released 02/06/2020 revised 05/15/2020 …...2020/05/15 · page 1 of 2 released 03/11/2020 revised...

Clinical Support and Patient Safety (CSPS) Released 02/06/2020

Revised 05/15/2020

Coronavirus (COVID-19)

Ambulatory Toolkit

Status Document Page(s)

GENERAL INFORMATION

DHMF Coronavirus Ambulatory Toolkit Cover 1 – 2

DHMF General Information and Facts 3

Points of Contact COVID-19 4

RECOVERY GUIDELINES

Recovery Implementation Guidelines 5 – 8

CSH Patient FAQ – Clinic Restart 9 – 10

10 COMMANDMENTS

Commandment 1: Daily Huddles

Huddles and Communication 11 – 12

Commandment 2: Physical Distancing

Physical Distancing 13 – 14

Waiting Room and Front Desk Guidelines 15 – 16

Commandment 3: Algorithms and Guidelines

Algorithms and Guideline Instructions 17

Telephone Screening – Initial Algorithm 18

Telephone Screening – Licensed Clinical Staff and Clinicians 19

Telephone Script – Frequently Asked Questions 20 – 21

Screening Stations Guidelines 22 – 24

Source Control Guidelines 25 – 27

Form – DHMF Source Control Screening 28

Check-In: Non-Scheduled Patients 29

Check-In: Scheduled Appointment 30 – 32

Ambulatory Algorithm – Identify, Isolate, Inform 33

CSH FAQ: New COVID-19 Symptom Checker Chat Box 34 – 35

Commandment 4: Cleaning

Cleaning Instructions 36

DH Care of Personal Clothing, Work Clothing, and Clinic Linens 37 – 38

DHMF Acceptable Surface Disinfectants For Use Against COVID-19 39 – 41

Commandment 5: Exposed HCP and Clinicians

Employee Health General Information 42

Employee Health Response Questions 43

Revised Employee Health COVID-19 Hotline 44

Employee Health COVID-19 If/Then Guidelines 45

Employee Health Leadership Talking Points – Workplace Exposure 46

Revised Form – Employee Screening Form CSH 47

New Form – Employee Self-Monitoring for Symptoms Form CSH 48 – 49

New Handout – Home Care For Employees CSH 50 – 52

of 125

Commandment 6: COVID-19 Training

Training Resources 53

Commandment 7: Droplet and Airborne Precautions

Respiratory Etiquette Stations 54

DHMF Universal Masking 55 – 56

DHMF Cloth Masks 57 – 58

Commandment 8: PPE and Supplies

PPE and Supply Instructions 59 – 60

DHMF N95 Respirators and Surgical Masks 61 – 62

New Types of Masks 63

Masking Priority 64

DH Conserve PPE – Reuse Guide 65

N95 Respirator Preparation for Reprocessing 66

CSH PPE Frequently Asked Questions 67 – 75

CDC PPE Standards 76

CSH Preventing Skin Injury from Prolonged N95 Mask Use 77 – 84

Donated PPE Evaluation 85

Donated PPE Checklist 86 – 87

Commandment 9: COVID-19 Testing Procedures

DHMF Requests for COVID-19 Testing 88 – 91

Quest Laboratory Testing Instructions 92

LabCorp Testing Instructions 93 – 94

Swab Sampling Process 95

Antibody Testing COVID CSH FAQ 96 – 97

Commandment 10: Daily Inventory Control

***coming soon***

BILLING / CODING / VIRTUAL VISITS

Billing / Coding / Copayments for COVID-19 98

Virtual Care Visit Request Form Guidance 99

Virtual Care Services 100

Virtual Care Agreement: Clinician Working From Home 101 – 104

Virtual Care Checklist 105 – 106

CSH Telehealth 107

Virtual Care Services Scheduling 108

Virtual Care Service (VCS) Guidance/Resources 109

PATIENT EDUCATION

Patient Education Instructions 110

Handout – Flu vs. COVID-19 – Patient Flyer (English, Spanish, Mandarin) 111 – 113

Handout – Cold and Flu Season Protections (English, Spanish, Mandarin) 104 – 116

Handout – Coronavirus Disease (COVID-19) (English) 117 – 118

Handout – What you need to know about COVID-19 (English, Spanish, Mandarin) 119 – 121

Handout – What to do if you are sick with COVID-19 (English, Spanish, Mandarin) 122 – 124

Handout – CSH Patient Addiction 125

Documents (without page numbers) are

available in PolicyManager: (Chrome works best for PolicyManager)

Dignity Health Patient Safety COVID-19 SharePoint

site click here

of 125

https://show.dignityhealth.org/publish/DHPatientSafety/SitePages/COVID-19.aspx


General Information and Facts Clinical Support and Patient Safety Department

Page 1 of 1 Released 02/06/2020

Revised 03/26/2020

Information About Coronavirus (COVID-19)

The Centers for Disease Control and Prevention (CDC) and the California Department of

Public Health (CDPH) are closely monitoring respiratory illness caused by Coronavirus

(COVID-19).

The COVID-19 virus continues to spread worldwide, with increasing numbers of cases in the

US.

The virus has been declared a pandemic with community spread. Travel history, though still

important per the current CDC guidelines, is not the only risk factor. This makes the virus

very difficult to distinguish from influenza and other seasonal viruses.

Infected patients appear to be able to shed the virus prior to the onset of symptoms—this is

accomplished from airborne (cough) and body fluid sources.

There are current reports from Clinics of shortages of Personal Protective Equipment (PPE)

and DHMF will continue to work directly with Supply Chain (SSRM) to address PPE

distribution, orders, shortages, etc.

The majority of patients have mild disease, and may not need to be seen in a Clinic. A

Clinician may determine that home isolation is the treatment of choice.

Because there are daily updates, it is best to use the following links for most current

information:

o Click here for CDC

o Click here for CDPH

COVID-19 Facts The CDC updates Frequently Asked Questions for Health Care Personnel. Click here to view

current information.

Public Health Reporting Requirements

Any COVID-19 case of an individual with at least one respiratory specimen that tested positive

for the virus that causes COVID-19 must be reported to the local Public Health Department.

Currently there is no recommendation to report suspected cases of COVID-19 to local public

health.

Click here for the current CDC guidelines for PUI.

Click here for a copy of the CDC PUI and Case Reporting Form.

Click here for a copy of the instructions for completing the CDC PUI and Case Reporting Form.

