September 30, 2021 — On 28 September 2021, the Civil Protection Headquarters of the Republic of Croatia issued a Decision on the introduction of a special security measure that health care institutions, companies performing health care activities and private health care professionals are obliged to implement when admitting patients (hereinafter: the Decision) of October 4, 2021.
The decision obliges healthcare institutions, companies performing healthcare activities and private healthcare professionals to request the presentation of an EU digital COVID certificate or appropriate other evidence * on vaccination, recovery or testing (hereinafter: other evidence) in order to control COVID. – 19.
Taking into account the comprehensiveness and availability of health care, the course of the COVID-19 epidemic, the 14-day cumulative incidence of new infections in all counties and the wide availability of vaccines as well as vaccination, which is in the wide population stage, the level of security in hospitals and all other health care facilities to be provided to health care users.
Basic settings: The EU digital COVID certificate or other evidence for patients in the healthcare system with the aim of combating COVID – 19 disease and preventing nosocomial infection is introduced in:
• health care institutions,
• companies performing health care activities and
• with private health professionals.
* Other evidence (instead of EU digital COVID certificate) relates to:
• persons who have survived COVID-19 and have been diagnosed on the basis of a rapid antigen test 9 months ago, as evidenced by a certificate issued by a primary care physician based on the findings of a rapid antigen test.
• persons who had been diagnosed with COVID patients in the family and had contact with these patients were declared so-called probable and their disease was not diagnosed by a laboratory test, as evidenced by a primary care physician’s certificate of recovery within 9 months, based on medical records .
• persons diagnosed with COVID-19 disease by PCR test more than 6 months ago and less than 9 months, as evidenced by a certificate of recovery issued by a primary care physician or a PCR test finding not older than 9 months.
• people who have had COVID-19, have been diagnosed with PCR, BAT or are likely to have been vaccinated with a single dose of the vaccine within 8 months of the illness and no more than 9 months have passed since receiving the first dose, as evidenced by a certificate from 2 primary care physicians of recovery or a positive PCR test and a certificate of vaccination with a single dose of COVID-19 vaccine with the vaccination date within 8 months of recovery and no more than 9 months after vaccination.
Comparison with previous practice: Obligations arising for patients in accordance with the Decision are not different from previous recommendations of the Croatian Institute of Public Health – TREATMENT OF PATIENTS, CLOSE CONTACTS OF PATIENTS AND TERMINATION OF ISOLATION AND QUARANTINE (Version 10) of 15 July 2021 / / https: /www.hzjz.hr/wp-content/uploads/2020/03/Postupanje-s-oboljelimabliskim-kontaktima-oboljelih-i-prekid-izolacije-i-karantene-5.pdf) in point 2.2.b. according to which it is necessary to test the following asymptomatic persons:
• Patients in whom hospitalization is planned as well as patients in whom it is planned to perform diagnostic-therapeutic procedures that generate an aerosol in specialist-consultative or hospital health care. Additionally, other patients requiring medical attention, but only if a high risk of exposure to infection is assessed based on triage.
• If the person has had laboratory-confirmed COVID-19 disease for the past nine months; or if she has received a second dose of COVID-19 vaccine in the past nine months (in the case of J&J, one dose is sufficient); testing according to the above indications is not necessary if there are no clear symptoms of the disease.
• If a person has had laboratory-confirmed COVID-19 and received a single dose of COVID-19 vaccine within eight months of recovery, the exemption from testing according to the above indications is extended to nine months of vaccination if there are no symptoms (immunocompromised and elderly). of 65 should receive two doses of vaccine regardless of recovery).
The decision enables the patient to prove the EU with digital COVID confirmation or presentation of appropriate other evidence from the document TREATMENT OF PATIENTS, CLOSE CONTACTS OF PATIENTS AND TERMINATION OF ISOLATION AND QUARANTINE, while based on the document other evidence.
If a high risk of exposure to infection is assessed on the basis of triage, accompanying persons, persons visiting hospitalized persons, parents / guardians staying with children and an accompanying childbirth cannot enter a health institution unless it is a necessary person in accompanied by minor patients and a necessary person accompanied by an adult who, due to a deteriorating health condition, cannot move safely alone in the health institution without accompaniment. The necessary person accompanied by minor patients and the necessary person accompanied by an adult who due to impaired health cannot move safely alone in the health institution, it is necessary to enable testing (BAT or PCR), and in case of a positive result it is not possible to enter the health institution.
Patients: EU digital COVID certification or presentation of appropriate other evidence for patients in the healthcare system is required:
• For planned hospitalizations (day hospitals are not included except for aerosol-generating procedures).
• For planned diagnostic-therapeutic procedures that generate an aerosol in specialist-consultative or hospital health care.
• Exceptionally, in hospital and specialist-consultative health care during examinations, planned and other stays in the day hospital and diagnostic and therapeutic procedures that do not generate an aerosol if a high risk of exposure to infection is assessed on the basis of triage.
