August 12, 2020 l Infection Prevention

COVID-19 Team Member Education

Post Acute Division

What is Coronavirus?

• Large family of viruses

• Cause a variety of illness

– Usually the common cold

• Common in fall and winter

• Common Coronavirus strains can be identified on the ACL Respiratory Viral Pathogen Panel:

– Coronavirus 229E (RC229E)

– Coronavirus NL63 (RCNL63)

– Coronavirus OC43 (RCO43)

– Coronavirus HKU1 (RCHKU1)

Note: These are not the COVID-19 strain.

Coronavirus• Some coronaviruses only affect people

• Some coronaviruses only affect animals

• Rarely animal coronaviruses can evolve and infect humans

Novel Coronavirus Severe Acute Respiratory Syndrome-CoV (SARS)

Middle Eastern Respiratory Syndrome-CoV (MERS)

Coronavirus Disease 2019(COVID-19)

Date 2003 - 2004 2012-current December 2019 - current

Country of Origin China Saudi Arabia (Arabian Peninsula) China (Wuhan City)

# Countries Affected 26 27 188

# Cases 8,098 2,494 17,109,335

Mortality Rate 10% 35% 3.6%

Host Bats Bats Bats?

Intermediary Host Civet Cat Camel Pangolin?Genome sequence of a novel coronavirus strain in pangolins is 99 % identical to the Covid-19 strain in infected people

World Map COVID-19

COVID-19 Transmission and Incubation PeriodSpread primarily from person-person:

• Between people who are in close contact with one another (within 6 feet)

• Through respiratory droplets produced when an infected person coughs or sneezes

– These droplets can land in the mouths or noses of people who are nearby or possibly inhaled into the lung

• Spread from contact from infected surfaces or objects

– Possible but thought to not be the main way virus is spread

Symptoms:

• Fever ≥100.0 F or ≥37.8 C degrees

• New or worsening cough, shortness of breath or difficulty breathing

• Chills, muscle or body aches, headache

• Sore throat, congestion or runny nose

• Loss of smell and taste

• Nausea, vomiting, diarrhea

Incubation Period:

• 2 -14 days

– Estimated median : 5 – 6 days

Infection Prevention Mitigation Strategies

• Hand Hygiene – Every Patient, Every Time

• Stay at home if you are sick

• Don’t touch your eyes, nose and mouth

• Respiratory etiquette (cover your cough)

• Personal Protective Equipment (PPE)

– Follow Home Care, Hospice, and SNF PPE guidance on the COVID-19 Information Center, Post-acute PPE information grid

• Environmental cleaning

– Increase cleaning of high touch surfaces

– High touch surfaces: Doorknobs, sink handles, light switches, hand rails, keyboards, phones etc.

– COVID-19 is effectively killed with EPA registered disinfectants (list on next slides)

• Screening of patients and household members at Intake for Home Care and with every visit

EPA Approved Disinfectants for COVID-19 Advocate Aurora Homecare and Hospice Patients

Contact/wet time for COVID-19 on hard, nonporous surfaces:

• Caviwipes1=3 minutes

• Micro-kill Bleach wipes=1 minute

• Super-Sani wipes=2 minutes

• Clorox wipes=4 minutes

• Clean Cut Disinfecting wipes=4 minutes

• Seventh Generation Disinfecting wipes, contact/wet time 10 minutes

As product availability changes; you may find other substitutions, read label for instructions including contact/wet time required for disinfection on the EPA reference page

Hand Sanitizer Replacement Products

Product availability may change

All hand hygiene requires20 second hand scrub!

Other replacement productsAvagardVioNexus

Other products may be added to the list and

all products require 20 second hand scrub

COVID-19 Screening Questionnaire PlanPatients & Household Members

Personal Protective Equipment (PPE)

COVID-19 PPE Home Care and Hospice

Donning and Doffing Video

PPE Donning

PPE Donning

PPE Doffing

PPE Doffing

PPE Doffing when at least 6 feet away from patient and household member

Mask GuidelinesMask to remain in place per Universal Masking

PPE Doffing

Donning and Doffing PPEWear universal facemask and eye protection for all patient and caregiver interactions! Must be in place upon entry to the home.

Perform hand hygiene and don PPE (gown and gloves) immediately upon entering the home, at least 6 feet away from the patient and household members

Doff PPE as you are ready to leave the home, near the exit door at least 6 feet away from the patient and household members except facemask and eye protection

Double bag PPE in plastic grocery bags and request patient dispose in their lined trash container

Perform hand hygiene and don gloves to clean and disinfect full-face shield or goggles with disinfectant wipes per guidelines and perform hand hygiene after cleaning and disinfecting

Refer to PPE Resource Guide in Home care, Hospice and Skilled Nursing Facilities (SNF) for full instructions

N-95 Masks are required for Aerosol Generating Procedures

Including but not limited to:Positive pressure ventilation (BiPAP/ CPAP)

High flow O2 Ventilator/place a HEPA filter between Y-piece of the breathing circuit

Tracheostomy care/suctioningNebulizer therapy

Cardio-pulmonary resuscitation (CPR) compressions onlySpeech-language pathologists (SLPs) may perform procedures that result in generation of aerosols (trigger cough)

See the entire list on the COVID-19 Information Center

In the home setting, airborne precautions with use of N95 mask and full-face shield are required during aerosol generating procedures and for 2 hours

following the procedure. Patients should keep door closed, away from family and pets while performing AGP and for 2 hours afterwards.

