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|
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
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
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:
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.
GOV - PPE
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.
Don PPE in the recommended order:
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:
|You may want to consider having an additional member of staff available to escort the patient from the waiting area|
|In the consulting room||
You may want to consider involving two members of staff.
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
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.