Recent COVID-19 Healthcare Updates and Resources

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

 

This blog is a digest of recent COVID-19 updates for healthcare entities and staff.  It also includes a must-read commentary you won’t want to miss and a resource for stress relief for staff.

COVID-19 cases have been reported in all 50 states, the District of Columbia, and multiple U.S. territories; many having wide-spread community transmission. Given the high risk of spread once COVID-19 enters a LTCF, facilities must act immediately to protect residents, families, and staff from serious illness, complications, and death. Strategies include recommendations to:

This position paper speaks to using masks in all healthcare settings – universal masking “within healthcare settings is a critical tool to protect staff and patients from being infected by asymptomatic and presymptomatic individuals and should be implemented in any community where coronavirus is occurring. Even a single case of community spread of COVID-19 means that healthcare facilities and staff are at risk because other asymptomatic and presymptomatic patients may come in for care and inadvertently infect staff. This document summarizes key steps and provides materials that may be helpful in implementing this recommendation.”

  • Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings…CDC was updated on April 13, 2020. Changed guidances include:
  • To address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.
  • This action is recommended to help prevent transmission from infected individuals who may or may not have symptoms of COVID-19.
  • Cloth face coverings are not considered PPE because their capability to protect healthcare personnel (HCP) is unknown. Facemasks, if available, should be reserved for HCP.
  • For visitors and patients, a cloth face covering may be appropriate. If a visitor or patient arrives to the healthcare facility without a cloth face covering, a facemask may be used for source control if supplies are available.
  • Actively screen everyone for fever and symptoms of COVID-19 before they enter the healthcare facility.
  • As community transmission intensifies within a region, healthcare facilities could consider foregoing contact tracing for exposures in a healthcare setting in favor of universal source control for HCP and screening for fever and symptoms before every shift.
  • Added links to updated guidance for:
  • Strategies to Optimize the Supply of PPE and other Equipment.
  • Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19
  • Interim Guidance on Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19.
  • Strategies to Mitigate Staffing Shortages.

 

  • Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19…CDC was updated April 13, 2020. Changes include:
  • Indicates a preference for use of the Test-based strategy to determine when HCP may return to work in healthcare settings.
  • Adds return to work criteria for HCP with laboratory-confirmed COVID-19 who have not had any symptoms.
  • Aligns with recommendations for universal source control for everyone in a healthcare facility during the pandemic.

 

  • Strategies for Optimizing the Supply of N95 Respirators…CDC was updated on April 2, 2020. Those changes are:
  • Conventional capacity strategies
    • Edited the section on use of airborne infection isolation rooms (AIIRs) for aerosol-generating procedures performed on patients with confirmed or suspected COVID-19 patients.
    • Added language on FDA’s Emergency Use Authorization (EUA) authorizing the use of certain NIOSH-approved respirator models in healthcare settings to the section on N95 alternatives.
  • Contingency capacity strategies
    • Added a section on temporarily suspending annual fit testing following updated guidance from OSHA.
    • Added more details in the extended use section.
  • Crisis capacity strategies
    • Added language on the use of respirators approved under international standards and updated the tables.
    • Combined sections on limited re-use of N95 respirators for tuberculosis and then COVID-19 patients. Added more details surrounding limited re-use.

 

  • Interim Additional Guidance for Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Outpatient Hemodialysis Facilities…CDC was updated April 12, 2020. Changes to this guidance are:
  • To address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms.
    • Cloth face coverings are not considered personal protective equipment (PPE) because their capability to protect healthcare personnel (HCP) is unknown. Facemasks, if available, should be reserved for HCP.
    • For visitors and patients, a cloth face covering may be appropriate. If a visitor or patient arrives to the facility without a cloth face cover, a facemask may be used for source control if supplies are available.
  • Definitions:
    • Cloth face covering: Textile (cloth) covers that are intended to keep the person wearing one from spreading respiratory secretions when talking, sneezing, or coughing. They are not PPE and it is uncertain whether cloth face coverings protect the wearer. Guidance on design, use, and maintenance of cloth face coverings is available.
    • Facemask: Facemasks are PPE and are often referred to as surgical masks or procedure masks. Use facemasks according to product labeling and local, state, and federal requirements. FDA-cleared surgical masks are designed to protect against splashes and sprays and are prioritized for use when such exposures are anticipated, including surgical procedures. Facemasks that are not regulated by FDA, such as some procedure masks, which are typically used for isolation purposes, may not provide protection against splashes and sprays.
    • Respirator: A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.

 

  • CMS posted COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers with a date of April 21, 2020. This 26-page document appears to be a reiteration of previous postings.  I am not seeing anything new but I’m still combing through it and comparing it to past documents.  Because of its date, I recommend retaining this copy and sharing it with your team.

 

Unprecedented solutions for extraordinary times: Helping long-term care settings deal with the COVID-19 pandemic is a commentary written by 4 physicians (Gaur S, et al. (2020). Unprecedented solutions for extraordinary times: Helping long-term care settings deal with the COVID-19 pandemic. Infection Control & Hospital Epidemiology, https://doi.org/10.1017/ice.2020.98).  This is a 2-page read, packed with needed information and perspectives.  The authors propose 5 measures “to help protect the 1.4 million individuals that already occupy beds in 1 of 15,600 LTC settings”.  Here’s an introductory excerpt:

“Without question, the segment of our population most at risk for severe and potentially lethal COVID-19 are older adults. Among older adults, residents living in long-term care (LTC) settings are among the most vulnerable by virtue not only of their healthcare needs but also by living in a communal setting populated by other individuals at high risk for disease acquisition. To date, LTC settings are the segment of the healthcare system with the most notable burden of COVID-19 cases. What is more alarming is that the overall quality ratings of LTC settings with COVID-19 outbreaks in King’s County, Washington, are least 3 of 5 stars. Furthermore, the average daily hours for direct care of residents by licensed nursing staff at these sites is at or above the national average. This finding suggests that the outbreaks of COVID-19 reported in these settings are not due to lapses in infection prevention and control; rather, the outbreaks detected are occurring in LTC settings despite reasonable practice.”  Keep reading.  You’ll be glad you did.

Be safe and stay healthy!