The CDC updates daily statistics on confirmed cases as well as statistics on the number of PUI

cases (click here).

of 125

https://www.cdc.gov/coronavirus/2019-ncov/index.html

https://www.cdph.ca.gov/

https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html

https://www.cdc.gov/coronavirus/2019-ncov/downloads/pui-form.pdf

https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19-Persons-Under-Investigation-and-Case-Report-Form-Instructions.pdf

https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

Coronavirus (COVID-19) – Points of Contact Clinical Support and Patient Safety Department


Revised 03/26/2020

Primary Contact: Lisa Mathews, RN

Director of Nursing, Infection Prevention

Office/Cell: (530) 351-2779

Secondary Contact: Cindy Garrett, RN

Regional Director, Clinical Operations

Office: (916) 861-1485

Cell: (530) 919-5467

Employee Health Contact: Kim Sandoval

Manager, Health and Safety, EH and Safety

Office: (209) 475-5509

Cell: (209) 923-5028

Executive Sponsor: Melanie Radko

Vice President, CSPS

Office: (916) 389-8051

Cell: (916) 878-6036

of 125

Coronavirus (COVID-19) – Recovery

Implementation Guidelines Clinical Support and Patient Safety Department


Revised 05/06/2020

To ensure safe care for patients, visitors, Health Care Personnel (HCP) and Clinicians,

operational leaders and their dyad Physician partners need to follow the guidelines below prior to

resuming in-person patient visits. As DHMF continues to refine some of the recommendations,

updates will be provided to this document.

RECOVERY – GENERAL INFORMATION

Guideline Source References

Process established to ensure Clinicians

continue Virtual Visits whenever appropriate

for patient and condition.

CDPH

CMA

Toolkit: Virtual Care Services

Each Medical Group should have a process to

gradually resume full scope of services over

time with guidance provided by the DHMF

Recovery Task Force.

CDPH

CMA

CSH

CDPH Guidelines

Patients with acute illness

that cannot be handled

through Virtual Visit.

Patients with chronic illness,

including behavioral health,

that have not been seen due to

stay-at-home rules and need

an in-person visit.

Preventative services

including well child and

vaccines, adult clinical

preventative services.

Previously cancelled or

postponed patients.

Other patients needing in

person visit to monitor status

of assess illness.

Priority scheduling (CMA):

Pediatric patients

Preventative Care

Elective surgeries

CommonSpirit Health

Virtual, In-Person (Virtual

First for Screening)

Chronic disease management

Annual Physical Evaluations

GYN Evaluations / Annual

Wellness

of 125




Revised 05/06/2020

Each Medical Group should follow appropriate

guidelines in determining which patients should

be prioritized for in-person visit.

CDPH

CMA

See above.

DHMF Leader or Medical Group Physician

leader should consult with local public health

and neighboring county public health prior to

resuming services to non-emergent and non-

COVID-19 care to determine if there are any

local COVID patterns that could impact

healthcare delivery.

CDPH

CMA

DHMF Leader or Medical Group Physician

leader should review indicators prior to

resuming: COVID specific infection rate,

hospitalizations, emergency room admissions,

ICU utilization, SNF outbreaks, and other

factors that could increase the spread.

CDPH

CMA

DHMF Quality Care Council (QCC) define

services into low, medium and high risk with

defined infection prevention and safety

standards.

Information to be available after

5/8/2020.

ORGANIZATIONAL PROCESSES


DHMF Leader will work with Supply Chain to

ensure the following:

Adequate stock of PPE for current needs

as well as potential surge needs

Clarity of risk level of patients

Establish PAR levels

Report daily inventory on hand / daily

usage reporting

Follow CDC guidelines for extended use

and reuse of PPE

CDC

CDPH

CMA

Toolkit: See Commandment 8 –

PPE and Supplies

DHMF Leader to ensure daily PPE counts are

provided no later than 9:00 a.m. each day via

Survey Monkey link.

Availability of testing with prompt results.

Ensure testing processes are in place for

patients.

CDPH

CMA

Toolkit: DHMF Requests for

COVID-19 Testing.

of 125




Revised 05/06/2020

Testing priority list is available in the toolkit.

Testing is not recommended for any

asymptomatic patient or HCP/Clinician.

Toolkit: Quest Lab Testing

Instructions

Toolkit: LabCorp Testing

Instructions

Ensure Universal Masking is implemented in

every Clinic. Ensure HCP and Clinicians are

wearing appropriate PPE not only when

providing patient care, but also wear a mask

when around other HCP or Clinicians in the

Clinic.

CDC

CDPH

CMA

Toolkit: Universal Masking

Ensure Source Control has been implemented in

all Clinics/Buildings. Source Control includes

the following/

Rigorous screening of HCP and

Clinicians

Temperature taken upon entry (separate

from vitals)

Policy to remove symptomatic HCP from

workplace

Face coverings for all patients, visitors,

others.

CDC

CDPH

CMA

Toolkit: Source Control Guidelines

DHMF Leader to ensure all HCP and Clinicians

are following physical distancing requirements

in work areas and common areas. This may

require temporary relocation of HCP or

Clinicians that previously worked within 6 feet

of each other.

CDPH

CMA

Toolkit: Physical Distancing

DHMF Leaders will avoid rotating HCP

between care for COVID-19 and non-COVID

patients whenever possible.

CDPH

SCHEDULE TEMPLATES


Extended hours should be considered to limit

the number of patients in an office at any given

time.

CDPH

CMA

Scheduling special or reserved hours for elderly

or immunocompromised patients to minimize

the risk of infection to vulnerable patients.

CDPH

CMA

of 125




Revised 05/06/2020

Special entrances or exam rooms for the

vulnerable patients.

CMA

PRE-VISIT PROCESSES


Because all persons are screened prior to

entering the Clinic/building, HCP do not need

to additionally screen telephonically for

possible COVID symptoms prior to in-person

visit.

CDPH

CMA

Toolkit: Source Control Guidelines

When patients are scheduled for an in-person

visit, HCP will explain to patients about

building screening, visitor limitations, masking,

etc. prior to arriving.

CDC

CDPH

CMA

Toolkit: Scheduled Appointment

Check-In

CHECK IN / WAITING ROOM / CHECK OUT


Every effort will be made by DHMF Leader

and Medical Group dyad partners to implement

and address patient flow systems to minimize

exposure and spread, which may include:

Remote check in / drive up check in and

wait in car until exam room is available.

Limit number of patients in waiting areas

Limit space between patients to a

minimum of 6 feet.

Where serving both well/sick in the same

common areas, use Non-COVID Care

zones (e.g. separate sick and well waiting

areas) and screen HCP and patients prior

to entering a Non-COVID Care zone.

Arrange office flow such that patients

enter and leave through separate doors.

Modify check-out procedures to

minimize/avoid any patient time in

central area or at check-out desk.

CDPH

CMA

DHMF Leader to ensure all articles such as

magazines, toys, coffee, or anything else that

may be handled by infected patients is removed

from waiting areas and Exam Rooms.

CMA Toolkit: Waiting Room and Front

Desk Guidelines

of 125

Restarting Clinic Visits

Patient Q&A

What can I expect during my next in-person visit?

