Guidance for health services to respond to changing COVID-19 transmission risks in the community.
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The Victorian Health Service Guidance and Response to COVID-19 Risks (VHSGR) has been developed to inform health service processes and interventions in response to changing risks of COVID-19 transmission in the community.

The role of the VHSGR is to bring together and collate in a central repository, guidance and advice which will support health services mitigate the risks of COVID-19 transmission, whilst at the same time providing appropriate care and safety for patients, staff and visitors.

It includes guidance on topics such as:

  • personal protective equipment (PPE) use
  • health care worker surveillance testing
  • patient pre-operative testing and screening
  • elective surgery
  • visitor information
  • outpatient consultations
  • emergency Department policy
  • healthcare worker mobility.

If it is decided that a risk rating should be changed, the Department of Health will enact and communicate the decision to health services. This website will also be updated immediately to reflect the new change to risk ratings.

Current risk rating

Current Victorian Health Service Guidance and Response to COVID-19 Risks (VHSGR) ratings in place in Victoria.

The map below shows the risk ratings across Victoria.

Risk rating Location Date the risk rating was applied
COVID Ready (green)

N/A

Not applicable
COVID Alert (amber)

N/A

Not applicable
COVID Active (red)

N/A 

Not applicable 
COVID Peak (black) Whole of Victoria 23 August 2021

Risk ratings

Risk ratings can be applied to the state of Victoria, or to specific geographical regions and/or individual health service.

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:

  1. COVID Ready (green) – low risk
    Updated Victorian Health Service Guidance and Response to COVID-19 Risks - COVID Ready (Word)
  2. COVID Alert (amber) – moderate risk
    Updated Victorian Health Service Guidance and Response to COVID-19 Risks - COVID Alert (Word)
  3. COVID Active (red) – high risk
    Updated Victorian Health Service Guidance and Response to COVID-19 Risks - COVID Active (Word)
  4. COVID Peak (black) – very high risk
    Updated Victorian Health Service Guidance and Response to COVID-19 Risks - COVID Peak (Word)

All decisions to change risk ratings will be made by the Victorian Department of Health.

COVID-19 risk levels: green is covid ready, orange is covid alert, red is covid active and black is covid peak
Victorian health service guidance and response to COVID-19 risks levels

Procedures at different risk ratings

See advice on appropriate health service procedures and activities at different risk ratings.

COVID Ready

Advice on appropriate health service procedures and activities at COVID Ready

Topic Recommended procedure
PPE Tier 1

Routine care of COVID negative. 

More information on Personal Protective Equipment (PPE).

PPE Tier 2

Routine care of low-risk SCOVID.

For staff undertaking COVID testing in community testing locations.

More information on Personal Protective Equipment (PPE).

PPE Tier 3

Aerosol-generating procedures (AGPs) and risk of aerosol-generating behaviours (AGBs) in low-risk SCOVID.

Exposure/care/contact with high-risk SCOVID and confirmed COVID patients.

For staff undertaking COVID testing at port-of-entry testing locations.

More information on Personal Protective Equipment (PPE).

Patient/resident testing and screening

Testing patients/residents with compatible clinical and/or epidemiological risk factors.

Health care worker surveillance testing

Mandatory testing of high-risk hospital work premises workers.

Workforce attestations and screening

Daily attestations at a minimum.

Elective surgery  All categories undertaken.
Visitors

Restrictions on visitors as per public health directions.

Pre-attendance screening based on clinical and epidemiological factors, at a minimum.

More information on visiting hospitals is available on coronavirus.vic.gov.au.

Specialist outpatient consulting Face-to-face or telehealth appointments to occur as per normal arrangements.
Emergency department 

As per normal emergency department triage and risk assessment protocols.

Vulnerable workers (high-risk employees) Appropriate for high-risk employees to attend work as per normal working arrangements.
Workforce mobility

High-risk hospital work premises workers are limited to working at one facility (where practical).

COVID streaming area workers must not work in a different campus or healthcare setting within 14 days, unless they have completed three consecutive rostered days off and returned a negative COVID-19 test within 48 hours before starting at the next workplace.

Student clinical placements

Student clinical placements permitted in all settings but restricted from providing care/being exposed to high-risk SCOVID and confirmed COVID patients.

COVID Alert

Advice on appropriate health service procedures and activities at COVID Alert

Topic Recommended procedure
PPE Tier 1

Routine care of COVID negative. 

More information on Personal Protective Equipment (PPE).

