Presented in collaboration with Nebraska ICAP, Nebraska DHHS HAI Team, Nebraska Medicine, and The University of Nebraska Medical Center Presented by Margaret Drake Moderated by Mounica Soma Panelists Dr. Salman Ashraf, MBBS Dr. Maureen Tierney, MD,MSc Kate Tyner, RN, BSN, CIC Ishrat Kamal-Ahmed, M.Sc., Ph.D Margaret Drake, MT(ASCP),CIC Teri Fitzgerald RN, BSN, CIC
Things we will cover in in th this webinar Unique situation in Critical Access Hospitals Clinic Long Term Care Hospital Dialysis
Links to Nebraska webinars Nebraska Acute Care Call every M,W, F at noon previous calls can be found Nebraska Hospital Association https://www.nebraskahospitals.org/coronavirus-covid-19-information.html Nebraska ICAP Long Term Care Webinars every Thursday at noon previous webinars and questions and answers found on ICAP website https://icap.nebraskamed.com/ Nebraska ICAP Outpatient Webinars every Thursday at 9 AM previous webinars and questions and answers found on ICAP website https://icap.nebraskamed.com/
Prevent the in introduction of f respiratory ry germs IN INTO your facility
Lock Down Access between Clinical Areas Prevent flow of non-essential personnel between your clinic, hospital, and long term care areas Especially important if they are all in one building Designate staff to work in only one area if previously they floated between clinic, acute care, and long term care Establish where staff are to enter their work area and do active screening temperature signs and symptoms hand out new mask
Use the experience you have • Yearly influenza epidemic strategies are useful now • Surveillance for respiratory infection in the local community • Active, daily surveillance in facility • When a case is suspected or confirmed, notify local public health • Implement isolation strategies immediately • Communicate with internal staff to implement isolation procedures (dietary, housekeepers, etc.)
CLINICS Prepare the Clinic • Know which of your patients are at higher risk of adverse outcomes from COVID-19. • Provide telemedicine appointments. • Know how to contact your health department. • Stay connected with your health department to know about COVID-19 in your community. Step up precautions when the virus is spreading in your community. • Assess supplies now and on a regular schedule • Daily counts • Extend use per national guidance • Secure storage
Clinics Communicate with patients. • Ask patients about symptoms during reminder calls. • Reschedule non-urgent appointments. • Post signs at entrances and in waiting areas about prevention actions. Prepare the waiting area and patient rooms. • Provide supplies — tissues, alcohol-based hand rub, soap at sinks, and trash cans. • Place chairs at least 6 feet apart. Use barriers (like screens), if possible. • If your office has toys, reading materials, or other communal objects, remove them or clean them regularly.
Clinics When Patients Arrive Place staff at the entrance to ask patients about their symptoms. • Provide symptomatic patients with tissues or facemasks to cover mouth and nose. • Limit non-patient visitors. Separate sick patients with symptoms. • Allow patients to wait outside or in the car if they are medically able. • Create separate spaces in waiting areas for sick and well patients. • Place sick patients in a private room as quickly as possible.
Clinics After Patients are Assessed Provide at-home care instructions to patients with respiratory symptoms. Consider telehealth options for follow up. Notify your health department of patients with COVID-19 symptoms. After patients leave, clean frequently touched surfaces using EPA-registered disinfectants — counters, beds, seating. Find signs for your clinic and infection prevention guidelines: www.cdc.gov/COVID19 Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinic-preparedness.html
Long Term Care Updated guidance to recommend that nursing homes: Restrict all visitation except for certain compassionate care situations, such as end of life situations Restrict all volunteers and non-essential healthcare personnel (HCP), including non-essential healthcare personnel (e.g., barbers) Cancel all group activities and communal dining Implement active screening of residents and HCP for fever and respiratory symptoms COVID-19 is being increasingly reported in communities across the United States. It is likely that SARS-CoV-2 will be identified in more communities, including areas where cases have not yet been reported. As such, nursing homes should assume it could already be in their community and move to restrict all visitors and unnecessary HCP from the facility; cancel group activities and communal dining; and implement active screening of residents and HCP for fever and respiratory symptoms.
Long Term Care https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html https://www.cdc.gov/coronavirus/2019-ncov/downloads/novel-coronavirus-2019-Nursing-Homes- Preparedness-Checklist_3_13.pdf https://icap.nebraskamed.com/
CAH Layout Plan where you will be caring for a COVID-19 positive patient • Do you have negative pressure rooms? • Do you have more than one hallway or unit in your facility? • Can you place COVID patients on one end of a hallway or unit? • Think about air flow- work with your facility management staff to determine airflow so air is not flowing from COVID area into area where medical/OB patients are housed
CAH Staffing Do you have enough staff to have a dedicated COVID nurse? Best if possible If not – work on plan for removal of PPE and bundling of cares for COVID patient before moving to non COVID patients IMPORTANT Same PPE cannot be worn between caring for COVID and non- COVID patients So if same personnel are care for both types of patients they will need at least 2 sets of PPE if you are doing reuse or extended use PPE Do you do infusions in the hospital?- Separate COVID area away form infusion area- if more than one person receiving an infusion can you do in separate rooms and not one large area
CAH If haven’t already start talking to surrounding other critical access hospitals in your area Could one hospital care for COVID patients only Could one hospital care for medical and OB patients only Caution- your PPS hospital in your area may not be able to take all your COVID patients Have you discussed with your PPS hospital when and who will transfer COVID patients needing a higher level of care? If you care for influenza patients you probably can care for most COVID patients What is your ventilator situation? Do you have ventilators and the staff trained to operate ventilators? If no this is a reason to transfer patient.
Dialysis Does your CAH have an outpatient Dialysis unit? https://www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis.html American Society of Nephrology https://www.asn-online.org/ COVID-19 patients will still need to come to all their dialysis appointments Both CDC and ASN have good resources on doing dialysis with a COVID-19 patient Screen before appointment Screen when they come again Separate room to do dialysis- best if last station- as far away as possible from all stations- 6 feet Patient wears a mask – staff wear isolation PPE for patient – and remove before moving to another patient.
Plan lannin ing for r Emplo loyee Abse senteeis ism • Ensure sick leave policies or furlough to stay home if they have symptoms of respiratory infection • Have a plan to bring in temporary staff, perhaps through an agency, when there is insufficient staffing due to illness or increased burden of care • We strongly recommend healthcare facilities develop staff policies to allow and account for potential absenteeism during community-wide outbreaks
Caring for In Individuals wit ith SUSPECTED COVID-19 19 • We recommend frequent daily cleaning with an EPA-registered, hospital-grade disinfectant of commonly touched environmental surfaces to decrease environmental contamination. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control- recommendations.html • If an individual meets the CDC case definition of a suspected case and an airborne isolation room is not immediately available, we recommend facilities place the individual in a single room
At present CDC is recommending that healthcare facilities use: St Standard Precautio ions, , Con Contact Precautions, s, Airborne Precautions, , (i (if no no N-95 use use sur surgical l face acemask) an and Eye Protectio ion . . This means wearing a gown, gloves, facemask, and goggles or a face shield. If using surgical facemask a face shield is preferable to goggles.
Support hand and respiratory hygiene, as well as cough etiquette by residents, visitors, and employees • Ensure employees clean their hands according to CDC guidelines https://www.cdc.gov/handhygiene/index.html • Encourage frequent hand hygiene among residents and visitors • Put alcohol-based hand rub in every resident room (ideally both inside and outside of the room) • Make sure tissues are available and any sink is well-stocked with soap and paper towels for hand washing • Audit and feedback handhygiene and PPE use
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