Facilities 4.9.2020 Dr. Salman Ashraf, MBBS and Kate Tyner, RN, - - PowerPoint PPT Presentation
Guidance and responses were provided based on information known on 4/9/2020 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates. COVID-19 Guidance for Outpatient Facilities
Nebraska ICAP
NE DHHS HAI-AR
Guidance and responses were provided based on information known on 4/9/2020 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates.
The following options can reduce in- person healthcare visits and prevent transmission of respiratory viruses in your facility:
telephone advice lines, patient portals, and on-line self-assessment tools, or call and speak to an office/clinic HCP if they become ill with symptoms such as fever, cough, or shortness of breath.
telephonic and telehealth interactions with patients.
triage and assess patients prior to entering the facility or immediately upon entering.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ambulatory-care-settings.html
Implement algorithms to identify which patients have respiratory symptoms that may be due to COVID-19 and need to be advised:
department
https://www.cdc.gov/coronavirus/2019- ncov/phone-guide/phone-guide-H.pdf https://www.cdc.gov/coronavirus/2019- ncov/hcp/ambulatory-care-settings.html
posters at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette
tissues, hand soap, waste receptacles, and alcohol-based hand sanitizer in readily accessible areas
for patients with respiratory symptoms
patients with respiratory symptoms
consider asking patients waiting to be seen to remain outside (e.g., stay in their vehicles, if applicable) until they are called into the facility for their appointment
safely
https://www.cdc.gov/coronavirus/2019- ncov/downloads/Symptoms.pdf https://www.cdc.gov/coronavirus/2019- ncov/hcp/ambulatory-care-settings.html
responsible
control guidance for COVID-19
validation
https://repository.netecweb.org/exhibits/show/ncov/item/697 https://repository.netecweb.org/exhibits/show/ncov/item/894
http://dhhs.ne.gov/Documents/COVID-19%20Screening%20and%20Testing%20Information.pdf
Facilities should implement sick leave policies that are non-punitive, flexible, and consistent with public health policies
stay home
work when they are ill
note for employees who are sick with respiratory symptoms
day and notify their supervisor if they become ills before returning to work
respiratory symptoms before entering the facility
https://www.aapacn.org/wp-content/uploads/2020/03/AADNS_COVID-19- Healthcare-Professional-Screening- Form_FIN_V.1.2.pdf?_cldee=amltLmJlcmtsYW5AbWNrbmlnaHRzLmNvbQ%3 d%3d&recipientid=contact-97e8d6e7c895e011ac48005056834d9b- 6df399ef97714013bbcd7bad5f279460&esid=e860278d-a372-ea11-80e3- 000d3a0dce1c
https://www.nebraskamed.com/sites/default/files/documents/c
Personal Protective Equipment: Patient care
Source Control: Non Clinical Staff Visitors
Don’t forget to wash these!
When: This is a recurring webinar Time: Every Tuesday 12.00pm – 1.00pm Topic: COVID-19 Update for Small and Rural Hospitals for Region VII Please click the link below to join the webinar: https://unmc.zoom.us/j/168131463 Or iPhone one-tap : US: +16699006833,,168131463# or +13462487799,,168131463# Or Telephone: Dial(for higher quality, dial a number based on your current location): US: +1 669 900 6833 or +1 346 248 7799 or +1 301 715 8592 or +1 312 626 6799 or +1 646 876 9923 or +1 253 215 8782 Webinar ID: 168 131 463
Use the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator, in the order they are received A transcript of the discussion will be made available on the ICAP website Panelists today are:
Kate Tyner, RN, BSN, CIC Margaret Drake, MT(ASCP),CIC Teri Fitzgerald RN, BSN, CIC Moderated by Mounica Soma, MHA
https://icap.nebraskamed.com/resources/
Responses were provided based on information known on 4/9/2020 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates. Nebraska DHHS HAI-AR and Nebraska ICAP Outpatient Facility Webinar on COVID-19 4/9/2020
section? Should they be COVID tested ahead of admission? Should they be quarantined ahead of their due date? Nebraska Medicine has good COVID-19 obstetrics screening guideline. They also have guidelines for obstetric care with COVID-19 suspected or confirmed infection in the OR. https://www.nebraskamed.com/sites/default/files/documents/covid-19/obstetrical-care-in- labor-and-delivery-covid-19.pdf https://www.nebraskamed.com/sites/default/files/documents/covid-19/guidelines-ob-care-
They are recommending screening all obstetric patients with unknown COVID status presenting to Labor and Delivery. They will be asked for exposure history, signs and symptoms, etc. There have been some discussions about having pregnant mothers be in kind of home quarantine 14 days prior to their delivery or at 37 weeks, etc. so they don’t end up in a situation where the mother and baby may have to be separated (in case the mother develop the infection during that time frame). A pre-birth home quarantine may help avoid that (although more clear guidance on this is still awaited). We recommend to consider following the Nebraska Medicine guidance as outlined in the documents above. (Additional clarification: Nebraska Medicine guidance recommend screening all obstetric patients presenting to labor and delivery and then make decisions on testing based on that screening results. However, all patients admitted for
19 test within last 72 hours before induction or C section, then the staff wears full PPE including N-95 mask)
infection patients? For active MRSA infection means an open wound that is draining – if you are going to be doing a wound cleaning or drainage where you will come into close contact with that wound, then you should wear the PPE before you do that procedure. However, if the wound is contained, or someone is just colonized with MRSA, you may not need to wear PPE or the gown. CDC has relaxed those recommendations. But, for anything like draining or cleaning a wound, it would require use of PPE. We hope that someday in the future, when this outbreak time is on, we can go back to our strict infection control guidance we used before. Continue to think about your standard precautions, protecting yourself from splashes, aerosols, debris, etc., to prioritize gown
impermeable gowns for non-wet type encounters. Last week, the CDC updated their PPE
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
able to sew gowns. Is there a specific material that would be acceptable for this? AAMI (an organization that helps with sterilization guidelines, dialysis water quality guidelines, etc.) has some guidance on fabrics that are appropriate and fluid impermeable. We are not a point in this battle that we can get that kind of fluid-impermeable fabric. If you have someone to sew gowns, you could use a heavy cloth like a lab coat (where a droplet would not soak through). These homemade gowns might supplement your gown inventory, using a homemade cloth gown for things that are non-wet where you don’t want to contaminate your uniform by brushing up against something. Continue to think how to use your non-permeable gowns for sprays and splashes.