PPE Tier 2

Routine care of low-risk SCOVID. 

For staff undertaking COVID testing in community testing locations.

More information on Personal Protective Equipment (PPE).

PPE Tier 3

Aerosol-generating procedures (AGPs) and risk of aerosol-generating behaviours (AGBs) in low-risk SCOVID.

Exposure/care/contact with high-risk SCOVID and confirmed COVID patients.

For staff undertaking COVID testing at port-of-entry testing locations.

More information on Personal Protective Equipment (PPE).

Patient/resident testing and screening

Testing patients/residents with compatible clinical and/or epidemiological risk factors.

Health care worker surveillance testing Mandatory testing of high-risk hospital work premises workers.
Workforce attestations and screening

Daily attestations at a minimum.

Elective surgery  All categories undertaken.
Visitors

Restrictions on visitors as per public health directions.

Pre-attendance screening based on clinical and epidemiological factors, at a minimum.

More information on visiting hospitals is available on coronavirus.vic.gov.au.

Specialist outpatient consulting

Telehealth encouraged.

Risk assessment for face-to-face appointments.

Emergency department 

Consider COVID service plans.

Vulnerable workers (high-risk employees) Where possible, high-risk employees should be considered for re-deployment.
Workforce mobility

High-risk hospital work premises workers limited to working at one facility (where practical).

COVID streaming area workers must not work in a different campus or healthcare setting within 14 days, unless they have completed three consecutive rostered days off and returned a negative COVID-19 test within 48 hours before starting at the next workplace.

Student clinical placements

Student clinical placements permitted in all settings but restricted from providing care/being exposed to high-risk SCOVID and confirmed COVID patients.

Students restricted to one campus/site only.

COVID Active

Advice on appropriate health service procedures and activities at COVID Active

Topic Recommended procedure
PPE Tier 1

Addition of eye protection when treating COVID negative patient/residents.

More information on Personal Protective Equipment (PPE).

PPE Tier 2

As per standard precautions where there is risk of exposure to blood or bodily fluids for COVID-negative patients/residents.

More information on Personal Protective Equipment (PPE).

PPE Tier 3

All exposure/care/contact with low-risk/high-risk SCOVID and confirmed COVID-19 patients.

For staff undertaking COVID-19 testing at port of entry and community testing locations.

More information on Personal Protective Equipment (PPE).

Patient/resident testing and screening

Testing patients/residents with compatible clinical and/or epidemiological risk factors.

Asymptomatic testing based on risk assessment.

Health care worker surveillance testing

Mandatory testing of high-risk hospital work premises workers.

Asymptomatic surveillance testing offered to healthcare workers in SCOVID wards, emergency departments (ED) and intensive care units (ICU).

Workforce attestations and screening

Daily attestations and enhanced screening based on clinical and epidemiological risk factors.

Elective surgery 

100% of Category 1, 2A.

100% of category 2B and 3 as default position.

Any reduction in Category 2B and 3 subject to a system assessment by the Department of Health.

Visitors

Restrictions on visitors as per public health directions.

Pre-attendance screening, based on clinical and epidemiological risk factors.

More information on visiting hospitals is available on coronavirus.vic.gov.au.

Specialist outpatient consulting

Telehealth recommended wherever possible.

Risk assessment for face-to-face appointments.

Emergency department 

Implement COVID service plans.

Vulnerable workers (high-risk employees) Health services should re-deploy high-risk employees based on risk assessment. Where not possible, consider whether appropriate to attend work.
Workforce mobility

Where practical, consider restricting all care facility worker and healthcare worker mobility to one campus/facility.

COVID streaming area workers must not work in a different campus or healthcare setting within 14 days, unless they have completed three consecutive rostered days off and returned a negative COVID-19 test within 48 hours before starting at the next workplace.

Student clinical placements

Student clinical placements permitted in all settings but restricted from providing care/being exposed to high-risk SCOVID and confirmed COVID patients.

Students restricted to one campus/site only.

COVID Peak

Advice on appropriate health service procedures and activities at COVID Peak

Topic Recommended procedure
PPE Tier 1

Addition of eye protection when treating COVID negative patient/residents.

More information on Personal Protective Equipment (PPE).

PPE Tier 2

As per standard precautions where there is risk of exposure to blood or bodily fluids for COVID negative patients/residents.

More information on Personal Protective Equipment (PPE).

PPE Tier 3

All exposure/care/contact with low-risk/high-risk SCOVID and confirmed COVID patients.

