20 May 2022

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

The WA Health COVID-19 Framework for System Alert and Response (SAR) (PDF 4MB) has been developed to inform WA’s state 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:

  • who should be wearing personal protective equipment (PPE) and when
  • arrangements for elective surgery, outpatient services and when to use telehealth and specialist day services
  • public dental services in the community
  • patient testing and screening expectations, for different care settings such as unplanned and planned care
  • health care worker screening and surveillance testing advice
  • student and volunteer access guidance
  • visitor access arrangements, including essential visitors/carers.

Alert levels

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

There are four 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 will be 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 response capacity measures will help inform the WA Chief Health Officer and Department of Health in reviewing and determining the appropriate alert level for each region.

The decision to change an alert level sits with 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 update to reflect the any changes to risk ratings.

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

Current COVID-19 Framework for System Alert and Response (SAR) ratings in place in Western Australia. The map below shows the alert level across Western Australia.

 

Alert level Location Date the risk rating was applied
COVID-19 ready (green)  N/A N/A
COVID-19 alert (amber) N/A N/A
COVID-19 active (red) Goldfields
Kimberley
Mid West
Pilbara
Perth / Peel
South West
Great Southern
Wheatbelt
03/03/2022
System at capacity (black) N/A N/A

Procedures at different alert levels

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

COVID-19 ready (green)
PPE guidance

The following applies, unless additional PPE guidance is recommended at certain alert levels below

  • Standard precautions apply at all times i.e. PPE used as required (e.g. surgical mask, gowns, gloves, protective eyewear for any patient contact or procedure when there is potential for blood/body fluid exposure)
  • Transmission based precautions e.g. negative pressure isolation room (NPIR), particulate filter respirator (PFR) when required for other diseases e.g. airborne precautions for tuberculosis, measles etc.
  • For all Aerosol Generating Procedures (AGPs) and Aerosol Generating Behaviours (AGBs), PFR and protective eyewear to be used
  • All inpatients and outpatients (if tolerated by the patient), carers, and permitted visitors presenting to any department to wear a surgical mask from entry to the facility, unless they are exempt*.

For management of patients who have tested positive for COVID-19 (PCR or RAT), symptomatic of COVID-19, currently in isolation/quarantine, or are close contacts of a case - Healthcare worker (HCW) to wear PFR, protective eyewear, gown and gloves when providing direct care.

*As per the 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

Refer to the standard precautions above.

*During the transition period to living with COVID-19 public health and social measures (PHSMs) will apply, including all visitors (and essential visitors/ carers) to wear a surgical mask

PPE advice for patient facing clinical care in community settings, including home visiting/outreach services – Refer to PPE advice for hospital settings at Green.

Supporting guidance

Service Capacity (ED, General Beds, ICU, Mental Health)
  • Continue to ensure preparedness against hospital readiness checklist
  • HSPs activate COVID-19 patient pathway protocols
  • Refer to local HSP guidance as per usual protocols and processes
Elective Surgery, including Private Hospitals

Public and private hospitals:

  • No restrictions
  • COVID-19 risk assessment is required, especially for those requiring general anaesthetic
Outpatient services including clinics, imaging, pharmacy, pathology (adults and paediatrics)
  • Face to face or telehealth appointments to occur as per normal arrangements
  • COVID-19 risk assessment is required
  • Outpatient COVID-19 plan in place

Supporting guidance

Specialist day services (adults and paediatrics) (e.g. patients undergoing renal dialysis, chemotherapy radiotherapy, transplant patients, immunosuppressed)

Screen attendees for epidemiological and clinical COVID-19 risk factors

  • Consider additional protective measures for vulnerable cohorts and high risk clinical care settings

Supporting guidance

*Note: to adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories and specialist day services may need to be reduced or can continue

Public mental health services – community, home and outpatient services
  • Face to face or telehealth appointments, including group therapy and home visits can continue
  • ECT and rTMS to proceed without restrictions
  • Consumers who are symptomatic or positive COVID-19 should not attend face to face appointments, instead: (a) alternate triaging pathways are to be available for emergency mental health care and (b) appointments to be deferred or delivered via telehealth

Supporting guidance

Local Mental Health Readiness Checklists – Further specific guidance can be found in other sections of the SAR

Public community dental services
  • Dental clinics should screen attendees for epidemiological and clinical COVID-19 risk factors via pre-appointment questionnaire
  • Patients who have clinical or epidemiological COVID-19 risk factors should not attend and alternate triaging pathways are available for emergency dental care
  • For all other patients who do not meet clinical or epidemiological COVID-19 risk factors, face to face appointments to occur as per normal
  • Dental COVID-19 plan is in place
  • Other public health safety precautions apply including use of detergent and disinfectant for all patient surrounds and high touch surfaces

Supporting guidance

Patient screening and testing (adults and paediatrics)

Screen attendees for epidemiological and clinical COVID-19 risk factors

  • Test all patients presenting to hospital with pneumonia or acute respiratory infection with a nose and throat PCR*
  • PCR* testing patients/residents with compatible clinical and/or epidemiological risk factors
  • No other testing requirements for asymptomatic patients

*If a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so

Supporting guidance

HCW screening and testing, includes volunteers and student/ clinical placements (assumes HCW are fully vaccinated)

HCWs are to seek immediate testing if they develop any symptoms compatible with COVID-19 - all to be tested with nose and throat PCR

