Care model for COVID-19 positive patients

As vaccination rates increase, and following the release of a new Department of Health policy, Monash Health has developed a new model of care for healthcare workers caring for COVID-19 positive or high risk sCOVID patients.

The new model of care has been established with the health and safety of our employees at the forefront. As a general principle, it will see only those healthcare workers who have had at least one dose of the COVID-19 vaccine working with COVID-19 positive or high risk sCOVID patients.

The model will again see Monash Health operate COVID dedicated patient care wards and a dedicated ICU, to decrease the number of healthcare workers coming into contact with COVID-19 positive patients.

Rapid testing technology will also be deployed, better allowing confirmation or otherwise of COVID-19 in patients, and will facilitate improved patient placement on admission.

At a minimum, use of rapid testing on high-risk sCOVID patients will be encouraged.

Vaccination of employees

Monash Health currently has a vaccine coverage of 55% of all healthcare workers and 75% in the 1a cohort who care for COVID patients directly. While the aim of the COVID-19 vaccination program is to have 100% of the workforce vaccinated, we are conscious that there will be a small number of employees who can’t be vaccinated or who choose not to be vaccinated.

Having dedicated COVID wards and a dedicated COVID ICU will decrease the need to have 100% vaccination coverage over all wards, although the ED remains an area where 100% vaccination rates will need to be achieved (unless a clear cold zone is created). All code teams (MET/Code Blue and Grey) will also need to be vaccinated. Additionally, admitting all COVID patients to one site (Monash Medical Centre) will again decrease the impact of 100% vaccination requirement. That said, it is critical that all employees working on COVID wards, COVID ICU, ED and code teams (MET/Code Blue and Grey) teams are vaccinated.

Where employees are not vaccinated, redeployment from high-risk wards should occur where community transmission is evident. This is a key reason that Unit Managers and Infection Prevention require oversight of the vaccination status of all employees.

Studies show that two doses of the vaccine provide the best protection, and that this occurs two weeks after the second vaccine dose has been given. However, some protection is afforded by the first dose and given this, plus the continued use of PPE, adequate ventilation and negative pressure isolation rooms, staff who have had one dose of vaccine will be able to care for COVID-19 patients.

Our clear preference is that all employees caring for COVID-19 patients have had two doses of any given COVID-19 vaccine, however one dose will be acceptable where it was given at least two weeks prior, and other precautions are taken.

The following employees will require vaccination in order to care for patients:

Nature of Employment Types of employees
COVID-19 wardsAll medical, nursing, allied health and support staff
COVID-19 ICUAll medical, nursing, allied health and support staff
EDAll employees unless a clear cold zone is established
Code teams (MET/Code Blue and Grey)All employees
Aged careAll employees
Community outreachAll employees
Screening sitesAll employees

Patient placement

On presentation at Monash Health, patients will continue to be managed at admission as per our COVID-19 protocols.

Rapid testing (eg GenExpert) will allow high risk patients (those with a clear epidemiological link to COVID-19) to be directed to the appropriate ward, but if results are not available such patients should be managed in the COVID ward in precautions until confirmed negative.

Approved by Chief Operating Officer, Martin Keogh, and Professor Rhonda Stuart

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