We look forward to seeing you soon. To help you prepare for your upcoming appointment, we want to

provide a few quick updates to our process to help us protect the health and safety of our staff and

patients:

We are screening all patients when they arrive for their appointments.

o Screening will include having your temperature taken before you enter the clinic and

going through a symptom checker. Please allow a little extra time to allow for this

process.

We also ask that you wear a mask when you come for the visit – a cloth mask is fine. Our staff is

also being screened daily and will also be masked inside our offices. If you do not have a mask,

one will be provided for you upon arrival. We will also ask that you use hand sanitizer before

you enter the building, if you don’t have it, we will provide it for you.

If you have any signs of symptoms such as fever, cough, shortness of breath, new loss of taste or

smell or if you are in close in-person contact with someone who has tested positive for COVID

within the prior 14 days, please call us prior to your appointment to determine if your

appointment should be rescheduled or not.

Finally, we are working to limit the number of people in our waiting rooms to comply with social

distancing guidelines. We have a limited visitor policy in place, with a few exceptions, such as a

pediatric patient or a patient who may need help due to mobility issues. Please call our office if

you have questions.

Is it safe for me to visit my doctor in person?

We’re following best practices and protocols to ensure the safety of our patients and staff. All of our clinical teams you interact with will be wearing a mask; they have been screened prior to coming into the office. We have cleaning and hand hygiene procedures in place, plus we have instituted additional precautions to further ensure patient safety from the coronavirus. We are limiting the number of people in our waiting rooms and are asking that only patients come into our clinic, with a few exceptions. We will separate patients following social distancing guidelines.

Will I be able to have a family member or friend with me?

To protect our patients, staff and community, we have a limited visitor policy and we are working to

limit the number of people in our waiting rooms, clinics and other areas to comply with social distancing

guidelines. There are a few exceptions, such as a pediatric patient or a patient who may need help due

to mobility issues. Your support person can remain close by.

of 125

Can I still see my doctor virtually?

Our clinics are open to take care of your health care needs whether in person or virtually. We continue

to offer virtual visits as a convenient option for our patients in addition to in-person visits. Call your

doctor to determine which option is right for your next visit.

of 125

Coronavirus (COVID-19) – Huddle Structure

and Communication Clinical Support and Patient Safety Department


Revised 04/09/2020

Across CommonSpirit Health (CSH), all affiliates are to ensure a four tier huddle system is

implemented to ensure communication and actions are in place across the organization. In

addition, there are multiple other COVID-19 huddles that are listed should you need to work

through or with other leaders on COVID related issues. If you have a DHMF or Medical Group

wide COVID-19 huddle that you would like listed, please provide that information (Jody Kinner)

and this information can be updated.

WEST DIVISION

Title Frequency Attendees Purpose/Agenda Tier 1:

Site / Clinic / Department

Locations

Daily

(varies by location)

Facilitator: Clinic Leader

(or Department Leader)

National/Affiliate

communication

updates

10 Commandments

Absenteeism

No Show Rates

Major Concerns

Tier 2:

Region Based Huddles

(North State, GSD, Ventura,

etc.)

Daily

(varies by region)

Facilitator: Region VP

Ops (or SLT Member)

National/Affiliate

communication

updates

10 Commandments

Absenteeism

No Show Rates

Major Concerns

Tier 3:

West Division Senior

Leadership Team (SLT)

Daily

12:15 p.m. – 1:00 p.m.

Facilitator: Mark Behl

CSH Physician Executive

FPMG Regional Med Dir

IDMG

MMG CMO/Quality

SCMG TBD

WCMG President/CMO

26 Admin Leaders

Information:

CSH Updates

Frontline Updates

Leadership Updates

Division hot topics

(e.g. virtual visits,

major initiatives,

comp/PSA issues,

etc.)

Tier 4:

Physician Enterprise

Executive Team (PEET)

Daily

1:00 p.m. – 1:45 p.m.

PEET Members

Mark Behl

Katherine Manual

John Gisla, MD

Information:

Leader Updates

National Updates

Division Updates

Selected Topics

OTHER COVID CALLS

Frequency Title Contact Person Friday 7:00-8:00 am CSH Physician Enterprise Leadership Gary Greensweig, DO

Daily 9:00-9:30 am Tier 2: Santa Cruz Vince Paradiso

Daily 9:30-10:00 am Tier 2: North State/Sequoia/SF Tristan Kouk

Daily 10:00-11:00 am GSD Hospital COVID Melanie Radko

Tu/Fri 12:00-1:00 pm CSH COVID-19 Task Force Cindy Garrett, RN

Daily 12:30-1:00 pm Tier 3: West Division Mark Behl

of 125

mailto:[email protected]?subject=COVID-19%20Huddle%20Update

Coronavirus (COVID-19) – Huddle Structure

and Communication Clinical Support and Patient Safety Department


Revised 04/09/2020

Frequency Title Contact Person

Daily 3:15-3:30 pm DHMF Incident Command Kim Sandoval

Daily 3:35-3:45 pm DHMF Safety Huddle Katherine Manuel

Daily 4:30-5:00 pm MMG/DHMF COVID Rich Conley

Daily 5:00-5:30 pm Tier 2: Southern/Central Region Joe Kim

of 125

Coronavirus (COVID-19) – Physical Distancing Clinical Support and Patient Safety Department


Revised 05/12/2020

Physical distancing is a critical safety measure to limit the spread of COVID. Physical

distancing applies to everyone – patients, Health Care Personnel (HCP), Clinicians, visitors,

vendors, etc. Physical distancing simply means that everyone maintains a 6 foot distance

between others. DHMF Leader is accountable to ensure physical distancing is in place and

followed for their areas of accountability.

General Public

DHMF Leader to ensure there is clear signage or alternative mechanisms to ensure patients,

visitors, and others remain 6 feet from each other.

Tape markings on the floor where people stand in line to keep distance between

individuals.

Ensure waiting room furniture is separated or marked off (“do not sit here” signage or

tape) with 6 feet of separation between waiting patients.

See Waiting Room and Front Office Guidelines for additional information specific to

Clinics.

Work Stations

DHMF Leader to ensure all HCP workstations (cubical, “Pods”, etc.) have at least a 6 foot

separation between people.

HCP working in cubicles without full wall separation (e.g. half walls between cubes) or

group “pods” have a 6 foot separation between individuals.

Most cubicles already provide for this distancing, but consider having people face

different directions (rather than people facing the same direction on the same shared

wall).

Measure to ensure a 6 foot separation between HCP workstations.

If some HCP are telecommuting, consider temporary cubical relocations for those not

telecommuting to ensure greater distance between HCP.

Consider temporary office relocations if there are vacant offices available (either due to

vacancy or telecommuting).

