covid-19 guidance for outpatient facilities update 3/19/2020 · 3/19/2020 · and public media...
TRANSCRIPT
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COVID-19 Guidance for Outpatient
FacilitiesUpdate 3/19/2020
Dr. Salman Ashraf, MBBS and Kate Tyner, RN, BSN, CIC
Nebraska ICAP
Dr. Maureen Tierney, MD,MSc
NE DHHS HAI-AR
Guidance and responses were provided based on information known on 3/19/2020 and may become out of date. Guidance is being updated rapidly, so users should look to
CDC and NE DHHS guidance for updates.
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https://www.cdc.gov/coronavirus/2019-ncov/downloads/Clinic.pdf
This and more at “Get Your
Clinic Ready for Coronavirus Disease 2019 (COVID-19)”
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinic-preparedness.html
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https://www.cdc.gov/coronavirus/2019-ncov/downloads/Please-Read.pdf
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Updates for the Public and Returning Travelers
All returning travelers have an increased risk of exposure to COVID-19
All returning travelers should limit public interactions, practice strict social-distancing, and self-monitor for symptoms
IF a returning traveler develops fever or respiratory illness, they need to IMMEDIATELY self-isolate and report to a provider or local health department
Returning travelers need to track the publicly reported COVID-19 disease burden in the areas to which they have travelled through both the local/state public health departments and public media websites.
Areas with widespread sustained transmission (e.g. CDC Level 3 countries plus U.S. locales such as WA state, Westchester County and NYC, NY, and CA esp. Santa Clara County,) are at increased risk and of special concern.
Such travelers should self-quarantine for 14 days and immediately report any symptoms consistent with COVID-19 infection to their health care provider. Individuals unable to observe the 14-day self-quarantine should consult with their local health department
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Health care workers with a travel history from an area with widespread sustained transmission [Level 3 Countries, NYC, California (esp. Santa Clara Co.), Washington state, Florida, or other high-risk exposure should self quarantine if possible and self monitor.
However, if because of HCP shortage or a needed expertise they should consult with a trained medical professional (e.g. infection preventionist or physician) at their facility and
Establish a protocol such as active monitoring with PPE while at work that mitigates the risk of patient and co-worker exposure.
Updates for the Public and Returning Travelers
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Commercial labs listed below had announced the availability of commercial tests through their portals. Published turnaround time is 3-4 days.
Any patient (+) for COVID-19 virus should be immediately reported to their local/state public health office.
All such (+) tests are provisional pending confirmation at NPHL. Request the commercial lab send the specimen to NPHL for all positive test
ARUP-No longer accepting new tests
Mayo –only providing for Mayo clinic patients
Quest -1000 tests nationally per day
LabCorp?
Commercial Lab Testing
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Availability of Testing
NPHL is performing the CDC-approved test.
– 20 specimens per run may be able to expand to about 100/day.
– Approval via LHD through the state DPH is necessary
UNMC - separate test through Regional Pathology Laboratory (RPL),
At capacity
Testing
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Inpatients with a clinical presentation consistent with COVID-19, after ruling out alternative diagnoses (negative RPP), should be considered for testing. Highest testing priority
Outpatients that are members of vulnerable or high-risk populations with a clinical presentation consistent with COVID-19, after ruling out alternative diagnoses (negative flu and RPP), should be considered for testing.
Vulnerable or high-risk populations include
o Healthcare workers
o Public safety (EMS, law enforcement, firefighters)
o Nursing home, group home, daycare attendees or employees
Most outpatients with a clinical presentation consistent with COVID-19 WITH A CLINICALLY CONSISTENT PRESENTATION should be considered a probable case of COVID-19 and self-isolate without expecting testing. Testing to rule out an alternative diagnosis is up to the PCP.
Testing Priorities
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Additional Criteria to Guide Evaluation and Laboratory Testing for COVID-19.
Priorities for testing may include:
1. Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.
2. Other symptomatic individuals such as, older adults (age ≥ 65 years) and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
This is what states with lots of transmission are doing. Also preserves PPE.
CDC: Criteria to Guide Evaluation and Lab Testing for COVID-19
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Discontinuation of Home Isolation for Persons with COVID-19 (Interim Guidance)Persons with COVID-19 who have symptoms and who are directed to care for themselves at home may discontinue home isolation under the following conditions: 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.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
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CDC Guidance as of 3/17/2020
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html
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https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
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Implement Crisis Capacity Strategy- facemasks• Cancel all elective and non-urgent procedures and
appointments for which a facemask is typically used by HCP.
• Use facemasks beyond the manufacturer-designated shelf life during patient care activities.
• Implement limited re-use of facemasks.
• Prioritize facemasks for selected activities
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
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Prioritization of activities For facemasks
• For provision of essential surgeries and procedures
• During care activities where splashes and sprays are anticipated
• During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable
• For performing aerosol generating procedures, if respirators are no longer available
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
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https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers
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Information HotlinesNebraska Medicine
Symptoms? 800.922.0000 prior to appointment or ER
CHIhealth.com 8AM to 8PMhttps://www.chihealth.com/en/patients-visitors/coronavirus-covid-19.html
If answer questions suggestive of coronavirus exposure or symptoms, then directed to an MD or ANP
Methodist
Hot Line 24/7 402-815-7425
Bryan Health
https://www.bryanhealth.com/coronavirus/
24/7 COVID-19 hotline at 402-481-0500
Regional West
https://www.rwhs.org/our-network/about-us/visitation-restrictions-covid-19-information
308-630-1580
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Monday – Friday 7:30 AM – 9:30 AM Central Time2:00 PM -4:00 PM Central Time
Call 402-552-2881
Infection Prevention and ControlOffice Hours
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Weekly COVID-19 Outpatient WebinarsDHHS in association with ICAP will continue to host weekly webinars specific to outpatient facilities in the state of Nebraska. The webinars will continue to address situation updates and essential information on COVID-19.
Link to weekly COVID-19 OP webinar invite
https://icap.nebraskamed.com/outpatient-covid-19-webinar-invite/
Link to past webinars and recordings
https://icap.nebraskamed.com/covid-19-webinars/
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Questions and Answer SessionUse 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 websitePanelists today are:
Dr. Salman Ashraf, MBBSDr. Maureen Tierney, MD,MScKate Tyner, RN, BSN, CICIshrat Kamal-Ahmed, M.Sc., Ph.DMargaret Drake, MT(ASCP),CICTeri Fitzgerald RN, BSN, CIC
https://icap.nebraskamed.com/covid-19-webinars-and-tools/