautions are the work practices required to achieve a basic level of infection prevention and control for all patients at all times. They include hand hygiene, respiratory hygiene, reprocessing of reusable medical devices, aseptic techniques, sharps/waste and linen disposal and environmental cleaning and use of PPE
  • Transmission-based precautions are extra work practices required in situations where standard precautions alone may be insufficient to prevent infection. They include droplet, contact and airborne precautions based on the route of transmission of the infectious agent e.g. use of a negative pressure isolation room (NPIR), allocation of single rooms, cohorting of patients, appropriate air handling, and enhanced cleaning and disinfection.
  • Transmission-based precautions must be used for COVID-19 positive patients, close contacts, patients who are symptomatic, and patients awaiting COVID-19 test results. At a minimum this should include wearing fit-checked PFR, gowns, gloves and protective eyewear for direct care
  • For all Aerosol Generating Procedures (AGPs) PFR, gown, gloves and protective eyewear are to be used 
  • For all Aerosol Generating Behaviours (AGBs) risk assess and manage as per local policy
In addition to the precautions outlined above:

All staff (all public health service facilities):
  • To wear a surgical mask, at a minimum, across all areas of the health facility. 
  • To wear fit tested and fit checked PFR* in ED (unless an area has been individually risk assessed to not require PFR. Definition of risk assessment for higher risk areas is set out in Appendix 1) 
  • To wear fit tested and fit checked PFR* when providing clinical care to vulnerable patients/cohorts. Definition of vulnerable patients/cohorts is set out in Appendix 1. 
  • Any staff member, may wear fit tested and fit checked PFR, in any setting if preferred 
  • Staff to comply with physical distancing in all shared areas (including meeting/tea rooms) where possible 
Patients:
  • All positive patients and close contacts, in all settings, to wear a surgical mask, at a minimum (or PFR if they choose or have been advised), as clinically tolerated, as per the COVID Transition (Face Covering) Directions unless they have a mask exception
  • Patients should be encouraged to wear a surgical mask
Visitors/Carers:
  • All visitors/ parents/carers/statutory personnel 12 years and over to wear a surgical mask in all clinical and non-clinical areas unless there is a mask exception under the COVID Transition Face Covering Directions or they choose to wear a PFR (fit-checked at their discretion).

*As per the COVID Transition (Face Covering) Direction a person may be exempt from wearing a face covering if they have a physical, developmental or mental illness, injury, condition or disability which makes wearing a face covering unsuitable

Supporting guidance

Healthcare worker screening and testing guidance
  • Health Care Workers include: all staff at a public or a public-private-partnership (PPP) health care facility setting, volunteers, students or others on clinical placement at these sites
  • All HCWs must be fully vaccinated unless a valid exemption exists

Symptomatic

  • If COVID-19 symptoms develop undertake RAT immediately (unless within 4 weeks of release from isolation)
  • If RAT positive:
    • isolate as per current COVID Transition (Testing and Isolation) Directions and refer to release from isolation guidance 
    • Stay home until well, (afebrile for 24hrs and resolution of acute symptoms) manage as appropriate and seek medical assistance if needed
  • HCWs who have recovered from COVID-19 and develop new acute respiratory symptoms, refer to Testing – Recent cases 
  • If exposed to COVID-19 in the workplace, manage as per the COVID-19 Infection Prevention and Control in Western Australian Healthcare Facilities guidelines

Asymptomatic and ongoing surveillance

  • No testing required for asymptomatic staff
  • Consider voluntary RATs 72 hourly, for vulnerable health care workers, HCWs working with vulnerable patients/cohorts or in higher-risk hospital areas. Definition of higher-risk hospital areas and Vulnerable patients/cohorts as set out in Appendix 1 applies. 

Close contacts

  • Asymptomatic close contacts must advise their employer that they are a close contact, and receive confirmation from their employer that they can attend work
  • The employer will determine if asymptomatic HCWs should attend work based on an individual risk assessment
  • Must return a negative RAT prior to each shift and actively monitor for symptoms
  • Wear a surgical mask outside the home at a minimum, and at work follow PPE guidance
  • If develop symptoms must leave the workplace and return home immediately and undertake a COVID-19 test

Recent Cases

  • If after the period of isolation has finished, there is substantial resolution of acute respiratory symptoms and no fever for 24 hours without the use of fever reducing medications, can be released from isolation. However, HCWs cannot attend work within 7 complete days after returning a positive test
  • If develop new acute respiratory symptoms, after release from isolation, stay home, no routine testing and seek medical care if needed
  • Recent cases who are within 4 weeks of release from isolation, no COVID-19 testing unless local HSP/hospital policies apply or assessed by a clinician that testing is required 

