Guidance and responses were provided based on information known on 4/9/2020 and may become out of date.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 4.9.2020 Dr. Salman Ashraf, MBBS and Kate Tyner, RN, BSN, CIC Nebraska ICAP Dr. Maureen Tierney, MD,MSc NE DHHS HAI-AR
New Ambulatory Tools (CDC) The following options can reduce in- person healthcare visits and prevent transmission of respiratory viruses in your facility: • Instruct patients to use available 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. • Identify sufficient HCP to conduct telephonic and telehealth interactions with patients. • Develop protocols so that HCP can 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
New Ambulatory Tools (CDC) Implement algorithms to identify which patients have respiratory symptoms that may be due to COVID-19 and need to be advised: • Seek 9-1-1 transport • Go to an emergency department • Come to your facility https://www.cdc.gov/coronavirus/2019- https://www.cdc.gov/coronavirus/2019- ncov/phone-guide/phone-guide-H.pdf ncov/hcp/ambulatory-care-settings.html
Safe Triage • Place visual alerts such as signs and posters at entrances and in strategic places providing instruction on hand hygiene, respiratory hygiene, and cough etiquette • Ensure supplies are available such as tissues, hand soap, waste receptacles, and alcohol-based hand sanitizer in readily accessible areas • Ensure facemasks are available at triage for patients with respiratory symptoms • Create an area to physically separate patients with respiratory symptoms • To reduce crowding in waiting rooms, 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 • Set up triage booths to screen patients safely https://www.cdc.gov/coronavirus/2019- https://www.cdc.gov/coronavirus/2019- ncov/hcp/ambulatory-care-settings.html ncov/downloads/Symptoms.pdf
Screening and Diagnosis • Designate HCP who will be responsible • Ensure they are trained on infection prevention and control guidance for COVID-19 • Perform training and competency validation https://repository.netecweb.org/exhibits/show/ncov/item/697 https://repository.netecweb.org/exhibits/show/ncov/item/894
Nebraska Test Site Information http://dhhs.ne.gov/Documents/COVID-19%20Screening%20and%20Testing%20Information.pdf
Monitor HCP and ensure maintenance of essential healthcare facility staff and operations Facilities should implement sick leave policies that are non-punitive, flexible, and consistent with public health policies • Allow ill healthcare personnel (HCP) to stay home • HCP should be reminded to not report to work when they are ill • Do not require a healthcare provider’s note for employees who are sick with respiratory symptoms • Advise employees to check for any signs of illness before reporting to work each day and notify their supervisor if they become ills before returning to work • Consider screening staff for fever or 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
Universal Masking • Healthcare workers wear a mask during clinical care • Achieves source control and decreases risk of spreading infection: protects patients and other healthcare workers if the healthcare worker have pre-symptomatic or asymptomatic COVID-19 • Implemented by facilities on a voluntary basis when the jurisdiction is experiencing community spread • Requires very strict adherence to • Extended use/reuse • Meticulous hand hygiene • Proper use and hygiene of the mask https://www.nebraskamed.com/sites/default/files/documents/c ovid-19/surgical-mask-policy-and-faq-nebraska-med.pdf
CDC on Homemade Cloth Face Coverings • Wear cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) • Use of simple cloth face coverings to slow the spread of the virus • Help people who may have the virus and do not know it from transmitting it to others • The cloth face coverings recommended are not surgical masks or N-95 respirators
What mask? Don’t forget to wash these! Source Control: Personal Protective Equipment: Non Clinical Staff Patient care Visitors
Infection Prevention and Control Office Hours Monday – Friday 7:30 AM – 9:30 AM Central Time 2:00 PM -4:00 PM Central Time Call 402-552-2881
New Day and Time- slightly different format 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
Questions and Answer Session 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: Dr. Salman Ashraf, MBBS Dr. Maureen Tierney, MD,MSc 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 1. What is your recommendation for OB patients who are scheduled for induction or Cesarean 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- operating-room-covid-19.pdf. 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 i n 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 obstetric care and delivery are being tested. Furthermore, if they do not have a negative COVID- 19 test within last 72 hours before induction or C section, then the staff wears full PPE including N-95 mask) 2. We are considering options to conserve PPE. What is the recommendation for ACTIVE MRSA 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 use. During this time you could consider using patient gowns, etc., to supplement your fluid impermeable gowns for non-wet type encounters. Last week, the CDC updated their PPE optimization strategies with some new ideas. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
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