For asymptomatic HCW working within a hospital area including Intensive Care Unit, High Dependency Unit, respiratory ward, a COVID-19 clinic, burns unit, labour and birth suite and post natal wards or other units at the discretion of the hospital operator:

  • If a HCW who has had contact with a positive COVID-19 patient is involved in a breach of infection control practices or PPE, then seek Public Health advice to decide if any additional COVID-19 testing is required, and undertake breach assessments at the HSP level, in accordance with policy

For asymptomatic, HCWs not mentioned above:

  • No routine asymptomatic testing

Supporting guidance

Student, clinical placement and volunteer access
  • Access for students/ clinical placements continue as per normal, noting restrictions on access with vaccination requirements
  • Access for volunteers permitted, follow HCW guidelines as considered part of staff group

Supporting guidance

Visitor access
  • Visitors welcome however proof of vaccination required
  • Restrictions for unvaccinated visitors*
  • All visitors and essential carers/parents/guardians to be risk assessed for wearing a surgical mask**
  • Pre-attendance health screening for all visitors and essential carers/parents/guardians based on clinical and epidemiological factors, at a minimum
  • All visitors and essential carers/parents/guardians are to be encouraged to perform hand hygiene on entry to the healthcare setting prior to entering the patient room and at regular intervals during their visits
  • Must register attendance via Service WA or Safe WA app, or manual register

*Clear exemption processes and pathways for exempt unvaccinated support person/s to be in place. Refer to visitor guidelines
**During the transition period and opening of borders, PHSMs will apply, including all visitors and essential carers/parents/guardians to wear a surgical mask

Supporting guidance

COVID-19 alert (amber)
PPE guidance

The following applies, unless additional PPE guidance is recommended at certain alert levels below

  • Standard precautions apply at all times i.e. PPE used as required (e.g. surgical mask, gowns, gloves, protective eyewear for any patient contact or procedure when there is potential for blood/body fluid exposure)
  • Transmission based precautions e.g. negative pressure isolation room (NPIR), particulate filter respirator (PFR) when required for other diseases e.g. airborne precautions for tuberculosis, measles etc.
  • For all Aerosol Generating Procedures (AGPs) and Aerosol Generating Behaviours (AGBs), PFR and protective eyewear to be used
  • All inpatients and outpatients (if tolerated by the patient), carers, and permitted visitors presenting to any department to wear a surgical mask from entry to the facility, unless they are exempt*.

For management of patients who have tested positive for COVID-19 (PCR or RAT), symptomatic of COVID-19, currently in isolation/quarantine, or are close contacts of a case - Healthcare worker (HCW) to wear PFR, protective eyewear, gown and gloves when providing direct care.

*As per the 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

In addition to the standard precautions outlined above:

  • All staff working at a healthcare facility to wear a surgical mask on entry to the facility and for the duration of their shift, this includes in shared areas such as meeting rooms, tea rooms
  • All patient facing staff who are working in clinical areas to add protective eyewear
  • PFR (e.g. N95 or P2) and protective eyewear in all areas of Emergency Departments and Mental Health Emergency Centres (or equivalents), for all patient facing staff

PPE advice for patient facing clinical care in community settings, including home visiting/outreach services: Refer to PPE advice for hospital settings at Amber

All patient facing staff to wear a surgical mask and protective eyewear during patient facing care

Supporting guidance

Service Capacity (ED, General Beds, ICU, Mental Health)
  • HSPs applying COVID-19 patient pathway protocols, including local HSP/service specific guidance
  • Patient Flow Command Centre active (monitoring)
Elective Surgery, including Private Hospitals

Public and private hospitals*:

  • 100% Category 1, 2 and 3 elective surgery continue unless if a positive case
  • COVID-19 risk assessment is required for all patients

*Note: to adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories may need to be reduced or can continue.

Outpatient services including clinics, imaging, pharmacy, pathology (adults and paediatrics)
  • Patients should not present if experiencing any symptoms of COVID-19
  • Outpatient clinics should all implement COVID-19 safe procedures (i.e. screening attendees for COVID-19 symptoms and other risk factors via questionnaires, practicing physical distancing within the clinical setting in line with density limits and PHSMs, frequent hand hygiene)
  • Alternative triage arrangements for people with COVID-19 symptoms or epidemiological factors
  • All outpatient services should return to using telehealth where possible, unless there is a critical reason why the person needs to physically attend

Supporting guidance

Specialist day services (adults and paediatrics) (e.g. patients undergoing renal dialysis, chemotherapy radiotherapy, transplant patients, immunosuppressed)

Screen attendees for epidemiological and clinical COVID-19 risk factors

  • Consider additional protective measures for vulnerable cohorts and high risk clinical care settings

Supporting guidance

*Note: To adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories and specialist day services may need to be reduced or can continue.

Public mental health services - community, home and outpatient services
  • Consumers (if suitable*) carers, and visitors presenting to community facilities to wear a surgical mask from entry and follow public health safety measures
  • Consumers* and other household members to wear surgical masks for home visits appointments
  • Face to face appointments to include physical distancing measures
  • Group therapy sessions are to be held virtually if appropriate, or reduced in participant size if face to face
  • Paediatric mental health services should ensure both parents are considered as essential visitors/carers and are able to attend appointments and family therapy together – complying with Visitor and PPE Guidelines
  • ECT and rTMS to occur as per normal arrangements and to include COVID-19 risk assessment
  • Leave. Voluntary patients should continue to have the right to access leave – refer to patient screening and test section
  • Consumers who are symptomatic or positive COVID-19 should not attend face to face appointments, instead: (a) alternate triaging pathways are to be available for emergency mental health care and (b) appointments to be deferred or delivered via telehealth

Supporting guidance

Local Mental Health Readiness Checklists – Further specific guidance can be found in other sections of the SAR

*As per the 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.

