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BSG, BASL & RCP Guidance for Healthcare Workers with Moderate Risk Inflammatory Bowel Disease and Liver Disease

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The contribution of all healthcare workers in the COVID-19 outbreak is very much valued. However, there is a requirement to protect those who may be at risk of an adverse outcome if they caught the virus. This is a guide for how the health service could reduce the risk of infection for those with moderate risk inflammatory bowel disease and liver disease.  There are available equally valuable roles that can be performed without direct contact with suspected or confirmed COVID 19 patients.

This advice is for patients with moderate risk inflammatory bowel disease and liver disease.

Definition of ‘Moderate Risk (stringent social distancing) inflammatory bowel disease’

Patients on the following medications:

  • Ustekinumab
  • Vedolizumab
  •  Methotrexate
  •  Anti-TNF alpha monotherapy (infliximab, adalimumab, golimumab)
  •  Thiopurines (azathioprine, mercaptopurine, tioguanine)
  • Calcineurin inhibitors (tacrolimus or ciclosporin)
  • Janus kinase (JAK) inhibition (tofacitinib)
  • Combination therapy in stable patients
  • Immunosuppressive/biologic trial medication

Definition of ‘Moderate Risk (stringent social distancing) liver disease’

  • Patients with decompensated liver cirrhosis

Advice

The following considerations should be taken into account

  • They should not have direct contact with patients with suspected or confirmed COVID19.
  • They are able to continue to work in a virtual or administrative capacity. For example, they would be able to do telephone triage, telephone clinics, helpline calls, and similar duties.
  • They should be supported in working from home if at all possible.
  • If working within a hospital environment it is essential to have adequate office space in an appropriate “clean” environment that does not have multiple unselected members of staff moving through.

It would be possible for them to do some low risk patient facing duties if the patients were screened prior to the contact. However given the current situation, this is not feasible although could be considered if the available testing changes.


Cathryn Edwards, BSG President
Tony Tham, Chair of the Clinical Services and Standards Committee, BSG
Philip Newsome, BSG Vice President Hepatology
Ian Arnott, Chair of the Inflammatory Bowel Disease Section, BSG

Resources

Hepatology patient risk groups

IBD Risk Grid