EU digital COVID certification or presentation of appropriate other evidence for patients in the healthcare system is not required:
• ** If delaying admission would impair the health condition, patients are already admitted, isolated, tested, and in case of a positive finding, they are provided with appropriate health care in isolation.
• In all activities at the primary level of health care.
• In hospital and specialist-consultative health care during examinations, planned and other stays in the day hospital and diagnostic and therapeutic procedures that do not generate an aerosol.
• When providing emergency medical care.
• When providing health care due to suspected COVID-19 or due to confirmed COVID-19 disease.
Accompaniment and visits: Accompaniment during childbirth, parents / guardians staying with children and persons accompanying patients and visiting hospitalized patients are obliged to present the EU digital COVID certificate or appropriate proof of vaccination, recovery or testing to the authorized person of the health care provider. protection. Accompaniment at birth, and persons who come to accompany patients and visit hospitalized patients, who have not suffered from COVID-19 for 9 months and have not been vaccinated, pay for the testing themselves and are tested before arriving at the health institution, while parents / guardians staying in accommodation with children at the expense of the HZZO, they are also tested at the expense of the HZZO based on the referral of the chosen doctor.
The EU digital COVID certificate or the corresponding proof of vaccination, illness or testing is not required to be presented by the necessary persons accompanied by minor patients, as well as the necessary persons accompanied by adults who cannot move safely alone in the health institution due to impaired health.
EU digital COVID certificate or appropriate proof of vaccination, illness or testing is not required to present children under 12 years of age who are accompanied by patients because they have no one to stay at home with, as well as children under 12 years of age visiting hospitalized parents / guardians, brothers and sisters.
Organizational issues: In accordance with the Decision, all directors of health care institutions must provide sufficient quantities of rapid antigen tests and at the same time organize facilities for verification of EU digital COVID certificate or appropriate other evidence of vaccination, disease or testing or testing, taking into account:
• spatial and organizational capabilities of the institution
• type of institution
• work schedule and scope, working hours and jobs
• specifics of the employee structure
• types of health services.
Whenever possible, the healthcare facility should arrange for PCR or BAT diagnostics of SARS-CoV-2 patients to be performed in its facility, to avoid overloading the referral-based system of the chosen physician. Exceptions may be planned hospitalizations and planned diagnostic-therapeutic procedures that generate an aerosol in specialist counseling or hospital health care, the delay of which in case of a positive finding will not impair the patient’s health if the patient travels to avoid unnecessary travel.
In day hospitals, and in more time-consuming diagnostic and therapeutic procedures that bring together immunocompromised patients and patients with extremely vulnerable health conditions, the health institution can organize BAT diagnostics and provide health care for positive patients, whenever possible, in isolation.
Contraindications for vaccination: Testing is also mandatory for persons who are not allowed to be vaccinated due to contraindications, and the test referral is issued by a selected primary care physician or tested in a health institution by presenting a certificate of contraindications and impossibility to complete the vaccination cycle with COVID vaccine. 19.
This instruction will be updated in accordance with the recommendations and instructions of the Croatian Institute of Public Health which will be issued during the validity of the Decision.
Recommendation for the use of personal protective equipment and the application of general anti-epidemic measures
- Regardless of the vaccination status of the employee and the patient, the healthcare professional uses personal protective equipment that depends on the type of activity he performs: lower level of security in interviews when it is possible to maintain physical distance, higher level of protection in procedures requiring close contact with the patient. aerosol-generating procedures and in case of suspicion of COVID-19 disease or COVID positive patients.
- When staying in a day hospital and specialist-consultative health care institution, the patient wears a mask whenever possible, given the health condition and features of the diagnostic therapy procedure, regardless of the vaccination status and possession of a digital COVID certificate or other evidence. necessary.
- Persons accompanying at birth, persons accompanying patients and visiting hospitalized patients wear a mask throughout their stay in the health institution. Parents / guardians who stay in accommodation with children wear a mask whenever possible and do not wear a mask when eating, maintaining hygiene and when sleeping, and especially consistently and correctly wear a mask when people who do not normally stay in that room enter the room and when movements by a health facility. Persons accompanying childbirth, persons accompanying patients and parents / guardians staying with children in relation to all other persons except the patient for whom they are in the health institution, maintain a physical distance of 2 meters whenever possible.
- EU digital COVID certificate or appropriate proof of vaccination, illness or testing is not required to present children under 12 years of age who are accompanied by patients because they have no one to stay at home with, as well as children under 12 years of age visiting hospitalized parents / guardians, brothers and sisters. Children under the age of 2 do not wear a mask. Children from the age of two to twelve under the supervision of a parent / guardian wear a mask appropriate to their age and state of health. All children maintain a distance from strangers as much as possible appropriate to their age and health condition under the supervision of a parent / guardian.
- It insists on enhanced and consistent hand hygiene, coughing and sneezing, avoiding handshakes and other physical contacts that are not necessary for everyone present, and ventilating the space.