Public community dental services
  • Dental clinics should screen attendees for epidemiological and clinical COVID-19 risk factors via pre-appointment questionnaire
  • Patients who have clinical or epidemiological COVID-19 risk factors should not attend and alternate triaging pathways are available for emergency dental care
  • Face to face patient care occurs with additional requirements of clients performing hand hygiene using Alcohol Based Hand Rub (ABHR) on arrival and pre-procedural mouth rinse, practicing physical distancing measures in reception and waiting areas, and other public health safety precautions*

If undertaking an AGP, RAT required on presentation

  • AGPs should only proceed for those who are RAT negative
  • If an AGP is necessary (cannot be delayed) on a RAT positive patient they are to be referred to a public hospital
  • If an AGP is necessary, a single room with the door closed or a closed cubicle should 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
  • Use of rubber dam and high-volume evacuation (HVE) is highly recommended
  • For 30 mins after an AGP, staff must wear a PFR and leave the clinical area undisturbed prior to environmental cleaning

Supporting guidance

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

Patient screening and testing guidance (adults and paediatrics)

Screen attendees for epidemiological and clinical COVID-19 risk factors

  • Test all patients presenting to hospital with pneumonia or acute respiratory infection with a nose and throat PCR* until testing capacity is reached then consider rapid antigen test (RAT) for diagnostic purposes
  • RAT on presentation for AGPs (including dental)

For unplanned patient presentations, including ED, and attendance at emergency maternity/mental health centres (or equivalents) recommend triaging:

  • Group 1: Positive COVID-19 case. No further testing required
  • Group 2: Test with RAT and/or PCR if: (i) a patient has symptoms of, or epidemiological risk factors for COVID-19; (ii) if patient unable to use PPE effectively (e.g. agitated patients, patients with dementia); or (iii) if patient unable to provide sufficient information on their symptoms or risk factors for COVID-19
  • Group 3: patient does not have symptoms of, or epidemiological risk factors for COVID-19 infection – no RAT or PCR testing needed
  • If decision to admit patient, RAT and/or PCR recommended

For planned patient presentations –

  • PCR Testing within 72 hours pre-admission and/or RAT on arrival (vaccinated and unvaccinated)*.

NB: Patients would need to isolate after a pre-admission PCR test until admission

For patients re-presenting for care or returning from day leave:

  • All patients who last presented, or last went out on leave more than 12 hours ago to be screened for clinical and/or epidemiological risk factors AND have a RAT
  • All patients who last presented, or last went out on leave less than 12 hours ago to be screened for clinical and/or epidemiological risk factors. RAT if indicated

Elective surgery, Including Private Hospitals

Public and private hospitals*:

  • Testing within 72 hours pre-admission and/or RAT on arrival (vaccinated and unvaccinated). NB: Patients would need to isolate after a pre-admission PCR test until admission
  • In instances where a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so

Outpatient services including clinics, imaging, pharmacy, pathology – Adult and paediatrics

No routine asymptomatic testing required, except consider optional RAT on presentation for

  • (i) maternity patient visit, including maternity admissions and labour ward and birth suite attendances; or
  • (ii) other appointments where a mask cannot be worn (e.g. some  ophthalmology and dermatology)

Specialist day services * – Adult and paediatrics

COVID-19 Release from isolation information for clinicians

  • RAT on presentation at each visit - this is to be reviewed with an aim to decrease frequency dependent on patient acceptability
  • If a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so

*If a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so

Supporting guidance

HCW staff screening and testing, includes volunteers and student/ clinical placements (assumes HCW are fully vaccinated)

HCWs are to seek immediate testing if they develop any symptoms compatible with COVID-19 - all to be tested with nose and throat PCR, until testing capacity is reached then consider RAT for diagnostic purposes

For asymptomatic HCW working within healthcare settings managing very high risk patients (e.g. transplant ward, haematology unit, oncology ward, renal dialysis units, IV lounge/similar day units):

  • Voluntary twice weekly RAT with a minimal interval of 72 hours apart
  • Any breach of infection control practices or personal protection equipment should be managed by the health service infection control team

For asymptomatic HCW working within a hospital area including Intensive Care Units, High Dependency Unit, respiratory ward, a COVID-19 clinic, burns unit, labour and birth suite/ maternal foetal assessment units and post natal wards, emergency departments including mental health emergency centres/observation areas (or equivalents), and other hospital units at the discretion of the HSP:

  • Voluntary twice weekly RAT with a minimal interval of 72 hours apart
  • Any breach of infection control practices or personal protection equipment should be managed by the health service infection control team

For asymptomatic, HCWs not mentioned above:

  • No routine asymptomatic testing

Supporting guidance

Student, clinical placement and volunteer access
  • Access for students/ clinical placements where possible, placements to be maintained. Noting access with vaccination requirements
  • Placement of students into areas of higher risk of contact with COVID-19, such as COVID-19 clinics, EDs or isolation wards, should be reviewed and subject to a risk assessment
  • The exclusion of secondary (high school) students undertaking work experience is at the discretion of HSPs
  • Access for volunteers permitted, providing they are vaccinated and appropriately trained in PPE, particularly if located within clinical environments – follow HCW guidelines as considered part of staff group and refer to PPE guidance