Supporting guidance

Patient screening and testing guidance

Screening questions - all presentations and all settings

  • Screen/risk-assess all attendees for symptoms of COVID-19, positive cases and close contacts 

Symptomatic unplanned presentations (including ED)

  • RAT patients with COVID-19-like symptoms, 
  • If RAT negative and symptoms persist, consider alternative diagnoses and PCR for other respiratory viruses 
  • If RAT positive, continue care with appropriate infection prevention and control assessment and precautions 
  • If RAT positive and history of recent infection (release from isolation within 4 weeks)*, for case-by-case assessment and clinical decision for further testing and management 
  • Refer to PPE guidance for infection prevention and control measures
  • No testing for release from isolation unless significantly immunocompromised, a renal dialysis patient or local HSP/hospital policies apply. Refer to Release of cases from isolation Information for clinicians for further information

Symptomatic planned presentations (including elective surgery/procedure)

  • RAT patients with COVID-19-like symptoms on presentation or at home within 24 hours of presentation 
  • See above for further management

Asymptomatic (planned and unplanned)

  • No asymptomatic testing, including for AGPs and AGBs (based on adequate PPE being in place), unless an identified close contact. 

Surveillance Testing

  • Voluntary 72 hourly asymptomatic RAT testing for patients at service discretion, dependent on facility infrastructure, airflow, ventilation, space for isolation and physical distancing. 

Supporting Guidance

Service capacity management guidance

Service Capacity (ED, General Beds, ICU, Mental Health)

  • HSPs applying local COVID-19 patient pathway protocols including service specific guidance
  • Patient Flow Command Centre actively referring COVID-19 positive patients from the COVID Care at Home program

Elective Surgery, including Private Hospitals

Public and private hospitals

  • 100% Category 1, 2 and 3 elective surgery continue
  • Continue to implement COVID-19 safe procedures (i.e. screen/risk-assess attendees for COVID-19 symptoms via questionnaires, practice physical distancing and frequent hand hygiene)
  • If COVID-19 positive, case-by-case assessment and clinical decision to continue treatment

Note: Department of Health will perform regular system assessment to determine if additional winter preparedness and/or service recovery strategies are required to manage and prioritise planned and non-urgent care, with the aim of preventing and reducing backlogs of care

Specialist day services and outpatient services (Including clinics, imaging, pharmacy, pathology) 

  • A full return to usual outpatient visits, including the ongoing use of telehealth and face-to-face appointments, where appropriate
  • Continue to implement COVID-19 safe procedures (i.e. screen/risk-assess attendees for COVID-19 symptoms via questionnaires, practice physical distancing and frequent hand hygiene)
  • Consider additional protective measures for vulnerable patients/cohorts. Definition of vulnerable patients is set out in Appendix.
  • If COVID-19 positive, for case-by-case assessment and clinical decision to continue treatment
  • Patient group sessions should include a prior risk assessment that considers infrastructure, airflow, ventilation, space for isolation and physical distancing and should continue with appropriate mitigation strategies in place

Supporting guidance

Public community dental services guidance
  • Dental clinics to screen attendees via a pre-appointment questionnaire to determine if they are COVID-19 positive, symptomatic or close contacts
  • Patients who are COVID-19 positive or symptomatic should have their dental treatment deferred if not urgent. Refer to COVID-19 positive or symptomatic section below.
  • Close contacts should continue to receive care as usual, with evidence of negative RAT
  • For all other patients, face to face appointments can continue with the following requirements:
    • Alcohol Based Hand Rub (ABHR) on arrival
    • Pre-procedural mouth rinse
    • Physical distancing measures are to be in place in reception and waiting areas
  • Service recovery plans to be in place to resume routine care and manage and prioritise any backlogs

AGPs on asymptomatic

  • Use of rubber dam and high-volume evacuation (HVE) is highly recommended
  • Staff must wear a fit-tested and checked PFR and protective eyewear and long-sleeved gown during the AGP and for 30 minutes after

COVID-19 positive or symptomatic

  • Deter care if not required
  • If patient required urgent care which cannot be postponed, a face-to-face appointment can occur provided with the following requirements:
    • Patient to use pre-procedural mouth rinse
    • Staff in treatment space must wear a PFR, protective eyewear and long-sleeved gown
  • For AGP’s on patients who are COVID-19 positive or symptomatic :
    • A single room with the door closed or a closed cubicle to be used if possible
    • If no cubicle, physically distance from other staff and patients (at least 2 metres) and limit the staff and other patients in the treatment space as much as possible. Visitors should not be present
    • Staff in treatment space must wear a PFR, protective eyewear and long-sleeved gown during and for 30 minutes after the AGP
    • Use of rubber dam and high-volume evacuation is highly recommended
    • Leave treatment space undisturbed for 30 minutes prior to cleaning due to the reduced air exchange rates in community clinics

