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Bronchiolitis admission pathway

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November 2023: This guidance is currently under review as it has gone beyond the standard review date. It reflects best practice at the time of authorship / last review and remains safe for use. If there are any concerns regarding the content then please consult with senior clinical staff to confirm.

Bronchiolitis admission pathway

Bronchiolitis requiring high flow

Appendix 1 - Aerosol Generating Procedures (AGPs)

List of aerosol generating procedures published by Health Protection Scotland, October 2020

  • Tracheal intubation and extubation
  • Manual ventilation
  • Tracheotomy or tracheostomy procedures (insertion or removal)
  • Bronchoscopy
  • Dental procedures (using high speed devices, for example ultrasonic scalers / high speed drills)
  • Non-invasive ventilation (NIV), Bi level positive pressure ventilation (BiPAP) and Continuous positive airway pressure ventilation (CPAP)
  • High flow nasal oxygen (HFNO)
  • High frequency oscillatory ventilation (HFOV)
  • Induction of sputum using nebulised saline
  • Respiratory tract suctioning (this does not include nasal/oropharyngeal suctioning)
  • Upper ENT airway procedures that involve respiratory suctioning
  • Upper gastro-intestinal endoscopy where open suction of the upper respiratory tract occurs
  • High speed cutting in surgery / post-mortem procedures if respiratory tract / paranasal sinuses involved
Appendix 2 - Personal Protective Equipment (PPE)

Droplet / Contact PPE:

  • Single use disposable gloves
  • Single use disposable apron (gown if risk of spraying/splashing)
  • Fluid resistant surgical mask
  • Single use re-usable eye/face protection (visor)

Airborne PPE:

  • Single use disposable gloves
  • Single use disposable gown
  • FFP3 mask
  • Single use or re-usable eye/face protection (visor)

 

National PPE recommendations jointly issued by the Department of Health and Social Care (DHSC), Public Health Wales (PHW), Public Health Agency (PHA) Northern Ireland, Health Protection Scotland (HPS) / National Services Scotland, PHE and NHS England 

Additional Notes
  • High flow nasal oxygen is an aerosol generating procedure. Patients should not be transported on high flow therapy.
  • Ward-level high flow should only be commenced in ward 2C
  • RCPCH-defined clinically extremely vulnerable children should be prioritised to a cubicle and should not be managed in a cohort bay, irrespective of virology results.
  • Consider weekly SARS-CoV-2 testing for all inpatients with a diagnosis of bronchiolitis. Increased frequency of testing should be considered following risk assessment and review of COVID-19 prevalence rates.
  • Patients undergoing AGPs should have weekly SARS-CoV-2 testing performed. Increased frequency of testing should be considered following risk assessment and review of COVID-19 prevalence rates.
  • Pathway developed using RCPCH National guidance for the management of children with bronchiolitis and lower respiratory tract infections during COVID-19, 2020.
Editorial Information

Last reviewed: 02 November 2020

Next review: 30 April 2024

Author(s): Craig Swinburne (Consultant Paediatrician), Lynn MacLeod (Consultant Paediatrician), Gillian Bowskill (Lead nurse for Infection Prevention and Control), Conor Doherty (Consultant in Paediatric Infectious Diseases).

Approved By: Paediatric Emergency Department Guidelines Group