Supporting guidance

Visitor access
  • Proof of vaccination required
  • Limitations on visitor hours and numbers of visitors to each patient, unless meet definition of an essential visitor
  • All visitors and essential carers/parents/guardians presenting to any department to wear a surgical mask
  • Pre-attendance health screening for all visitors and essential carers/parents /guardians based on clinical and epidemiological factors, at a minimum
  • Must register attendance via Service WA or Safe WA app, or manual register
  • Restrictions for unvaccinated visitors*
  • Refer to Visitor Guidelines for detailed guidance and operational principles
  • RAT testing for visitors and essential carers/parents/guardians to high risk areas/vulnerable patient cohorts. Hospital operator to determine high risk area for that hospital (e.g. oncology wards, ICU)
  • RAT every third day for long term regular visitors

Supporting guidelines

*Clear exemption processes and pathways for exempt unvaccinated support person/s to be in place. Refer to visitor guidelines

Widespread transmission (red)
PPE guidance

The following applies, unless additional PPE guidance is recommended at certain alert levels below

  • Standard precautions apply at all times i.e. PPE used as required (e.g. surgical mask, gowns, gloves, protective eyewear for any patient contact or procedure when there is potential for blood/body fluid exposure)
  • Transmission based precautions e.g. negative pressure isolation room (NPIR), particulate filter respirator (PFR) when required for other diseases e.g. airborne precautions for tuberculosis, measles etc.
  • For all Aerosol Generating Procedures (AGPs) and Aerosol Generating Behaviours (AGBs), PFR and protective eyewear to be used
  • All inpatients and outpatients (if tolerated by the patient), carers, and permitted visitors presenting to any department to wear a surgical mask from entry to the facility, unless they are exempt*.

For management of patients who have tested positive for COVID-19 (PCR or RAT), symptomatic of COVID-19, currently in isolation/quarantine, or are close contacts of a case - Healthcare worker (HCW) to wear PFR, protective eyewear, gown and gloves when providing direct care.

*As per the 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

  • All staff working in clinical areas at a healthcare facility to wear a surgical mask on entry & exit to the facility including in shared areas such as meeting/tea rooms and whilst transitioning to a clinical area whereby they are to change their PPE to a PFR and protective eyewear
  • All staff entering a HCF are to continue to wear a surgical mask unless they work in an area that cannot be accessed by residents, patients or visitors. Surgical masks are to be worn in areas shared with residents, patients or visitors with the addition of protective eyewear to be worn when transiting through clinical areas.
  • To ensure consistency of application in high risk healthcare settings, local mask wearing policies should be followed.

PPE advice for patient facing clinical care in community settings, including home visiting/outreach services: Refer to PPE advice for hospital settings at red, and

  • Consider alternative to home visits - i.e. telehealth alternatives
  • Reduce number of ‘others’ attending- i.e. consider how to limit attendees to care receiver and carer/parent only

Supporting guidance

Service Capacity (ED, General Beds, ICU, Mental Health
  • HSPs activate internal COVID-19 capacity management protocols
  • Patient Flow Command Centre active – coordinating flow of COVID-19 Care at home patients into acute hospital settings
Elective Surgery, including Private Hospitals

Public hospitals*:

  • 100% category 1
  • Reduce/defer Category 2 & 3 elective surgery in accordance with the caps set by the Department of Health.
  • COVID-19 risk assessment is required for all patients

When directed by the Department of Health:

  • Reduce/Defer Category 3 elective surgery
  • Defer cosmetic surgery and non-medical procedures

*Note: To adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories may need to be reduced or can continue.

Outpatient services including clinics, imaging, pharmacy, pathology (adults and paediatrics)
  • Patients should not present if experiencing any symptoms of COVID-19
  • Provide Outpatient services by telehealth and defer non-urgent face to-face consulting where clinically safe
  • Outpatient clinics should all implement COVID-19 safe procedures (i.e. screening attendees for COVID-19 symptoms and other risk factors via questionnaires, practicing physical distancing within the clinical setting, in line with density limits and PHSMs, frequent hand hygiene)

Supporting guidance

Specialist day services (adults and paediatrics) (e.g. patients undergoing renal dialysis, chemotherapy radiotherapy, transplant patients, immunosuppressed)

Screen attendees for clinical COVID-19 risk factors

  • Consider additional protective measures for vulnerable cohorts and high risk clinical care settings

Supporting guidance

*Note: To adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories and specialist day services may need to be reduced or can continue.

