COVID-19 Working Well Protocols

Working Well and Employee Health

COVID19 Employee Health Response Flow Chart_V4

Questions and Answers from CDC Clinician Outreach webinar on optimizing PPE

  1. When are people most infectious? People likely most infectious when most symptomatic, but onset and duration are unknown –  incubation 2-14 days – not sure how that plays into transmission
  2. When should O/P clinics cancel routine visits?   Prioritize urgent and emergent for several weeks to protect staff and PPE
  3. When should inpatients with confirmed COVID-19 be discharged? Whenever clinically indicated. If discharged home, consider ability to adhere.
  4. Is air in patient rooms infectious? For how long?  Not known.   When can a vacated room can be entered by a HCP?  If the room was only occupied a few minutes, it dissipates in a matter of minutes.  But if the patient was in there longer, risk is more.  Use similar precautions that you would use for TB patients.
  5. How do you decontaminate a respirator? This is complex.  There is not a single disinfection method for all models.  There is no CDC approved way to decontaminate a disposable respirator.  CDC is working on this.
  6. When can transmission based precautions be discontinued? There is guidance on the CDC website. For hospitalized patients, the decision is multifactorial and case-by-case.  Criteria to consider include resolution of fever without medication, improvement in respiratory symptoms.  Using a test-based approach should be considered, particularly for those who are severely ill.
  7. If resources are available, should patients be isolated in a private room regardless of exposure or travel history?  Yes.
  8. What is being to do expand use of PAPRS in hospitals?  CDC is in discussion with respirator manufacturers.  The government is are working with Ford Motor to produce respirators.  It is important that hospitals have up-to-date cleaning procedures for re-useable respirators.
  9. If a patient has a known cause of illness, like flu, should they be tested for COVID? Providers should use their clinical judgment. But there are cases of co-infection.
  10. Do patients need to be in airborne isolation rooms? No, they can be in regular exam room with door closed.  Only needed for aerosol generating procedures
  11. Do you need PPE to perform nasopharengeal swap if suspect COVID? Yes, use usual PPE.  But it does not need to be performed in airborne isolation room
  12. If there are no NIOSH-approved products, can you use them from other countries? On CDC website there is a list and the FDA also has issued authorization with the countries it can be used from.  Do not use products from China, because they have gotten some counterfeit products.  Check the list.
  13. What about chloroquine and hydroxychloroquine? Both medications are used for malaria and inflammatory conditions.  Both have invitro activity against SARS and hydroxychloroquine may have more potency.  But there have been no trials on using these drugs, although trials are underway.  It is important to note that there have been adverse events with hydroxychloroquine and both medications have known safety risks.
  14. What cleaning agents work against the virus? The EPA lists 10 agents on their website
  15. What PPE should environmental workers wear when cleaning rooms that hold, or have held, a patient with COVID-19? If the patient is in the room, use all recommended PPE, a respirator or face mask.  If those are not available, use eye protection, gown, gloves. If the patient is not there, gown and gloves should be sufficient.
  16. Can I make a non-traditional respirator for health care settings? Is there information about this?    CDC NIOSH approves them.   Approval requirements are available from them.
  17. As hospital space become limited, can patients with COVID-19 share rooms? A patient with confirmed COVID-19 can be cohorted with other confirmed patients.  But do not cohort suspected cases.

Return to Work Criteria for HCP with Confirmed or Suspected COVID

What strategies are people planning to use for when HCP may return to work in healthcare settings

CDC guidance

  1. Test-based strategy. Exclude from work until
    • Resolution of fever without the use of fever-reducing medications and
    • Improvement in respiratory symptoms (e.g., cough, shortness of breath), and
    • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens).
  1. Non-test-based strategy. Exclude from work until
    • At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,
    • At least 7 days have passed since symptoms first appeared

All information is anecdotal

  1. Nurse at large testing site in Boston – they recommend option 1
  2. Pharmacist in Florida working in one of the large chains – they are requiring 14 days post-recovery, but I cannot get a good sense if they are requiring repeat testing 