Physical distancing is required unless there is absolutely no possibility of such due to

building constraints as determined by the DHMF Leader.

o Physical distancing is a safety issue and no exceptions should be granted for

purposes of convenience or efficiency.

o If it is impossible to address physical distancing, DHMF Leader must ensure

increasing of other preventative measures like always wearing a face mask when

in that work area (not taking off mask to eat/drink), cleaning surfaces frequently

throughout the day, not sharing equipment (e.g. telephone) without cleaning

between people.

Meetings

When conducting meetings, follow some of the following basic guidelines:

Utilize WebEx, Zoom or conference calls rather than in-person meetings.

If an in-person meeting is necessary, ensure participates sit 6 feet apart (e.g. use of a

larger conference room might be necessary).

of 125

Coronavirus (COVID-19) – Physical Distancing Clinical Support and Patient Safety Department


Revised 05/12/2020

There should be no in-person meetings of 10 or more individuals as directed by the

Governor of California.

Common Areas

When HCP are in the same work environment and in common areas, follow some of the

following basic guidelines:

Use technology (e.g. Jabber, email, phone, etc.) to share information rather than walking

to someone’s work space. This includes sending files electronically rather than printing

out hardcopies to pass around.

When delivering items, be aware of 6 foot separation whenever possible. You can

consider delivering items when someone is at lunch or on a break.

Avoid social gathering activities such as close contact while on a break or during lunch.

Always try to maintain the 6 foot separation.

Remember to wash your hands frequently and avoid touching your face after picking up

items in the office.

Avoid eating lunch, heating food, getting coffee/water with others without 6 feet of

separation. Consider staggering lunch hours to limit the number of people needed to

prepare food at the same time.

Avoid crowded elevators whenever possible. Consider using stairs if possible or consider

waiting for another elevator if one has multiple people in it.

The DHMF has prepared a Physical Distancing flyer that is available to be printed and posted

around work environments as a reminder to all.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=4e7d816f-e9e3-43b1-b168-5a40fe2b08c7

Coronavirus (COVID-19) – Waiting Room and

Front Desk Guidelines Clinical Support and Patient Safety Department


Revised 05/11/2020

DHMF’s top priority is safety, not only for our patients but for our Health Care Personnel (HCP).

Below are guidelines to be utilized for HCP who are checking-in patients in Clinics (e.g. MORs)

and instructions for designated waiting areas. As per the DHMF Recovery Guidelines, every

effort will be made by DHMF Leader and Medical Group dyad partners to implement and

address patient flow systems to minimize exposure and spread (click here).

Waiting Area and Exam Room

DHMF Leader to ensure all articles such as magazines, toys, coffee, or anything else that

may be handled by infected patients is removed from waiting areas and Exam Rooms. This

would exclude Respiratory Station items such as tissues, hand sanitizer, touch free trash can.

Check-In Station

DHMF Clinic Leader is to tape/mask a line (e.g. masking tape or painter’s tape) on the floor

6 feet from the location of MOR workstation (6 feet from the computer monitor), with

signage: “If you have respiratory symptoms, please stay behind of the line (click here for

signage). Work with Facilities if you need assistance.

o Tape will be replaced when it gets worn or appears tattered.

DHMF Clinic Leader will work with Facilities to install “Sneeze Guards” at reception desks

(e.g. Plexiglas shield).

Waiting Area

DHMF Clinic Leader to ensure there is a designated area of the waiting room for patients

with respiratory symptoms that is separate from other waiting patients.

CDC guidelines recommend that patient’s sit 6 feet apart from others, regardless if Clinic is

seeing sick patients or well patients.

If furniture cannot be physically separated, utilize the “Don’t Sit Here” signage to ensure

individuals do not sit in chairs right next to others (click here for signage).

Consider options to limit number of patients in waiting areas.

Check-In Process

MORs will be wearing a surgical mask as part of the Universal Masking Guidelines.

All individuals will have been provided a face mask (if they did not already have one) prior

to entering the building.

o Excludes children under 2 and individuals unable to wear a mask (e.g. difficulty

breathing, etc.).

o Anyone excluded from wearing a mask should have tissue they can hold over their

nose and mouth.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=8a17e2d7-4901-478f-9ebd-ca638eb03083

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=32ced527-9ddb-4c41-9c7e-d92c2a6acaa0

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=54417f82-8e9d-4113-a144-e226428693d4

Coronavirus (COVID-19) – Waiting Room and

Front Desk Guidelines Clinical Support and Patient Safety Department


Revised 05/11/2020

All individuals will have completed the Source Contact Screening prior to coming into the

Clinic.

Patients will not have anyone with them unless the patient meets the following criteria:

o One adult for a minor child

o Once adult for a frail, disabled, or elderly person that needs assistance

If patient has a visitor that doesn’t meet the above criteria, or has more than one visitor, the

individual(s) will be asked to wait outside or in their car (note, this will have been addressed

prior to arriving at the Clinic).

If a patient refuses to wear a mask, obtain the patient’s cell phone number and ask the patient

to wait in their car and HCP will contact them for registration and Clinical Team triage. Ask

patient to return to their car and not stop in any other areas (e.g. laboratory, restrooms, café,

etc.)

If other persons refuse to wear a mask, ask person to leave the Clinic and not stop in

any other areas.

of 125

Coronavirus (COVID-19) – Algorithms and

Guideline Instructions Clinical Support and Patient Safety Department


Revised 04/24/2020

DHMF Telephone Screening – Initial Algorithm (click here for copy)

Many Clinics utilize Medical Office Receptionists (MOR) or a centralized call center who answer phone

calls from patients requesting an appointment. It is important to remember that Medical Assistants (MA)

and Licensed Vocational Nurses (LVN) cannot assess patient symptoms or provide clinical triage. However,

non-licensed staff can ask specific questions related to patient travel and can rule out those patients who do

not meet the at-risk criteria. This simple algorithm can assist non-licensed staff in the initial screening.

DHMF Telephone Screening – Licensed Clinical Staff and Clinician Algorithm (click here for copy)

It is important to ensure there are Licensed Clinical Staff or Clinicians that can provide the follow-up in

depth screening. This allows for a second telephone conversation with patients that meet the potential PUI

criteria to further validate their signs and symptoms (e.g. did the patient take their temperature? Did the

patient report having a fever? Etc.), and for the Clinician to determine if the patient should receive home

care/isolation, be scheduled for an appointment, or triaged to higher level of care. Please note, only

Registered Nurses (RNs) or Clinicians can make any assessment or provide triaging to patients

Cerner Documentation of Infectious Disease Risk Screening

Any HCP that provides screening (telephonic or in-person), needs to document that screening outcome in the

EHR. If there is no record of the COVID-19 screening in the EHR, then patients may be screened repeatedly

which can be frustrating to our patients. Options for documenting the screening include Cerner Powerchart

Infectious Disease Risk Screening which is being modified to include updated COVID-19 information.