Public mental health services - community, home and outpatient services
  • Face to face appointments are to cease, be deferred or held virtually where possible and clinically appropriate
  • Group therapy sessions are to cease, be deferred or held virtually where possible and clinically appropriate
  • If urgent care is required in outpatient setting, community or home and cannot be deferred or delivered via alternative methods (e.g. telehealth), assessment and treatment (including administering medication) will be provided and consumer to wear surgical mask, as per Amber Alert guidance
  • Paediatric mental health services should ensure both parents are considered as essential visitors/carers and are able to attend appointments and family therapy together – complying with Visitor and PPE Guidelines
  • ECT and rTMS. Defer routine and planned ECT and rTMS, where appropriate and based on clinical assessment
  • Leave. Voluntary patients should continue to have the right to access leave – Refer to patient screening and testing section
  • Where essential or urgent refer to Service Capacity at red alert level and local procedures for delivering ECT to positive COVID-19 patients

Supporting guidance

Local Mental Health Readiness Checklists - Further specific guidance can be found in other sections of the SAR

Public community dental services
  • Dental clinics should screen attendees for clinical COVID-19 risk factors via pre-appointment questionnaire
  • Patients who have clinical COVID-19 risk factors should not attend and alternate triaging pathways are available for emergency dental care
  • Face to face patient care occurs with additional requirements of clients performing hand hygiene using Alcohol Based Hand Rub (ABHR) on arrival and pre-procedural mouth rinse, practicing physical distancing measures in reception and waiting areas, and other public health safety precautions*

If undertaking an AGP, RAT required on presentation

  • If an AGP is necessary (cannot be delayed) on a RAT positive patient they are to be referred to a public hospital
  • AGPs should only proceed for those who are RAT negative
  • When performing an AGP, a single room with the door closed or a closed cubicle should 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.
  • Use of rubber dam and high-volume evacuation (HVE) is highly recommended
  • The staff in the treatment space should wear successfully fit tested PFRs and protective eyewear during the AGP and for 30 minutes after

Supporting guidance

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

Patient screening and testing guidance (adults and paediatrics)

Screen attendees for clinical COVID-19 risk factors

  • Test all patients presenting to hospital with symptoms consistent with COVID-19 with a RAT* as soon as possible. If RAT negative and symptoms persist, consider repeat in 24 hours.

For unplanned patient presentations, including ED:

  • RAT on presentation for AGPs (including dental)
  • If supplies of RAT* adequate, test all patients presenting to emergency departments with RAT to assist with patient management
  • If RAT limited & PCR testing at capacity all patients to be managed as positive COVID-19 patients
  • Provision of medical care takes precedence over the availability of the test result.

For planned patient presentations:

  • RAT* on presentation with a move to RAT at home prior to attendance (or on presentation); alert service if positive, before attending (vaccinated and unvaccinated)

*In most cases, a Positive RAT* should be considered a positive COVID-19 case. Confirmatory PCR testing can be ordered, if advised by either an Infectious Disease Physician or a clinical microbiologist, or as per local guidelines and protocols

For patients re-presenting for care or returning from day leave:

  • All patients who last presented, or last went out on leave more than 12 hours ago to be screened for clinical risk factors AND have a RAT
  • All patients who last presented, or last went out on leave less than 12 hours ago to be screened for clinical risk factors. RAT if indicated

For recent COVID-19 cases:

  • Patients should be screened for past COVID-19 infection within the previous 12 weeks
  • Recovered immuno-compromised patients to be RAT tested and case by case consideration as to whether to defer care in consultation with an Infectious Diseases Physician, Infection Prevention and Control Team, or Clinical microbiologist, or as per local guidelines and protocols

Surveillance testing inpatients: Consider regular surveillance testing with RAT up to every 72 hrs, particularly in settings where there are immunosuppressed patients, where it is difficult to physically distance patients or as directed by your local infectious diseases/ microbiology department.

Furthermore, consider a RAT prior to an AGP if more than 24 hours have elapsed since the last RAT

Consideration should factor in if a patient has recently recovered from COVID-19 and are within 12 weeks from release from isolation

Elective Surgery, including Private Hospitals

Public hospitals*:

  • RAT at home on the day of admission (or on arrival). In instances where a positive RAT is returned, case by case consideration to defer care, if clinically safe to do so

Private hospitals (and Day Surgery Centres): 

  • Screening and testing requirements as per above, however, COVID testing to be undertaken by Private Hospital Pathology partners
  • If a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so

Standard guidance for recent COVID-19 cases and surveillance testing as above applies

Outpatient services including clinics, imaging, pharmacy, pathology – Adult and paediatrics

  • No routine asymptomatic testing required, except consider optional RAT on presentation for planned maternity admissions and labour ward and birth suite attendances

Standard guidance for recent COVID-19 cases and surveillance testing as above applies

Specialist day services* – Adult and paediatrics

COVID-19 Release from isolation information for clinicians

  • RAT on presentation at each visit  with a move to RAT at home prior to attendance; alert clinic if positive, before attending
  • If positive RAT, case by case consideration to defer care, if clinically safe to do so

Standard guidance for recent COVID-19 cases and surveillance testing as above applies

*If a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so.

Supporting guidance

HCW screening and testing, includes volunteers and student/ clinical placements (assumes HCW are fully vaccinated)

HCWs are to seek immediate testing if they develop any symptoms compatible with COVID-19 with a RAT as soon as possible. If RAT negative & symptoms persist, repeat RAT in 24 hours. Positive RAT* should be considered positive COVID-19 case

*In most cases, a Positive RAT should be considered positive COVID-19 case. Confirmatory PCR testing can be ordered, if advised by either an Infectious Disease Physician or a clinical microbiologist, or as per local guidelines and protocols

For asymptomatic HCW working within healthcare settings - RATS to WA Health Staff (announced from 15 March 2022)

  • All WA Health staff and staff in WA PPP hospitals who, whilst at the workplace, are advised of the requirement to have a RAT, are to be provided sufficient RATs for testing
  • Voluntary RAT every 72 hours is to be provided to all staff working in WA public hospitals and health care facilities, including WA PPP hospitals

Any breach of infection control practices or personal protection equipment should be managed by the health service infection control team.