Staying well at work for HCPs

  1. In addition to practices such as washing your hands frequently and maintaining social distancing, the following measures will help keep you safe while at home and work:
    • Wear clothing to work that can readily be washed at home.
    • Wash your work clothes thoroughly yourself – generally use a normal laundry detergent according to washing machine instructions and dry thoroughly using the warmest temperatures recommended on the clothing label.
    • Consider bringing a change of clothes to wear home at the end of your shift or upon arrival to home.
    • Don’t wear scrubs out in public. People are afraid during this crisis, so they may think you are contagious. Some of our own caregivers have been confronted by strangers about this.
    • Consider going to “bare below the elbows” so that it is easier to wash hands/forearms and avoid the possibility that long sleeves are inadvertently contaminated.
    • Don’t wear ties, as they are harder to clean and might become contaminated.
    • Wipe before you type – disinfect a shared computer keyboard before you start to use it
    • Disinfect your cell phone, pager, laptop computers or other devices before you go home.
    • Avoid having your rounding team cluster around a single computer.

From AMA:

  • It is important to take conservative measures to protect yourself and your patients. While a face mask is standard precaution, patients should also be evaluated in a private room—ideally an airborne infection isolation room—with the door closed.
  • It is important to use standard, contact and airborne precautions, as well as wearing eye protection, gloves and disposable scrubs before entering the room when caring for a PUI.

https://www.ama-assn.org/delivering-care/public-health/2019-novel-coronavirus-6-questions-doctors-are-asking

 

Data on Masks/PPE

All information is anecdotal

  1. At Partners: Mask (surgical) for everyone on premises, handed to you as you walk in. Same mask all day unless obviously soiled.
  2. Massachusetts DPH guidance on prioritization of PPE The Massachusetts Department of Public Health has released “Guidance on Prioritization of PPE in MA https://www.mass.gov/doc/guidance-for-prioritization-of-personal-protective-equipment-ppe-in-massachusetts/download“. In the near term, given current supplies, PPE will be prioritized for medical facilities on the front lines. Please submit all requests for PPE via the channels shown. The Commonwealth will coordinate your requests. For hospitals, nursing homes, community health centers, emergency medical services, local public health, and other health facilities, this means to request or report PPE shortages to your regional Health and Medical Coordinating Coalition (HMCC)
  3. Boston Children’s: List of approved aerosol generating procedures for N95 respirator use while caring for a child with suspected or confirmed COVID-19
    • Bronchoscopy
    • Resuscitation involving emergency intubation or CPR
    • Endotracheal intubation or extubation
    • Open suctioning of airway secretions or cough assist
    • Sputum induction
    • HFNC
    • CPAP/BIPAP
    • Autopsy
    • Nebulized treatments
  1. UMass Memorial requiring staff to wear facemasks at all time while on premises.  All employees

  2. Boston Children’s Mask Policy
    • Beginning Wednesday (3/25) staff entering the hospital will be asked to attest to their health and given an ear loop mask for use while at Boston Children’s Hospital.
    • Hospital employees will receive7KPXS4LC9TKLVVY33KGDan ear loop mask when entering the hospital.
    • Employees will be asked to attest to the following question: Do you have the following symptoms: fever, cough, sore throat, muscle aches OR difficulty breathing?
    • The hospital issued daily mask is worn when at the hospital, except when eating/drinking, being in a private space, or when inside the rooms of patients on droplet, airborne precautions, or COVID-19 precautions.
    • The mask is worn when caring for patients on no transmission-based precautions as well as while seeing patients on contact precautions or enhanced contact precautions only.
    • For patients on droplet or airborne precautions and COVID-19 precautions remove the mask and store in a safe space and don new PPE.
    • Wear and re-use your hospital issued daily mask for the entire shift.
    • Only replace the hospital mask if wet, visibly soiled or damaged.
    • Staff with those symptoms will be asked to go home and call Occupational Health Services.

Eyewear

  • If your patient has a fever, cough, shortness of breath, sore throat, difficulty breathing or muscle aches and does not meet criteria for COVID-19 testing, the recommended precautions are contact droplet and eyewear.