Supporting guidance

* Other recommended public health safety precautions apply including use of detergent and disinfectant for all patient surrounds and high touch surfaces

Public mental health services guidance

Refer to patient screening and testing guidance

For patients who are COVID-19 positive or symptomatic with unknown COVID-19 status:

  • Isolate in a single ensuite room, if patient able - if patient is unable to isolate then place patient in a cohorted zone for maximum preventative measures
  • Continue care with appropriate infection control precautions
  • Consider if telehealth is clinically appropriate
  • Use state-wide coordination for bed management/allocation via the mental health Patient Flow Coordinator

For community services, home visits, group therapy and face to face appointments, patients (if suitable*), carers, and visitors to

  • Wear a surgical mask, unless there is a mask exception* or a patient is unable to tolerate a mask due to their clinical circumstances
  • Follow physical distancing and standard precautions
  • Consider if telehealth is clinically appropriate
  • Undertake a risk assessment prior to re-introducing group therapy sessions and put appropriate mitigation strategies in place. Definition of risk assessment for higher risk areas is set out in Appendix 1
  • For paediatric mental health services, both parents are considered essential visitors/carers and both should attend appointments and family therapy
  • For ECT and rTMS, can occur as per normal arrangements with inclusion of COVID-19 risk assessment and mitigations in place
  • For day leave, voluntary patients should continue to have the right to access leave. Screen patients on return from leave and follow Patient screening and testing guidance
  • Voluntary 72 hourly asymptomatic RAT testing for patients at service discretion

* As per the  COVID Transition (Face Covering) Direction a person may be exempt from wearing a face covering if they have a physical, developmental or mental illness, injury, condition or disability which makes wearing a face covering unsuitable

Supporting guidance

Further specific guidance can be found in other sections of the SAR

Student and volunteer access guidance

Access for students/clinical placements

  • Where possible, placements to be maintained. Noting vaccination, PPE, Healthcare Worker testing guidance requirements

Access for volunteers

  • Volunteers arepermitted, providing they are vaccinated and appropriately trained in use of PPE, Guidance for PPE and Healthcare Worker testing applies as considered part of staff group

Supporting guidance

Visitor access guidance

Visiting hours and numbers

  • Visiting hours as per local site policies/guidance.
  • No more than two visitors per patient may visit at a time (not including essential visitors defined in the Visitor Guidelines)
  • When more than two (2) visitors are requested, approval is required from the person in charge of a hospital or their authorised delegate as per the Visitors to Hospital and Disability Support Accommodation Facilities Direction. Approval to allow more than 2 visitors should be based on a risk assessment of the patient and clinical area
  • Outside of visiting hours, only essential visitors/or those with approved exemptions allowed

Proof of vaccination

  • Proof of vaccination checks to be conducted at the health services discretion
  • Signs, at every access point to the public health service facility, must be in place advising visitors that accepted proof of vaccination or proof exemption must be made available upon request by a relevant officer or member of staff. Refer to the Proof of Vaccination Directions

Screening and Testing

  • Screen/risk-assess all visitors including carers/parents/guardians for, symptoms of COVID-19, positive cases and close contacts
  • Asymptomatic visitors attending to visit vulnerable patients/cohorts must have a RAT on presentation or evidence of a negative RAT result taken at home within 24 hrs of presentation. Refer to Appendix 1 for definition of vulnerable patients/cohorts.
  • Asymptomatic visitors NOT visiting vulnerable patients/cohorts are not required to have a RAT.

Symptomatic, close contact and positive visitors

  • COVID-19 positive or close contacts are NOT permitted to enter a health facility (irrespective of RAT result) within seven days of being identified as a case or a close contact unless approved for compassionate or end of life reasons
  • Symptomatic visitors are NOT permitted to enter health facility (irrespective of RAT result) at any time unless for compassionate reasons or end of life reasons.
  • Symptomatic visitors attending for compassionate or end of life reasons must have approval, must undertake a RAT and have an IPC plan in place for short, ushered visits.

Refer to COVID-19 Public Hospital Visitor Guidelines and Visitors to Hospital and Disability Support Accommodation Facilities Direction for detailed guidance and operational principles

Supporting guidance

Supporting guidance materials

The following links and guidance materials provide detail to the high level advice which has been mapped and collated into the SAR. People should continue to check the information published at these links to ensure they are reviewing the most up to date, published guidance.

National guidelines

State guidelines for WA

Definitions of frequently used terminology

Some high level definitions for terms used in the SAR and related to COVID-19 have been outlined below.