For close contacts, refer to Furlough Guidelines for guidance for close contacts returning to work during their isolation period

For recent COVID-19 positive HCW: Recovered HCW in high-risk settings, who are within 12 weeks of release from isolation and are asymptomatic are not required to be re-tested within the 12 weeks.

Supporting guidance

Student, clinical placement and volunteer access
  • Access for students/ clinical placements (as per Amber advice)

  • Where possible student placements to be maintained, but formal teaching sessions will be unlikely
  • Students may be deployed to support the response in appropriate ways however must be vaccinated, PPE trained and fit tested prior to attending health sites
  • Placement of students into areas of higher risk of contact with COVID-19, such as COVID-19 clinics, EDs or isolation wards, should be reviewed and subject to a risk assessment
  • The exclusion of secondary (high school) students undertaking work experience is at the discretion of HSPs
  • Access for volunteers - where possible, volunteers to be maintained, providing they are fully vaccinated and appropriately trained in PPE, particularly if located within clinical environments. Follow HCW guidelines as considered part of staff group refer to PPE guidance.

  • Consideration should be given to any COVID-19 risk factors that volunteers may have, such as chronic disease or respiratory illness, in determining what role and duties each person undertakes
  • Consider pre-shift screening

Supporting guidance

Visitor access
  • Limitations on visitor hours and only two visitors per patient at a time.
  • Proof of vaccination required
  • All visitors and essential carers/parents/guardians presenting to any department to wear a surgical mask
  • Pre-attendance health screening for all visitors and essential carers/parents/guardians based on clinical factors, at a minimum
  • Must register attendance via Service WA or Safe WA app, or manual register
  • Unvaccinated visitors to undertake a supervised RAT test every visit, unless person has proof of negative PCR within last 24 hours
  • Outside of visitor hours, only approved essential visitors/ exemptions for emergency, compassionate, labour or approved parent/guardian/carer scenarios as set out in Visitor Guidelines
  • Refer to Visitor Guidelines for detailed guidance and operational principles
  • RAT for permitted visitors and essential carers/parents/guardians each visit if in an area defined as high risk (e.g. Critical care units (NICU, PICU, ICU), haematology unit, radiotherapy, Mental health inpatient units, oncology ward, renal dialysis unit, burns, transplant units, and labour & birth suite, maternal foetal assessment units & post natal wards)

*Clear exemptions process and pathway for unvaccinated visitors to be in place for short, controlled, ushered visits in emergency/ end of life situations, and/or for appropriate maternity or parent/guardian access

Supporting guidance

System capacity (black)
PPE guidance

The following applies, unless additional PPE guidance is recommended at certain alert levels below

  • Standard precautions apply at all times i.e. PPE used as required (e.g. surgical mask, gowns, gloves, protective eyewear for any patient contact or procedure when there is potential for blood/body fluid exposure)
  • Transmission based precautions e.g. negative pressure isolation room (NPIR), particulate filter respirator (PFR) when required for other diseases e.g. airborne precautions for tuberculosis, measles etc.
  • For all Aerosol Generating Procedures (AGPs) and Aerosol Generating Behaviours (AGBs), PFR and protective eyewear to be used
  • All inpatients and outpatients (if tolerated by the patient), carers, and permitted visitors presenting to any department to wear a surgical mask from entry to the facility, unless they are exempt*.

For management of patients who have tested positive for COVID-19 (PCR or RAT), symptomatic of COVID-19, currently in isolation/quarantine, or are close contacts of a case - Healthcare worker (HCW) to wear PFR, protective eyewear, gown and gloves when providing direct care.

*As per the 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

  • All staff working in clinical areas at a healthcare facility to wear a surgical mask on entry & exit to the facility including in shared areas such as meeting/tea rooms and whilst transitioning to their ward/unit whereby they are to change their PPE to PFR and protective eyewear
  • Comply with physical distancing requirements in all HCW break areas where possible.
  • All non-clinical staff entering a HCF and staff working in non-clinical areas can continue to wear a surgical mask with the addition of protective eyewear if they transit through clinical areas

PPE advice for patient facing clinical care in community settings, including home visiting/outreach services: Refer to PPE advice for hospital settings at black, and

  • Consider alternative to home visits - i.e. telehealth alternatives
  • No additional attendees other than parent/carer

Supporting guidance

Service Capacity (ED, General Beds, ICU, Mental Health)
  • Patient Flow Command Centre active – (i) coordinating flow of COVID-19 Care at home patients into acute hospital settings and oversight of interhospital transfers between HSPs, depending on capacity and (ii) coordinating flow of acute COVID-19 patients in private hospitals unable to provide care in an acute hospital setting
Elective Surgery, including Private Hospitals

Public and private hospitals*:

  • Defer all elective surgery, except for Category 1 and select Category 2 procedures where clinical and community risk assessment and/or Peer Review indicates a need to proceed. This includes consideration to be given to impacts of delaying complex cancer surgery
  • Defer cosmetic surgery and non-medical procedures
  • COVID-19 risk assessment is required for all patients

Note: To adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories may need to be reduced or can continue.