For staff undertaking COVID-19 testing at port-of-entry and community testing locations.

More information on Personal Protective Equipment (PPE).

Patient/resident testing and screening

Testing patients/residents with compatible clinical and/or epidemiological risk factors.

All patients undergoing elective procedures requiring general anaesthetic must be screened and tested for COVID-19.

Additional patient testing as per risk assessment.

Health care worker surveillance testing

Mandatory testing of high-risk hospital work premises workers. 

Increased asymptomatic surveillance testing of HCWs in SCOVID wards, emergency departments (ED) and intensive care units (ICU).

Workforce attestations and screening

Daily attestations and enhanced screening based on clinical and epidemiological risk factors.

Elective surgery 

100% of Category 1.

Additional Categories subject to a system assessment by the Department of Health.

Visitors

Restrictions on visitors as per public health directions.

More information on visiting hospitals is available on coronavirus.vic.gov.au.

Specialist outpatient consulting

Face-to-face outpatient appointments by exception.

Risk assessment for face-to-face appointments.

Emergency department 

Escalated COVID service plans.

Vulnerable workers (high-risk employees)

High-risk employees are to be redeployed or if not possible, furloughed.

Workforce mobility

Where practical, all healthcare worker mobility restricted to one campus/facility.

COVID streaming area workers must not work in a different campus or healthcare setting within 14 days, unless they have completed three consecutive rostered days off and returned a negative COVID-19 test within 48 hours before starting at the next workplace.

Student clinical placements

Student clinical placements restricted from providing care/being exposed to high-risk SCOVID/confirmed COVID patients.

Student clinical placements restricted from high-risk hospital work premises including ED, ICU and COVID/SCOVID.

Terminology explained

Definitions of frequently used terminology

Read the definitions of frequently used terminology.

Confirmed COVID case

A person who tests positive to a validated SARS-CoV-2 test.

Low-risk SCOVID case

Includes persons awaiting the results of a test, where there may be symptoms that could be consistent with COVID-19 but no epidemiological risk factors. Where a patient/resident’s history cannot be obtained, they should be considered as a low-risk suspected (SCOVID) case until further screening information can be obtained, at which point a revised diagnosis of the patient/resident’s condition can be made and appropriate changes to PPE implemented.

High-risk SCOVID case

A person in quarantine for any reason with or without a compatible clinical illness. This group of people is also referred to as 'at-risk'.

People who have been released from a quarantine facility (in the last 14 days) but have not undertaken any post-quarantine testing (days 17 and 21) should be tested and Tier 3 PPE should be utilised until their negative status is confirmed.

A person who has a compatible clinical illness and meets one or more of the following epidemiological risk factors (within 14 days prior to illness onset):

  • contact with a confirmed case or an exposure site as defined by public health
  • was employed in an area where there is an increased risk of COVID-19 transmission for example:
    • aged care workers/healthcare workers working in a location where there are active outbreaks
    • other high-risk industries (such as abattoirs) where there are known cases /or high levels of community transmission
  • lived in or visited a geographically localised area at high risk, as determined by public health
  • has been released from a quarantine facility.

COVID negative

  • A person who tests negative to a validated SARS-CoV-2 nucleic acid test.
  • A person who is a cleared case.
  • A person who screens negative and/or has no clinical or epidemiological risk factors for COVID-19.

Mandatory healthcare worker testing

Healthcare worker testing is required for any worker involved in the direct care of confirmed COVID-19 patients or who interacts with a high-risk hospital work premises.

Testing includes one throat-nose swab PCR and four saliva swab PCR (or on all other days attending work) per week.

Asymptomatic surveillance testing

One throat-nose swab per week.

Increased asymptomatic surveillance

One throat-nose swab PCR and four saliva swab PCR (or on all other days attending work) per week.

Clinical risk factors

Symptoms that are clinically compatible with COVID-19, such as fever, cough, shortness of breath, sore throat, loss of smell or taste.

Epidemiological risk factors

  • A person in quarantine for any reason in the last 14 days.
  • Contact with a confirmed case of COVID-19 and/or visited an exposure site as defined by public health.
  • Was employed/volunteered in an area where there is an increased risk of COVID-19 transmission such as hotel quarantine, ports of entry, aged care/health care services where there are active outbreaks, other high-risk industries (such as abattoirs) where there are known cases or high levels of community transmission.
  • Lived in or visited a geographically localised area at higher risk, as determined by public health.