Please contact your CSS for additional information on the Infectious Disease Risk Screening module. If

your Clinic wishes to utilize a “banner”, it should include one of the following:

COVID-19 [or COVID-19] Screening Clear xx/xx/xx [enter date of screening]

COVID-19 [or COVID-19] Screening At-Risk xx/xx/xx [enter date of screening]

DHMF Source Control Guidelines (click here for copy)

These guideline assists DHMF Clinic Leaders to implement the CDC Infection Prevention guidelines for

Source Control which includes screening of all persons entering a DHMF Clinic or service for the symptoms

of COVID-19 and temperature; ensuring all persons entering the Clinic/building wear a mask; and facilitate

limiting the number of those who enter the Clinic to slow the spread of disease.

DHMF Non-Scheduled Patient Check-In Algorithm (click here for copy)

Some DHMF Clinics provide Walk-In services; and it is a possibility that a person might arrive at any Clinic

requesting to see a Clinician. Patients should have already been provided a mask and screened for symptoms

prior to arriving in the Clinic. The DHMF algorithm was developed to aid in the process once they arrive at

check-in.

DHMF Scheduled Patient Check-In Guidelines (click here for copy)

If a Clinician determines that a patient who is “at-risk” per the DHMF algorithms should be scheduled for an

appointment, there are several guidelines that can be implemented based on Clinic size, staffing, etc. DHMF

Leader and Clinicians should collaborate immediately to determine which process works best for their

Clinic. Once determined, the DHMF Leader must train HCP to inform patients on what to do when they

arrive for their appointment, and ensure HCP are educated and equipped when the patient arrives.

Ambulatory Algorithm – Identify, Isolate, Inform (click here for copy)

The Ambulatory Algorithm provides the instructions on what needs to occur for patients identified as “at-

risk” for COVID-19. Ensure all HCP know the process for masking, isolation, cleaning, etc. if an “at-risk”

patient is seen in a Clinic.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=c37f2841-32e3-452e-b7ed-602ded3c531f

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=33d382f2-44a6-4f68-a402-683a615da8d5

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=d4ea671a-40a4-4481-b587-05096700134f

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=c18f7a1b-fef5-41ab-bacd-0d78cb4f7b60

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=6436ff45-e4b0-416f-b67e-dcbf77ffe0cd

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=8028df29-87b9-4b00-8a48-276060515297

ACTION:

1) Inform the patient that a nurse or Clinician will be calling them back promptly to further discuss their symptoms to determine the best next steps.

3) Send EHR URGENT message to Licensed Clinical Staff or Clinician to contact patient SAME DAY for more in-depth screening.

NOTE: For WCMG, transfer the call the to RN/LVN in Urgent Care for further instructions.

Coronavirus Telephone Screening – Initial AlgorithmClinical Support and Patient Safety (CSPS)

Revised 04/09/2020

Is the patient complaining of ANY of the following: Fever; Cough; Shortness of breath; Difficulty breathing; or, Concern with Coronavirus exposure

YES

No additional screening needed at this time. Schedule appointment using standard

process (e.g. visual visits).NO

Is the patient expressing any serious concerns with ability to breath right now?

ACTION:1) Keep patient on the phone.

2) Transfer the patient to a Registered Nurse (RN) or Clinician to provide immediate

triage directions (e.g. 911, go to ED, schedule appointment, etc.).

YES

NO

of 125

ACTION:

1) Schedule an appointment and provide appointment arrival instructions (see Scheduled Appointment Check-In Guidelines).

3) Follow Ambulatory Algorithm – Identify, Isolate, Inform upon arrival.

Coronavirus Telephone ScreeningLicensed Clinical Staff and Clinician Algorithm

Clinical Support and Patient Safety (CSPS)Revised 03/18/2020

EHR urgent messages for patient telephonic follow up:Contact patient for further in-depth telephonic screening to determine disposition:

ACTION:Provide home care instructions including instructions on what

to do if symptoms worsen.

Note: Registered Nurses should always follow standard triage procedures and Clinicians should use their clinical judgement if patients require higher level of care based on clinical signs and symptoms (e.g. referral to ED, 911, etc.).

Reminder: Risk Exposures

Does the Clinician want the patient to schedule an appointment either for further assessment or for specimen collection for

COVID-19 Testing?

Does the Clinician recommendhome care / isolation?

Does the Clinician recommend transfer to higher level of care?

ACTION:Inform patient to call 911 or refer to the closest ER.

YES

YES

NO

NO

YES

1) Fever AND/OR symptoms of lower respiratory illness (cough, SOB); and travel from affected geographical areas 14 days of onset of symptoms.

2) Fever AND/OR symptoms of lower respiratory illness (cough or SOB); and within the 14 days prior to onset of symptoms had close contact with a laboratory -confirmed case of Coronavirus.

3) Symptoms of respiratory illness (e.g. fever, cough, shortness of breath) without alternative explanatory diagnosis (e.g. influenza).

of 125

Coronavirus (COVID-19) – Telephone Script

Frequently Asked Questions (FAQ) Clinical Support and Patient Safety Department


Revised 05/06/2020

Q: I want to be tested for COVID-19.

A: Are you feeling sick?

If YES: Follow the DHMF Telephone – Initial Screening Algorithm (Click here)

If NO: Currently the CDC recommends patients who have signs or symptoms be

tested for the virus. I am glad you are feeling well. Our doctors want us to remind

everyone that washing your hands and keeping a 6 foot distance from others is the

best way to prevent spread of the virus.

Q: What do I do if I think I have COVID-19?

A: By answering a few questions I can assist you to determine the best course of action to

ensure you receive the care you need. Let me ask you a few questions (Follow the

DHMF Telephone – Initial Screening Algorithm (Click here).

Note: If “No Additional Screening At This Time” (teal box instructions) is identified, it is

okay to tell the patient that according to the current guidelines, they are not considered

at-risk for the COVID-19. Follow the algorithm for the next steps.

Q: I have a fever and/or cough. Should I stay home from work?

A: I am sorry you are not feeling well. Just like for any virus, our doctors are

recommending that if you have a fever and cough you stay home and limit contact with

other people. May I ask you a few questions? (Follow the DHMF – Initial Screening

Algorithm (Click here)

Note: If “No Additional Screening At This Time” (teal box instructions) is identified, it is

okay to tell the patient that according to the current guidelines, they are not considered

at-risk for the COVID-19. Follow the algorithm for next steps.

Q: May I have a note excusing me from work?

A: Work excuse notes do not require an appointment. I will send an EHR message to our

clinical team indicating your request for a work excuse note. They will follow-up with

you shortly.

Q: I have [ANY SYMPTOMS OTHER THAN FEVER AND/OR COUGH] and I am

worried that I have COVID-19.