A team member must wear the brand of N95 mask they were fit-tested for;A non fit-tested N-95 mask is equivalent to a procedural mask

What not to do…• Please do not wear PPE when not indicated

– Preservation of our PPE is critical

– PPE used unnecessarily out of fear places all of AAH frontline caregivers at risk for a “when it is really needed”

– Do not wear an N95 mask unless performing an aerosol generating procedure or AGP performed within 2 hours of your visit

• Do not wear an N95 mask that you have not been fit tested for

• Do not bring healthcare bag, computer and or phone into the home of a suspected/confirmed COVID-19 patient

• Do not alter the PPE in any way such as:

– Taping gloves at the wrist to the gown

– Putting a surgical mask over N95

– Wearing 2 gowns on top of each other

– Double gloves

Post-Acute DivisionCleaning of Reusable Equipment for Patients in Isolation

PPE Scenarios

Patient Scenario #1What PPE should be worn by HCP providing care to asymptomatic patients with no history of exposure to COVID-19 who are being evaluated for a non-infectious complaint such as hypertension?

➢Complete telephonic screening assessment for patient and members of the household before every visit for temperature (>100.0 F or > 37.8 C) without use of fever reducing medication, new or worsening cough, new SOB or difficulty breathing, sore throat, congestion or runny nose, nausea, vomiting, diarrhea, loss of taste or smell, chills, headache, or muscle or body aches.

➢ If the patient and members of the household remains free of fever and symptoms, wear universal facemask and eye protection and gloves as required

Patient Scenario #2What PPE should be worn by HCP providing care to symptomatic patient (fever, cough, sore throat, and runny nose) with a history of exposure to a person with COVID-19 who is receiving wound care to a sacral wound?

➢ Perform hand hygiene

➢ Facemask in place per Universal Masking and full-face shield per Universal Eye Protection

➢ Don PPE: gown, and gloves (facemask and full-face shield are in place per universal masking and eye protection guidelines)

➢ as soon as you enter the patient’s home, at least 6 feet away from the patient and household members

➢ Do not bring healthcare bag, computer, or phone into the home.

➢ Order dedicated patient care equipment if available.

➢ Continue wearing facemask and full-face shield. Dispose of gown and gloves in double plastic bag at door to exit the home at least 6 feet away from the patient and household members; request patient/household members dispose of double bagged trash in their lined trash container.

➢ Clean and disinfect full-face shield with clean, gloved hands with disinfectant per required contact/wet time and when dry, store in zip lock bag, remove gloves and perform hand hygiene

Patient Scenario #3What PPE should be worn by HCP providing care to symptomatic patient (fever, cough, shortness of breath) with a history if a positive COVID-19 test that was completed 6 days ago?

The patient has a new tracheostomy for throat cancer and requires education including a return demonstration for suctioning.

➢ Perform hand hygiene

➢ Don N95 mask and full-face shield for eye protection prior to entry to the home.

➢ Check that mask has air-tight seal, straps and nose bridge is secure on mask

➢ Perform hand hygiene and don gown and gloves immediately upon entry into the home at least 6 feet away from the patient and household members.

➢ Do not bring healthcare bag, computer, or phone into the home

➢ Order dedicated equipment if available

➢ After visit, dispose PPE except N-95 and full-face shield, in a double plastic bag at door to exit the home at least 6 feet away from patient and request patient dispose of trash in their lined trash container.

➢ Upon leaving the home; clean full-face shield with clean, gloved hands with dedicated disinfectant wipes and store in zip lock bag when dry, remove gloves and perform hand hygiene. Remove N95 mask touching strap only and place in brown paper bag, don facemask per universal masking and perform hand hygiene.

Patient Scenario #4• A patient is discharged to a skilled nursing facility following a total knee

replacement. The patient was receiving physical therapy and required INR monitoring for post-operative atrial fibrillation.

• The patient is 2 weeks post-op and is discharged home for PT and SN. The patient is afebrile and he has no evidence of infection.

• Does the patient require PPE?

• Since the patient was discharged from a skilled nursing facility and is asymptomatic for COVID-19; the patient will complete telephonic pre-screening and monitoring for signs and symptoms of COVID-19.

• If screening is negative; PT and SN will follow Standard precautions, and universal masking and eye protection and will wear facemask and eye protection,(gown and gloves if needed per standard precautions) for home care visits. Monitor closely for signs and symptoms.

• If the patient reports any fever or symptoms; notify the provider and wear full PPE for a patient under investigation for COVID-19.

AAH COVID-19 Information Center

COVID-19 Information Center

Post Acute and Palliative Care Section

COVID-19 Patient Education

Thank you!