Coronavirus (COVID-19) Update for Pharmacy Professionals - PowerPoint PPT Presentation

Coronavirus (COVID-19) Update for Pharmacy Professionals

COVID-19 Symptoms HTTPS://WWW.HOPKINSMEDICINE.ORG/HEALTH/CONDITIONS-AND-DISEASES/CORONAVIRUS/CORONAVIRUS-FACTS- INFOGRAPHIC

Where is Tennessee at Today? Age Ranges of Confirmed Cases Total Tests Number Number Testing Location Completed Negative Positive 0-10 2 11-20 9 TN State Public Health 21-30 43 497 464 33 Laboratory 31-40 32 41-50 24 All other commercial and 51-60 18 -- -- 121 private laboratories 61-70 10 71-80 8 Total positives in TN 154 81+ 8 HTTPS://WWW.TN.GOV/HEALTH/CEDEP/NCOV.HTML

TDH COVID-19 Assessment Sites Carter Hawkins Sumner Claiborne Montgomery Unicoi Davidson Shelby Washington Greene Sullivan Williamson Wilson https://www.tn.gov/health/cedep/ncov/remote-assessment-sites.html

TN Department of Health COVID-19 Public Information (State-Wide): 877.857.2945 (10 a.m. – 10 p.m. CST Daily) ◦ Hamilton County: 423.209.8383 ◦ Shelby County: 901.692.7523 ◦ Knox County: 865.215.5555 To request testing at the TN Department of Health, please call 615.741.7247

Considerations for Pharmacists and Pharmacy Professionals

COVID-19 Treatment Considerations Medications being evaluated ◦ Hydroxychloroquine/Chloroquine ◦ Antivirals (Remdesivir, Lopinavir/ritonavir) ◦ Tocilizumab (IL-6 inhibitor) ◦ Other agents Fever Disclaimer: These resources are ◦ Tylenol provided as information only and are ◦ Ibuprofen/NSAIDs (?) not recommendations for treatment. Each patient should be individually Fluids/Nutritional Support/Oxygen/Ventilator evaluated for symptoms and severity Vaccines (under development) to determine needs for treatment. https://www.idstewardship.com/coronavirus-covid-19-resources-pharmacists/

HCP Exposure Risks and Considerations Low Risk: Low-risk exposures generally refer to brief interactions with patients with COVID-19 or prolonged close contact with patients who were wearing a facemask for source control while HCP were wearing a facemask or respirator. Medium Risk: Medium-risk exposures generally include HCP who had prolonged close contact with patients with COVID-19 who were wearing a facemask while HCP nose and mouth were exposed to material potentially infectious with the virus causing COVID-19. High Risk: High-risk exposures refer to HCP who have had prolonged close contact with patients with COVID-19 who were not wearing a facemask while HCP nose and mouth were exposed to material potentially infectious with the virus causing COVID-19. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

HCP Exposure Risks and Considerations Close contact for healthcare exposures is defined as follows: a) Being within approximately 6 feet (2 meters), of a person with COVID-19 for a prolonged period of time (such as caring for or visiting the patient; or sitting within 6 feet of the patient in a healthcare waiting area or room); or b) Having unprotected direct contact with infectious secretions or excretions of the patient (e.g., being coughed on, touching used tissues with a bare hand). HCP not using all recommended PPE who have only brief interactions with a patient regardless of whether patient was wearing a facemask are considered low-risk . ◦ Examples of brief interactions include: brief conversation at a triage desk; briefly entering a patient room but not having direct contact with the patient or the patient’s secretions/excretions; entering the patient room immediately after the patient was discharged. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

HCP Exposure Risks and Considerations Low Risk: Perform self-monitoring with delegated supervision until 14 days after the last potential exposure. Asymptomatic HCP in this category are not restricted from work. They should check their temperature twice daily and remain alert for respiratory symptoms consistent with COVID-19 (e.g., cough, shortness of breath, sore throat). Medium and High Risk: Undergo active monitoring, including restriction from work in any healthcare setting until 14 days after their last exposure. If they develop any fever (measured temperature >100 F or subjective fever) OR respiratory symptoms consistent with COVID-19 (e.g., cough, shortness of breath, sore throat), they should immediately self-isolate. https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