A: I am sorry you are not feeling well. COVID-19 is a lung infection and the symptoms of

this virus are fever and cough. It does not sound like you have symptoms of COVID-19.

Would you like to schedule an appointment/virtual visit to see a Clinician for your

symptoms?

If YES, schedule appointment or visual visit.

If NO, ask the patient if they would like phone call from someone on the clinical

team or whether they plan to continue their own care at home.

of 125




Coronavirus (COVID-19) – Telephone Script

Frequently Asked Questions (FAQ) Clinical Support and Patient Safety Department


Revised 05/06/2020

Q: I just saw on the news that there are a positive confirmed cases of COVID-19 in my

community. What can I do to protect myself and prevent the spread of disease?

A: Our doctors want us to tell everyone that washing your hands is the best way to prevent

spread of the virus as well as physical distancing (social distancing) which means

keeping 6 feet distance between other people. Also, the CDC is recommending that

people not go to the Emergency Room or hospital unless absolutely necessary.

Q: Is {DHMF, Medical Group, Physician, etc.} prepared for the COVID-19 spread?

What precautions are being taken?

A: Yes, our Clinicians are prepared for this situation. We have had teams in place since

January made up of doctors and experts on infections and remain updated on the current

status of this situation. We are very well-prepared.

Q: Is there a vaccine available for the COVID-19?

A: There is no vaccine at this time. However, we still have flu vaccine and if you or your

family have not had the flu vaccine this season our doctors recommend that you get the

flu vaccine now since it is much more likely for you to get the flu than for you to get

Coronavirus. Have you had your flu vaccine?

If YES: That is very important and thank you for being current with that vaccine.

If NO: Provide current information on how to obtain a flu vaccine.

of 125


Screening Station Guidelines Clinical Support and Patient Safety Department


Revised 05/11/2020

All DHMF Clinics/buildings that provide patient care services will implement the CDC source

control guidelines which includes a screening station(s) for all individuals that enter the building.

DHMF Clinics, buildings, and staffing varies across California. Below are guidelines that can be

utilized based on each individual Clinic’s unique circumstance. DHMF Leader and Clinicians

should meet to determine the best option for their specific Clinic and/or building.

Face Mask and Symptom Screening for All Individuals

The CDC guidelines include two critical source control processes that can either be done at

the same time or in two separate locations.

o All individuals will wear a face mask before entering the building/Clinic.

o All individuals will be screened for signs/symptoms before proceeding to their

location (e.g. clinic, mailroom, lab pick up location, etc.)

Selecting a Location

For Clinics that are located in a building that is primarily housed with DHMF services, face

mask distribution and screening for symptoms should occur at the entrance to the building.

o Consider closing multiple entrance points and funnel through a centralized entry.

For Clinics that are located in a building with many various businesses/tenants, face mask

distribution may need to be in a separate location than screening for symptoms. However,

both functions should be done prior to entering the Clinic (e.g. hallway, lobby, etc.). DHMF

Leader may need to work with building owners to ensure minimal disruption to other

businesses.

Supplies for Face Mask Distribution

Table or cart

Face mask supplies (enough for daily volume) and in the following order of preference:

o Cloth Mask

o Dust Mask

o Expired N95 Mask

o Surgical Mask

o If no masks available – provide tissues to cover mouth (last resort)

Mark individual waiting points 6 feet apart for people who will be in line to be screened (e.g.

tape, etc.).

Signage for table “Masking Dos and Don’ts (click here)

Supplies for Symptom Screening

Table/cart (may be the same location as face mask distribution if at entrance to the building)

Touch Free thermometer

Hand Sanitizer

Tissues

No-touch trash can

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ac0d0aa6-ec7c-46ed-8332-cdca6c3280c6




Revised 05/11/2020

Source Control Screening form for use by HCP performing the screening (click here)

Signage for table (Click here).

Mark individual waiting points 6 feet apart for people who may be in line to be screened (e.g.

tape, etc.).

Process for Screening all Individuals

Screening will occur for all individuals with business/appointment at a DHMF Clinic which

includes HCP, Clinicians, patients, visitors, vendors, etc.

Ensure everything is set up prior to the start of each day. Supplies should be kept in a secure

location overnight or during any closed times (e.g. lunch).

Some locations may want to have several signs and multiple languages so multiple people

can be assisted at a time to ensure there is not a backlog of people unable to enter the

building/area.

Ensure table is staffed by HCP during all Clinic hours when people would be entering the

building/area.

o HCP are to wear a Surgical Mask at all times while at the station.

o HCP should avoid direct contact with people (e.g. do not shake hands).

For face mask distribution:

o HCP will welcome the person entering the building/area and explain that for the

safety of everyone, all individuals will need to wear a face mask and participate in

a symptom screening for COVID prior to going to their destination.

o If a patient is accompanied by someone else, confirm the patient meets the criteria

for a single visitor (one person for a minor child; or one adult to accompany a

frail, disabled, elderly person). No more than one visitor meeting the criteria is

permitted. If the visitor does not meet this criteria, or if the patient is

accompanied by more than one visitor, the patient should proceed with screening

and their family/friend(s) should remain outside or in their car.

o If individual is already wearing a face mask, direct them to the symptom

screening location (if in a separate area).

If symptom screening location is in a different area, instruct the person to

go directly to that location and not stop elsewhere.

o If individual is not wearing a face mask, provide a face mask and:

Instruct the individual to wear the facemask at all times while in the

building.

Instruct the individual in the use of the face mask (Click here).

o If an individual is not able to wear a face mask (e.g. children under 2, individuals

with breathing problems, etc.), provide the person with tissues and request they

keep that over their nose/month.

For symptom screening (same location or separate location):

o HCP will welcome the person entering the building/area and ask them to review

the sign (Click here).

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=a8b77bbd-2939-4f6c-b8bf-b9aabd03aa51



https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=61a2387b-5ce5-41ed-add5-90951d9eb819




Revised 05/11/2020

o Ensure every person is wearing a face mask prior to symptom screening.

o HCP will conduct the Source Control Screening on every individual (Click here)

and provide the appropriate instructions as defined at the bottom on the Screening

Tool form.

o HCP will squirt hand sanitizer into the persons hands (people should not touch the

hand sanitizer container).

o Patients that are symptomatic will be instructed to go directly to the Clinic and not

stop in restrooms, café, etc.

of 125


Coronavirus (COVID-19) – Source Control

Guidelines Clinical Support and Patient Safety Department


Revised 05/11/2020

The Centers for Disease Control (CDC) has interim Infection Prevention Recommendations for

Healthcare settings related to “source control”. Source control includes everyone entering a

healthcare facility (e.g., Health Care Personnel (HCP), patients, visitors, vendors, etc.),

regardless of symptoms. Source control involves having the infected person wear a cloth face

covering or face mask over their mouth and nose to contain their respiratory secretions.

