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Cervical Smears in the time of COVID-19

This guidance was written during the time of the Covid-19 crisis and based on an original protocol from The Orchard Partnership in Wiltshire. Practices can adapt this to their own requirements based on local guidance. For expert advice on infection control (IC) you are recommended to speak to the IC lead at your local CCG.

We do need to be clear as we move into the recovery and restoration phase that this is an ever-changing landscape. We will aim to keep updating the guidance, however bearing in mind how quickly the situation changes you are advised to check the content before taking any actions.

    Useful links & Comments
Why?

Cervical screening is one of 11 NHS population screening programmes available in England.

PHE collects data on uptake of cervical screening you can search by practice, area, CCG and PCN ( fingertips PHE)

NHSE/I and PHE (smear taking during Covid-19)

GOV.UK National Cervical Screening Programme

Keeping up to date

GOV UK – cx training guidance

Who should be seen?

Women will receive a letter for their routine 3-5 yearly smear. However, during the Covid-19 crisis please check your regional guidance, this will provide details on how women will be recalled.

If you have a backlog, you may want to prioritise those women who have had treatment to their cervix, and or receiving smears regularly, it is more important to continue than delay and they should be encouraged to attend keeping exposure to risk to a minimum.

 

The Eve Appeal – patient information during the Covid-19 crisis

FSRH Position Statement Covid- 19

PHE regional offices

Where?

Consider creating designated smear clinics allocating specific appointments or direct patients to a ‘cold site’ if appropriate.

If you are still operating a ‘hot site’ you may want to negotiate with another practice in your PCN to allow your patients to attend there.
Booking the appointment

Inform the patient when making the appointment:

  • They will be asked to wear a face mask on arrival and during the procedure
  • To come alone if possible
  • Not to attend if they are symptomatic
  • Staff will be wearing PPE for theirs and the staff’s protection
  • They will have their temperature taken on arrival
  • To go the toilet at home before arrival as this minimises the time spent in the practice
  • Reassure them this procedure will be undertaken in a safe environment based on IC guidance
  • Social distancing rules (2m) to be adhered to except at the time of actual taking the smear

Administration could be undertaken remotely ensuring the patient’s records are up to date. Admin/reception staff could be allocated to this task.

Social prescribers/link workers could contact those women who have previously DNA’d

Recording personal information -you could consider if there is a facility for patients to be able to update any information themselves e.g.

  • The woman’s LMP
  • Contraception status
  • Any abnormal vaginal bleeding
  • Risk of potential STIs
  • Previous smear history

GOV - PPE 

Wessex LMCs

Infection Control Advice for Practices

RCN infection control

GOV UK - infection prevention and control 

Infection Prevention Control (PIC) - policies 

 

Before calling the patient into the room

Pre-prepare equipment and write the patient’s details on the bottle and ensure completed paperwork as per normal procedure.

  • Wash hands

Don PPE in the recommended order:

  1. apron/gown
  2. mask
  3. eye wear
  4. gloves

Consider using the same face masks and visors for the whole session.

Aprons and gloves to be changed between each patient

We would strongly recommend that you undertake a risk assessment, if you have any queries you speak to your CCG IC lead for further guidance.

 

Click here for a helpful video produced by a Leeds GP

PHE have also produced a video for PPE

PHE have a page for Infection Prevention Control that includes details on PPE along with a table of recommended PPE for Primary Care

IPS Training package on IC

 

Confirm with the patient:

  • Name
  • DOB
  • Address
  • Temperature
You may want to consider having an additional member of staff available to escort the patient from the waiting area
In the consulting room
  • Perform the smear
  • Inform the patient they will receive their result in the post
  • Patient leaves the consulting room and the building
  • Staff doff PPE washing hands at each stage as per national guidelines
  • Dispose of PPE and waste correctly
  • Clean the room

Staffing

You may want to consider involving two members of staff.

  • 1 experienced smear taker,
  • 1 non-trained to help with taking the patients temperature, calling the patient in help with donning / doffing of PPE, cleaning the room and completing the administration

Consider the risks of having more than one person in the room in terms of exposure to possible Covid-19. Also issues around confidentiality.

Check that the woman is comfortable with having another person present during the procedure and record chaperone offered/declined

July 2020

Cervical screening – PPE

Following our previous communications on cervical screening appointment and the national primary care bulletin item on 9 June bulletin , we wanted to send a reminder that practices are responsible for determining local arrangements for use of personal protective equipment (PPE). This will be informed by national guidance for use of PPE by health and social care workers on COVID-19 https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/covid-19-personal-protective-equipment-ppe and recommended PPE for primary, outpatient and community care https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/877599/T2_Recommended_PPE_for_primary_outpatient_and_community_care_by_setting_poster.pdf

Following queries around what is considered adequate PPE to undertake a cervical smear we have taken advice from an IC lead at a CCG:-

“If there is a risk of splash during Cervical Screening, I would expect the clinician to have risk assessed appropriately and been wearing face/eye protection pre COVID-19” Under current PPE guidance clinicians should be wearing – Gloves, Apron, Mask +/-a eye protection where the risk assessment identifies a risk of splash to the face/eyes. National guidance does not advocate double gloving Pre or during COVID-19”

We would strongly recommend that you undertake a risk assessment and if you have any queries you speak to your CCG IC lead for further guidance.

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Updated on Wednesday, 26 May 2021 631 views