USP: Personal Protective Equipment (PPE) Shortage PPE SHORTAGE CONSERVE GARB AND PPE Implementing the strategies described may Garb for direct patient care personnel should not be aligned with provisions in General take priority. Chapter <797>. Limit staff performing sterile compounding. Reuse of garb and lack of garb may increase ◦ Schedule staff to maximize compounding time the risk of microbial contamination of the CSP and limit number of compounders per day or and the environment. shift. ◦ Modify staging activities to minimize passage Facilities should carefully consider the impact into and out of the compounding areas. on the CSP and the environment and implement risk-mitigating strategies to help If necessary, establish and document ensure quality CSPs deviations from existing Standard Operating Procedures (SOPs). https://www.usp.org/sites/default/files/usp/document/about/public-policy/usp-covid19-garb-and-ppe.pdf

USP: Personal Protective Equipment (PPE) Shortage FOR SHORTAGES OF GARB USED FOR STERILE NON-HD COMPOUNDING Face mask Gown ◦ Reuse of face masks is not recommended ◦ Use clean, washable, dedicated non-disposable because of the risk of introducing microbial garments (e.g., gowns, lab coats). Long-sleeved bioburden from used masks. Storage in bags garments are preferred, and if not available, (e.g., plastic or paper) is not recommended wear sleeve covers. Preferably, wash garments because they may contain bioburden and may after each shift or sooner when visibly soiled. generate particles and microbial contamination. ◦ Retain and reuse disposable gowns as long as ◦ Use clean fabric (e.g., polyester) to cover nose they are intact and not visibly soiled. Preferably, and mouth (e.g., bandana, washable face mask). discard used disposable gowns each day. Don a clean face cover each time before ◦ Store garments in a manner that minimizes entering the compounding area. contamination. ◦ Exclude HCP at higher risk for severe illness ◦ Maintain garments inside of classified area or within the from COVID-19 from contact with known or perimeter of the segregated compounding area (SCA) suspected COVID-19 patients. https://www.usp.org/sites/default/files/usp/document/about/public-policy/usp-covid19-garb-and-ppe.pdf

USP: Personal Protective Equipment (PPE) Shortage FOR SHORTAGES OF GARB USED FOR STERILE FOR SHORTAGES OF PPE USED FOR STERILE NON-HD COMPOUNDING HD COMPOUNDING Shoe Cover Shortages Prioritize gowns and chemotherapy gloves for preparing antineoplastic agents in Table 1 of ◦ Implement dedicated shoes for the the NIOSH list. compounding area. Preferably, dedicated shoes should be cleaned regularly. PPE is designed to minimize exposure of Head and Hair Cover healthcare personnel to HDs. PPE should not be reused when compounding antineoplastic ◦ Use clean fabric to cover head and hair. drugs in Table 1 of the NIOSH list. Preferably, wash after each shift or sooner when visibly soiled. https://www.usp.org/sites/default/files/usp/document/about/public-policy/usp-covid19-garb-and-ppe.pdf

USP: Personal Protective Equipment (PPE) Shortage IF FACILITIES ARE NOT ABLE TO OBTAIN GARB OR PPE Adopt a risk-based approach and limit Where feasible, increase cleaning and anticipatory compounding. disinfecting frequency. Storage times should be assigned Consider increasing frequency of surface conservatively based on patient need and the sampling in the primary engineering control to type of garb mitigation strategy that is used. determine effectiveness of cleaning Use the shortest feasible beyond-use dates procedures and work practices. (BUDs) while giving consideration to avoiding ◦ If any changes are needed, promptly remediate drug shortages and maintaining patient access and consider assigning shorter BUDs. to essential medications. https://peernetwork.criticalpoint.info/storage/files/COVID- CriticalPoint Recommendations: 19%20Garbing%20Shortage%20Recommendations%2020200313.pdf https://www.usp.org/sites/default/files/usp/document/about/public-policy/usp-covid19-garb-and-ppe.pdf