All DHMF Clinics that provide in-person patient care will implement the CDC source control

guidelines. The information below provides a summary which will remain in effect until such

time that the CDC amends their current recommendations. Below are the specific actions,

reasoning, and comments/supportive documents.

Implementation Planning

Action Reasoning Comments / Supportive

Documents

Place reception area furniture in a

manner that enables patients to be 6

feet apart or place some areas out of

service.

Physical Distancing Check reception daily for

furniture or signage set up.

Toolkit: Waiting Room and Front

Desk Guidelines

Limit entrances to a single entry if

possible, or ensure screening at all

entry points to the building.

Directs flow of

people.

Set up area daily when in-

person visits occur

Set up location:

1) For DHMF buildings – outside/at

front door of the building

2) Non-DHMF buildings – before

entry to the Clinic.

Set up schedule for HCP to work at

entry point(s). Ensure individuals

maintain 6 foot distance if there is a

line of people upon entry.

Directs flow of

people.


person visits occur

See supplies necessary in

Toolkit: Screening Stations in

Clinic Buildings

Set up location upon entry (if different

than face mask distribution location)

for screening of all persons entering

the building/Clinic. Ensure

individuals maintain 6 foot distance if

there is a line of people upon entry.

Directs flow of

people.


person visits occur


Clinic Buildings

of 125




Revised 05/11/2020

Appointment Scheduling Instructions


Documents

Instruct patients that they need to

wear a face mask before entering

DHMF Clinic and at all times while

in the Clinic.

Limits spread of

illnesses.


Clinic Buildings

Toolkit: Scheduling In-Person

Appointments

Instruct patient that they will need to

go through an initial screening and

temperature check upon entry to the

building and allow for extra time for

that screening.


Clinic Buildings


Appointments

Instruct patient that visitors are not

permitted. Exceptions only for the

following:

- One parent of a minor child

- One adult companion for frail,

disabled or elderly patients who need

assistance

If patient meets criteria to have a

visitor present, explain to the patient

that the visitor must also wear a face

mask and that their visitor will also be

screened and have a temperature

check. Any visitors with symptoms

will not be permitted to enter the

building/Clinic.

Limits number of

persons in Clinics.

If persons accompany the

patient and do not meet visitor

exception, person is to wait in

car or outside of

building/Clinic.


Clinic Buildings


Appointments

Instruct patients about any Clinic

specific information (e.g. drive by

testing, staying in car until visit, etc.)

Physical Distancing Toolkit: Scheduling In-Person

Appointments

Process During Business Hours


Documents

Provide a face mask to all persons

before entering the facility if not

already wearing one (excludes persons

2 years of age or younger or anyone

unable to wear a mask (e.g. difficulty

breathing).

Limits spread of

illnesses.


Clinic Buildings

Toolkit: Masking Priority

of 125




Revised 05/11/2020

Instruct all persons to perform hand

hygiene before and after wearing

mask, or after touching face or face

mask.

Limits spread of

illnesses.


Clinic Buildings

Toolkit: Posting – Masking Dos

and Don’ts

Instruct all persons how to wear a face

mask properly and at all times while in

the building/Clinic or in public.

Insures proper use. Toolkit: Screening Stations in

Clinic Buildings

Toolkit: Posting – Masking Dos

and Don’ts

Screen all persons for COVID-19

symptoms using the Source Control

Screening Tool – which includes a

questionnaire and temperature.

For everyone’s safety, any persons

refusing to be screened or have a

temperature check will not be

permitted into the building/Clinic.

Identifies persons

who may not realize

they are ill or could

be contagious.


Clinic Buildings

Toolkit: Form – Source Screening

of 125





Coronavirus (COVID-19) –

Source Control Screening Tool Page 1 of 1

Released 04/27/2020

Revised 05/11/2020

ALL PERSON ENTERING PATIENT CARE BUILDING

Screening Action

Do you have any of the following:

Cold like symptoms / runny nose

Cough

Chills (with or without repeated shaking)

Muscle pain / body aches

Headache

Sore throat

New loss of taste or smell

If NO – go to next question.

If YES – STOP: See instructions below.

Have you had a fever of 100.0º F (37.7º C) or

higher in the last 72 hours?



Take person’s temperature (touch free). Was

the temperature reading 100.0º F (37.7º C) or

higher?



Are you having or had any recent shortness of

breath?



Have you had any close, in-person contact with

someone who has tested positive for COVID-

19 in the last 14 days?

(For HCP and Clinician Screening Only: Excludes close

contact while at work of positive patients while wearing

all appropriate PPE)

If NO – proceed into building/Clinic.


ACTION FOR ANY YES ANSWER

Patient HCP/Clinician Visitor/Others

Assist patient to an available,

private space (exam room,

designated area, etc.).

Instruct HCP/Clinician to go

home and DHMF Leader to

contact Employee Health

immediately for further

direction.

Instruct visitors/others

(delivery personnel, couriers,

visitors, etc.) that due to the

safety for all, they are not

permitted in the building.

* NOTE: If anyone refuses to be screened or have their temperature taken they will not be

permitted to enter the building/Clinic/report to work.

FOR HCP / CLINICIANS - REPORTING TO WORK DIRECTIONS:

If you develop any symptoms while at work such as cold symptoms, runny nose, cough, chills,

muscle/body aches, fatigue, GI symptoms (nausea, vomiting, diarrhea), sore throat, new loss of

taste or smell, or headache, even if mild, please notify your DHMF Leader immediately.

Employee Health COVID-19 Hotline: 916-844-1567.

Employee Health Email: [email protected]

of 125

mailto:[email protected]

Coronavirus – Non-Scheduled Patient Check-In (e.g. Urgent Care) Algorithm

Clinical Support and Patient Safety (CSPS)

Revised 04/24/2020

Is the patient experiencing any of the following:

Fever, cough, shortness of breath; or difficulty breathing?

ACTION:

1) MOR should already have on a surgical mask under Universal

Masking Guidelines.

2) Patient should already have on a face mask upon entry to the building

and been screened for symptoms and temperature. Ensure patient (and

visitor if applicable) is wearing the face mask.

3) Immediately escort patient to an exam room if available. If

unavailable, escort patient to a separate designated area of the waiting

room, or have patient wait in their car until an exam room is available.

4) Notify Clinical Team ASAP to expedite rooming of the patient.

5) Clinical Team to follow Ambulatory Algorithm.

Check patient in using standard

process. NO

YES

NOTE:

Any patient who presents for an appointment should have been provided a face mask to wear while in the building.

of 125


Scheduled Appointment Check-In Guidelines Clinical Support and Patient Safety Department


Revised 05/06/2020

DHMF Clinics, buildings, and staffing varies across California. Below are several guidelines

that can be utilized based on each individual Clinic’s unique circumstances. DHMF Leader and

Clinicians should meet to determine the best option for their specific Clinic and/or building.