rules as the surgery mask face-to-face patient care wearers? It is an important hygiene piece not addressed in national guidelines. It is better to take the cloth mask off on a break like lunch, laying it dirty side down on a clean paper towel, cleaning hands carefully before and after donning and doffing the mask. We have not seen this in any written requirements, but we want to maintain our good basic hygiene practices. It is recommended that the masks be washed at least once per worker shift.
they doff and store that appropriately? Until the next use? You can appropriately conserve the N95 and use it again. There has to be a procedure established on safe storage of the N95. Options include using a paper bag to store it. There are protocols on the Nebraska Medicine website on N95 and surgical mask preservation. Find it here: https://www.nebraskamed.com/sites/default/files/documents/covid-19/COVID- Extended-Use-Reuse-of-PPE-and-N95.pdf?date03212020 . UV disinfection sites for masks are planned for five or six sites around Nebraska. DHHS hopes to announce those sites by next week. The N95 can be safely reused if safely stored in a paper bag in a well-ventilated space. If during the use the mask is soiled or damaged (saturated), it cannot be used. If it still looks good, you can store it correctly and then use it. Once the disinfection is available it could even extend the life longer.
directive that came out from Gov. Ricketts’ office last Friday? If it is in the directed health measure’s recommendation, you do. There are different facets to
you can send an email to the DHHS or ICAP. If a person has a positive COVID test, then they need two negative COVID tests. If they have clinical symptoms, the guidance depends on the resolution of the symptoms when the quarantine can end. Other quarantine guidance for families in the home of COVID positive patients is also described in that directed health measure.
Confusion is possible because the directed health measure has clarifying language toward the end of the document. Dr. Tierney will re-examine the wording and share the guidance when she has that available. She advises reading the more specific information near the end of the document.
concerning for COVID who have had close occupational exposures with COVID-19. We have been isolating and quarantining patients and family members respectively. Is this appropriate
Statewide, DHHS hopes that testing capacity will continue to grow, and become more easily
COVID and develops symptoms consistent with COVID, making the assumption that the person has COVID and treating their contacts also have it is the right way to go. Testing might be needed if the person is in inpatient hospitalized or a healthcare worker. Tests also need to be prioritized for those living in a shelter, dormitory, and/or assisted living facilities.
with Nasal Pharyngeal swab, do we need to change gowns between each patient? Because some of the patients being tested in the sequence could be negative and some will be positive, you would not want to expose negative people in that line with soiled PPE. In vehicle testing, it could be appropriate because of less patient contact- so more appropriate to not change the bunny suit between patients. It is imperative to still change gloves and clean surfaces between people. In a clinic situation, it is unlikely to be seeing a constant line of
the PPE. There is a crisis level strategy from the CDC that allows leeway in keeping the same gown between patients who may have same infectious disease, but it is preferred to change gowns if at all possible.
It does make a difference. [In the drive through situation] It would be unlikely to have body-to- body contact. In that case the person doing the testing could keep the same gown would still need to change gloves and do hand hygiene. If the gown becomes soiled, such as being exposed to a large amount of fluid- like being sneezed on, then go back to Standard Precautions and change the gown.
Having a negative flu and negative RPP is no longer required as part of the COVID testing
Unless there is a high level of clinical suspicion (contact with a patient with the flu) for flu, (although RSV is still being seen in Nebraska), it is not required and not recommended unless clinical decision-making indicates these tests should be done. You can go right to COVID testing.
with patient interaction should wear masks. It is not written policy but recommended. We have seen transmission where no one knew COVID was in the community until it had spread in a facility. As further information, Dr. Tierney offered that Dr. Redfield of the CDC said yesterday that healthcare workers who were exposed to a COVID positive patient but are asymptomatic, can go back to work with a mask if all other staffing options have been exhausted. There should be close active monitoring of their symptoms before starting work every day.