COVID-19 definitions

Carer

Carer including essential visitors such as a Labour support person, parent or designated guardian of an admitted child (including a neonate), designated guardian for a patient living with a disability, an end-of-life support person, a family member or friend required to visit a patient in the case of an emergency. 

Clinical and Epidemiological risk factors

Clinical risk factors are symptoms of COVID-19 infection and include fever, sore throat, cough, 

fatigue, runny nose, loss of taste and smell and/or difficulty breathing, vomiting and/or diarrhoea.

Other risk factors include: 

  • close contacts of cases, 
  • Those waiting on test results
  • Unvaccinated or partially vaccinated
  • Known cases

Community based clinical care

Includes patient facing care in community-based settings run by HSPs, including for example Child and Adolescent Community Health Clinics, WACHS remote area clinics and nursing posts, public community dental services, home based settings and outreach care 

Community transmission

Community transmission refers to when there are multiple COVID-19 cases in the community, where the source is unknown and presumed to have been acquired from another case within that jurisdiction

Health Care Worker

A person who provides health, medical, nursing, midwifery, pathology, pharmaceutical, social work or allied health services to a patient at the health care facility (irrespective of whether those services are provided for consideration or on a voluntary basis and irrespective of whether that person is employed or engaged. Including: Volunteer, student in placement, health support workers and ambulance officer.

Higher-risk hospital areas

Higher risk hospital areas are those areas risk assessed by the local site where:

  • There is a higher proportion of patients who may have undiagnosed COVID-19 
  • There occurs a higher risk of aerosol generating behaviours such as yelling, shouting, 
  • It may be more difficult to maintain physical distancing or PPE use

Refer to definition of Risk assessment for higher risk areas.

Mental Health Advocates and other statutory personnel

Mental Health Advocates are not considered visitors and have a statutory right to access mental health units under the Mental Health Act 2014. Other Statutory Personnel may also be required to undertake legal, safety, Industrial relation and emergency functions. 

Outpatient services

Includes clinics, imaging, pharmacy, pathology etc.  May include examination, consultation, treatment, or other service provided to non-admitted non-emergency patients in a specialty unit or under an organisational arrangement administered by a hospital.

Public health service facility

A facility at which public health services are provided

Risk assessment for higher risk areas

Risk assessment undertaken by local sites should include assessment of: 

  • adequate infrastructure, airflow, ventilation, space for isolation and physical distancing in the patients room, cubicle, bathroom or other areas where care is provided to that patient
  • Patient population group i.e. vulnerable patients/cohorts
  • COVID-19 status of patient (i.e. patients awaiting COVID-19 test results, known positive cases)
  • Urgency of the treatment that is required

Specialist day services

Includes planned frequent/ regular patient presentations for services such as dialysis, chemotherapy, haematology (i.e. frequent transfusions) or short stay admission (<24 days) to another service provided to non-emergency patients in a specialty unit or under an organisational arrangement administered by a hospital

Visitor

A family member or friend who is not a carer, or someone with a statutory role.  Refer to Visitor Guidelines for additional definitions of different types of visitors.  

Vulnerable patients/cohorts

Individuals or groups of individuals who are assessed by the local site to be significantly immunocompromised.

Abbreviations
Abbreviation High level definition Abbreviation High level definition
AGPs Aerosol-Generating Procedures PFR Particulate Filter Respirator
AGBs Aerosol-Generating Behaviours PHSM Public Health and Social Measures
BAU Business As Usual PPE Personal Protective Equipment
CDNA Communicable Diseases Network Australia PCR Polymerase Chain Reaction
CHO Chief Health Officer rTMS Repetitive transcranial magnetic stimulation
DoH Department of Health RAT Rapid Antigen Testing
ED Emergency Department SA South Australia
ECT Electroconvulsive Therapy SAR WA Health COVID-19 Framework for System Alert and Response
HCW Healthcare Worker SHICC State Health Incident Control Centre
HSPs Health Service Providers SME Subject Matter Experts
IC Incident Controller TBC To be confirmed
ICU Intensive Care Unit VIC Victoria
LWC Living with COVID-19 WA Western Australia
NSW New South Wales WACHS Western Australian Country Health Service
NPIR Negative Pressure Isolation Room    

Further information

Links to relevant policy and guidance documents are included in supporting guidance materials section and provide further detail around each of the guidance topics.

Each health service provider will have additional site and service specific operational protocols and pathways which are not part of the SAR. Therefore, please check your local COVID-19 resources.

The SAR does not cover other broader public health and prevention strategies to reduce community transmission risks, HSP specific procedures including influenza season and HSP surge management processes, guidance for other non-WA Health healthcare service settings, pharmaceuticals and therapeutics information, or specific clinical pathways or models of care. COVID-19 service preparedness actions are also outside the scope of this guidance.