Outpatient services including clinics, imaging, pharmacy, pathology (adults and paediatrics)
  • Patients should not present if experiencing any symptoms of COVID-19
  • Provide Outpatient services by telehealth and defer non-urgent face-to-face consulting where clinically safe
  • Outpatient clinics should all implement COVID-19 safe procedures (i.e. screening attendees for COVID-19 symptoms and other risk factors via questionnaires, practicing physical distancing within the clinical setting, in line with density limits and PHSMs, frequent hand hygiene)

Supporting guidance

Specialist day services (adults and paediatrics) (e.g. patients undergoing renal dialysis, chemotherapy radiotherapy, transplant patients, immunosuppressed)

Screen attendees for clinical COVID-19 risk factors.

  • Consider additional protective measures for vulnerable cohorts and high risk clinical care settings

Supporting guidance

*Note: To adapt to changing COVID-19 conditions, the Department of Health will perform regular system assessments to determine if a percentage of Elective Surgery categories and specialist day services may need to be reduced or can continue.

Public mental health services - community, home and outpatient services

As per red guidance:

  • Face to face appointments are to cease, be deferred or held virtually where possible and clinically appropriate
  • Group therapy sessions are to cease, be deferred or held virtually where possible and clinically appropriate
  • If urgent care is required in outpatient setting, community or home and cannot be deferred or delivered via alternative methods (e.g. telehealth), assessment and treatment (including administering medication) will be provided and consumer to wear surgical mask as per Amber Alert guidance
  • Paediatric mental health services should ensure both parents are considered as essential visitors/carers and are able to attend appointments and family therapy together – complying with Visitor and PPE Guidelines
  • ECT and rTMS. Defer routine and planned ECT and rTMS, where appropriate and based on clinical assessment
  • Leave. Voluntary patients should continue to have the right to access leave - Refer to patient screening and testing section
  • Where essential or urgent refer to Service Capacity at red alert level and local procedures for delivering ECT to positive COVID-19 patients

Supporting guidance

Local Mental Health Readiness Checklists - Further specific guidance can be found in other sections of the SAR

Public community dental services

If urgent dental care is required:

  • Dental clinics should screen attendees for clinical COVID-19 risk factors via pre-appointment questionnaire
  • Patients who have clinical COVID-19 risk factors should not attend and alternate triaging pathways are available for emergency dental care
  • Face to face patient care occurs with additional requirements of clients performing hand hygiene using Alcohol Based Hand Rub (ABHR) on arrival and pre-procedural mouth rinse, practicing physical distancing measures in reception and waiting areas, and other public health safety precautions*

If undertaking an AGP – RAT required on presentation

  • If an AGP is necessary (cannot be delayed) on a RAT positive patient they are to be referred to a public hospital
  • AGPs should only proceed for those who are RAT negative
  • When performing an AGP, a single room with the door closed or a closed cubicle should 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.
  • Use of rubber dam and high-volume evacuation (HVE) is highly recommended
  • The staff in the treatment space should wear successfully fit tested PFRs and protective eyewear during the AGP and for 30 minutes after

Supporting guidance

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

Patient screening and testing guidance (adults and paediatrics)

Screen attendees for clinical COVID-19 risk factors

  • Test all patients presenting to hospital with symptoms consistent with COVID-19 with a RAT* as soon as possible. If negative and symptoms persist, consider repeat RAT in 24 hours.
  • RAT on presentation for AGPs (including dental)

For unplanned patient presentations, including ED:

  • If supplies of RAT* adequate, test all patients presenting to emergency departments with RAT to assist with patient management
  • If RAT limited & PCR testing at capacity all patients to be managed as positive COVID-19 patients
  • Provision of medical care takes precedence over the availability of the test result

For planned patient presentations:

  • RAT* at home prior to attendance (or on presentation); alert service if positive, before attending (vaccinated and unvaccinated)

*In most cases, a Positive RAT* should be considered a positive COVID-19 case. Confirmatory PCR testing can be ordered, either an Infectious Disease Physician or a clinical microbiologist, or as per local guidelines and protocols.

For patients re-presenting for care or returning from day leave:

  • All patients who last presented, or last went out on leave, more than 12 hours ago to be screened for clinical risk factors AND have a RAT
  • All patients who last presented, or last went out on leave, less than 12 hours ago to be screened for clinical risk factors. RAT if indicated

For recent COVID-19 cases:

  • Patients should be screened for past COVID-19 infection within the previous 12 weeks
  • Recovered immuno-compromised patients to be RAT tested and case by case consideration as to whether to defer care in consultation with an Infectious Diseases Physician, Infection Prevention and Control Team, or Clinical microbiologist, or as per local guidelines and protocols

Surveillance testing inpatients: Consider regular surveillance testing with RAT up to every 72 hrs, particularly in settings where there are immunosuppressed patients, where it is difficult to physically distance patients or as directed by your local infectious diseases/microbiology department.

Furthermore, consider a RAT prior to an AGP if more than 24 hours have elapsed since the last RAT 

Elective Surgery, including Private Hospitals

Public and Private hospitals*:

  • RAT at home on the day of admission (or on arrival). In instances where a positive RAT is returned, case by case consideration to defer care, if clinically safe to do so  

Outpatient services including clinics, imaging, pharmacy, pathology – Adult and paediatrics

  • No routine asymptomatic testing required, except consider optional RAT on presentation for planned maternity admissions and labour ward and birth suite attendances 

Specialist day services* – Adult and paediatrics

COVID-19 Release from isolation information for clinicians

  • RAT at home prior to attendance; alert clinic if positive, before attending
  • If positive RAT, case by case consideration to defer care, if clinically safe to do so 

*If a positive PCR or RAT is returned, case by case consideration to defer care, if clinically safe to do so.