Aerosol-generating procedure (AGP)

Procedures performed on patients/residents that are more likely to generate higher concentrations of infectious respiratory aerosols. Examples include bronchoscopy, tracheal intubation, non-invasive ventilation (for example, BiPAP, CPAP), high-flow nasal oxygen therapy, manual ventilation before intubation, intubation, cardiopulmonary resuscitation, suctioning, sputum induction, and nebuliser use.

Aerosol-generating behaviour (AGB)

Behaviours that are more likely to generate higher concentrations of infectious respiratory aerosols. Examples include persistent and/or severe coughing, screaming and shouting, and women in active labour who exhibit heavy breathing and panting.

Visitor restrictions

There may be occasions where COVID-19 transmission risks result in health services restricting visitors to their facility to ensure the safety of staff, patients, residents and visitors. However, there will be some exceptions to these restrictions even when risk levels are increased, including:

  • to provide essential care or support for the patient's immediate physical or emotional wellbeing, including support for people living with mental health conditions or dementia
  • as the parent, carer or guardian of a person under the age of 18
  • as a nominated person (as defined in the Mental Health Act 2014), including for patients living with dementia
  • as an interpreter or to provide language support
  • to learn to support the patient or resident's care upon discharge
  • as the partner or support person of a patient in maternity care, or pregnancy
  • accompanying a patient to an emergency department or outpatient appointment, if necessary
  • as immediate family (including kinship) of a patient with life-threatening condition
  • for end-of-life support or immediate family member(s) of a patient or aged care resident whose medical condition is life-threatening.

Higher risk employee categories

  • Aboriginal and Torres Strait Islander people 50 years and older with one or more chronic medical conditions
  • People 65 years and older with chronic medical conditions
  • People 70 years and older
  • People with compromised immune systems
  • Pregnant women > 28 weeks gestation

High-risk hospital work premises

High-risk hospital Work Premises means any hospital ward treating a confirmed case or cases of SARS-CoV-2.

High-risk hospital work premises worker

Any worker involved in the direct care of patients in high-risk hospital work premises (see above) AND those workers who interact with high-risk hospital work premises.

Enhanced screening

Additional screening over and above Department of Health guidance, which could include local hospital-specific requirements, such as temperature checks.

Elective surgery system assessment

The system assessment will consider: 

  • whether the current outbreak is escalating, or de-escalating
  • local epidemiology of the outbreak
  • workforce demands
  • bed capacity
  • ICU capacity
  • community restrictions
  • safety of patients, healthcare workers and the community
  • other risks and demands on the system.

Health services will be advised well in advance of any reductions to elective surgery, to allow time for adequate planning and preparation.

This will also allow patients who were due to have their procedures shortly following the announcement, to continue to receive their care.

When the COVID Active (red) risk rating applies:

  • the default position will be 100% Category 1 and 2A and 100% of Category 2B and 3 elective surgery permitted
  • a system assessment may determine that the percentage of Category 2B and 3 surgery should be reduced
  • the system assessment will be undertaken regularly whilst the COVID Active (red) rating applies.

When the COVID Peak (black) risk rating applies:

  • the default position will be Category 1 elective surgery only permitted
  • the Department of Health will perform a system assessment regularly to determine if a percentage of other Categories can be permitted while the COVID Peak (black) risk rating is applied.

Suggested options on restricting non-urgent surgery

If the Department of Health determines that the proportion of Category 2B and 3 surgery should be reduced (that is, to 75% of Category 2B and 3), the decision as to what surgeries to complete as part of the permitted portion lies with the health service.

Health services should consider:

  • avoiding cancelling 'long waiters' rather than making a blanket decision based on category. The long waiting patient list could be performed, providing it is within the percentage cap
  • avoiding doing multi-day or complex cases if there is a concern around ICU bed availability
  • continuing to screen, diagnose and treat cancer (in COVID Active). 

COVID streaming area

Any patient treatment area, as nominated by the health service within a COVID streaming hospital, which is used to treat confirmed COVID-19 cases and includes COVID-19 negative pressure rooms.  

Areas through which COVID-19 confirmed patients may transit or are temporarily treated (e.g. emergency departments, radiology, operating theatre) are not considered COVID streaming areas.

COVID streaming hospital

A nominated hospital that delivers ongoing care to confirmed COVID-19 cases.

COVID streaming area rostered worker

Any worker whose primary function is to provide care, services or support in a COVID streaming area.