Supporting guidance

HCW screening and testing, includes volunteers and student/ clinical placements (assumes HCW are fully vaccinated)

HCWs are to seek immediate testing if they develop any symptoms compatible with COVID-19 with a RAT as soon as possible. If RAT negative & symptoms persist, repeat RAT in 24 hours. Positive RAT* should be considered positive COVID-19 case

*In most cases, a Positive RAT should be considered positive COVID-19 case. Confirmatory PCR testing can be ordered, if advised by either an Infectious Disease Physician or a clinical microbiologist, or as per local guidelines and protocols

For asymptomatic HCW working within healthcare settings - RATS to WA Health Staff

  • All WA Health staff and staff in WA PPP hospitals who, whilst at the workplace, are advised of the requirement to have a RAT, are to be provided sufficient RATs for testing
  • Voluntary RAT every 72 hours is to be provided to all staff working in WA public hospitals and health care facilities, including WA PPP hospitals

Any breach of infection control practices or personal protection equipment should be managed by the health service infection control team.

For close contacts, refer to Furlough Guidelines for guidance for close contacts returning to work during their isolation period

For recent COVID-19 positive HCW: Recovered HCW in high-risk settings, who are within 12 weeks of release from isolation and are asymptomatic are not required to be re-tested within the 12 weeks.

Supporting guidance.

Student, clinical placement and volunteer access

  • Access for students/ clinical placements (as per Amber advice)
  • Where possible student placements to be maintained, but formal teaching sessions will be unlikely
  • Students may be deployed to support the response in appropriate ways however must be vaccinated, PPE trained and fit tested prior to attending health sites
  • Placement of students into areas of higher risk of contact with COVID-19, such as COVID-19 clinics, EDs or isolation wards, should be reviewed and subject to a risk assessment
  • The exclusion of secondary (high school) students undertaking work experience is at the discretion of HSPs
  • Access for volunteers - where possible, volunteers to be maintained, providing they are fully vaccinated and appropriately trained in PPE, particularly if located within clinical environments. Follow HCW guidelines as considered part of staff group refer to PPE guidance.
  • Consideration should be given to any COVID-19 risk factors that volunteers may have, such as chronic disease or respiratory illness, in determining what role and duties each person undertakes
  • Consider pre-shift screening

Supporting guidance

Visitor access

As per red guidance:

  • Limitations on visitor hours and only two visitors per patient at a time
  • Proof of vaccination required
  • All visitors and essential carers/parents/guardians presenting to any department to wear a surgical mask
  • Pre-attendance health screening for all visitors and essential carers/parents /guardians based on clinical factors, at a minimum
  • Must register attendance via Service WA or Safe WA app, or manual register
  • Unvaccinated visitors recommended to undertake a supervised RAT test every visit, unless person has proof of negative PCR within last 24 hours
  • Outside of visitor hours, only approved essential visitors/ exemptions for emergency, compassionate, labour or approved parent/guardian/carer scenarios as set out in Visitor Guidelines
  • Refer to Visitor Guidelines for detailed guidance and operational principles
  • RAT for permitted visitors and essential carers/parents/guardians each visit if in an area defined as high risk (e.g. Critical care units (NICU, PICU, ICU), haematology unit, radiotherapy, mental health inpatient units, oncology ward, renal dialysis unit, burns, transplant units, and labour & birth suite, maternal foetal assessment units & post natal wards)

*Clear exemptions process and pathway for unvaccinated visitors to be in place for short, controlled, ushered visits in emergency/end of life situations, and/or for appropriate maternity or parent/guardian access

Supporting guidance

Supporting guidance materials

The following links and guidance materials provide detail to the high level advice which has ben 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/Essential visitor/ support person

 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. 

Health Care Worker HCW

 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.

High risk clinical care

 Patients who access certain care procedures and treatments, or who may be considered immunocompromised or at greater risk of complications from contracting COVID-19, such as: dialysis patients, high risk of endoscopy group (in most cases), cancer treatment, organ transplant, immunology, haematology, Critical Care Units (NICU, PICU and ICU), Radiotherapy, Mental Health inpatient unit (no isolation rooms, group therapy frequent AGBs, specialised workforce), Burns, labour and birth suite and post-natal wards

Statutory Personnel including Mental Health Advocates

 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. 

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 essential visitors, ad hoc visitors, ad hoc volunteers, in reach service providers and visitors in quarantine that have a modified quarantine direction to visit a health care facility in exceptional circumstances.  

Clinical and Epidemiological risk factors

 Clinical risk factors are symptoms of COVID-19 infection.

Epidemiological risk factors are:

  • close contacts of cases,
  • people at higher risk of exposure to COVID-19 (e.g. travel history to areas with higher rates of COVID-19, people who care for people with COVID-19 or who have contact with people more likely to have an active infection)
  • people in high and special-risk settings, including where disease amplification is likely, or where people live or visit others who have an increased risk of sever disease and death e.g. health care settings, residential aged care settings, primary schools, high-density/crowded housing, Aboriginal and Torres Strait Islander communities, correctional and detention facilities, homeless shelters and residential/crisis hostels, mining sites, food processing/distribution/cold storage facilities including abattoirs

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

Long episodes of care

 As per definition for Prolonged episodes of care: direct face to face contact with a patient when duration is 15 minutes or more and where physical distance cannot be maintained

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

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

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 flu 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.