Visit Scheduling and Confirmation– Instructions for Patients

Instructions to be provided to the patient upon scheduling the appointment:

o Your safety and the safety of other patients and employees is our top priority.

o Do you have a mask?

If YES: Please have your mask on before you enter the Clinic/building.

If NO: We will provide you a mask when you arrive.

o Do you have hand sanitizer?

If YES: Please use hand sanitizer before you enter the building.

If NO: We can provide you hand sanitizer when you arrive to register.

o You will go through a symptom screening including having your temperature taken

before entering the Clinic. Please allow a little extra time for this process.

o For the safety of everyone, at this time we are not allowing visitors with patients in

our continued effort to slow the spread of the virus. If you need someone to drive

you to your appointment, they are more than welcome to wait outside or in their

car.

If the patient expresses concern, the following exceptions are permitted:

One parent of a minor child

One adult companion to frail, disabled or elderly patients who need

assistance

If a patient meets the criteria above, inform the patient that visitors

will also need to be screened and will not be permitted to

accompany the patient if they have any signs or symptoms.

For those Clinics that have implemented a process for patients to remain in their car until

their appointment (patients will still need to be screened prior to entering the building):

o We would like you to remain in your car until we are ready to escort you into the

building/Clinic. What phone number can we call you at when our exam room is

ready? (document phone number).

o We will contact you and meet you at the front entrance to the building/Clinic (be

specific if there are multiple entrances).

HCP Respiratory Etiquette Tables

Separate from the screening stations, respiratory etiquette tables should still be available in

locations throughout the building/clinic.

Respiratory Etiquette Tables should include standard supplies excluding surgical masks as

face masks will be provided at the point of entry (hand sanitizer, tissue, no-touch trash

can). Consider placing in areas to prevent theft.

of 125

https://saml.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=58325924-aa5b-468b-839b-be5776deb8c9




Revised 05/06/2020

Print and display the “Cover Your Cough” sign at freestanding stations (Click here).

Escorting Patient into the Clinic/Building

Contact patient by phone when an exam room is ready. Contact the patient if there will be

any delays in their appointment time and keep them updated with any delays.

HCP will wear appropriate PPE (see DH Ambulatory Algorithm).

HCP will avoid any direct contact with the patient (e.g. do not shake hands).

HCP will escort the patient through the face mask distribution and the symptom screening

process before proceeding to the clinic.

HCP will ensure physical distancing with others while escorting patient to the Clinic.

If in an elevator, HCP will push appropriate floor buttons. Avoid crowded elevators if at

all possible.

Patient will be escorted directly to the Clinic by HCP and immediately roomed following

the DH Ambulatory Algorithm. Registration should occur in the exam room and not in a

waiting area.

Outside Building Triage and Assessment

Consider possible triage and assessment outside of a building/Clinic.

Instructions to be provided to the patient upon scheduling the appointment:

o Your safety and the safety of other patients and employees is our top priority.

o We would like you to remain in your car until we are ready to assess you which

will occur initially outside of the building. What phone number can we call

you at when our Clinician is ready to meet you? (document phone number).

o We will call you to arrange the meeting location (e.g. car location, bench

location, etc.) when the Clinician is ready for your visit.

o Clinician should be sensitive on location to meet patient to protect their privacy

and limit concern by others in the public that might see the interactions.

o To reduce public concern, only the Clinician would provide an assessment

outside of the building.

Clinician will put on a gown, surgical mask, gloves and face shield prior to leaving Clinic.

o If an NP swab specimen will be collected, an N95 respirator is required to be

worn during the specimen collection.

Clinician will take appropriate PPE and supplies for visit and a mask for the patient to

wear

Instruct patient to put on the mask if they are not already wearing one.

Instruct patient in the use of the mask (Click here).

Clinician to take necessary vitals and perform any other assessment and determine next

steps.

If patient needs to enter the building:

o Clinician will ask the patient to wait in the car until they are called on their cell

phone to enter the building.

of 125

https://saml.policymedical.net/policymed/api/document/show/472/DHMF-S.3.4.021%20-%20ATTACH%20A%20Cover%20Your%20Cough%20-%20Official%20Portrait?path=472/documents/a95006b7-57be-4a39-ad5c-b51c2de00d3e.pdf

https://saml.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ac0d0aa6-ec7c-46ed-8332-cdca6c3280c6




Revised 05/06/2020

o Clinician will remove PPE before entering the building; place in additional

plastic bag; and use hand sanitizer.

o Clinician will go directly to the Clinic and put on new PPE (all HCP to follow

DH Ambulatory Algorithm).

o Follow instructions above on escorting patients into the Clinic.

of 125

Ambulatory Evaluation and Management of Patients Under Investigation for COVID-19 (Coronavirus Disease)

• Immediately notify Clinic Leadership (e.g. Infection Prevention or Ambulatory Leader)

• If not using commercial laboratory for COVID-19 testing, coordinate testing with local PublicHealth department

• Report all positive test results to local Public Health Department

STEP 3: INFORM

Continue with usual triageSymptoms of respiratory illness, including fever (subjective or >100.4°F or >38.0°C), or cough, shortness of breath, difficulty breathing

STEP 1: IDENTIFY SIGNS AND SYMPTOMS

YES

NO

Continue usual evaluation and treatment using isolation precautions appropriate to diagnosis

Maintain contact and droplet isolation with eye protection.

If aerosolizing procedure(s) are anticipated (e.g. breathing treatment, oral suctioning, intubation, sputum induction, bronchoscopy), wear a N95 respirator instead of a standard mask

Clinician suspects probable COVID-19Clinician determines respiratory illness due to other causes (e.g. influenza, RSV, parainfluenza)

Mask patient, move to private room, place in contact and droplet isolation with eye protection until further assessment (gown, gloves, standard mask, eye protection [goggles or faceshield])

Wear N95 respirator when obtaining any nasopharyngeal swab (or facemask if a respirator is not available)

STEP 2: ISOLATE APPROPRIATELY

YES YES

DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly.March 18, 2020

Questions? Contact your Infection Preventionist or Ambulatory Leader at your facility.

of 125

FAQ: New COVID-19 Symptom CheckerChat Box

What is the COVID-19 symptom checker chat box and how does it work?

The symptom checker chat box is an automated feature whereby each visitor is

greeted with a welcome message and general COVID-19 information from the CDC

which is updated every four hours. The patient then responds to questions asked by

the symptom checker chat box to receive further guidance to appropriate care based

on symptoms, potential exposure, and other risk factors. The primary goals are to help

patients stay informed, reduce calls and/or visits to clinics and ERs when unnecessary,

and provide immediate guidance for those who may be fearful or concerned.

How can the COVID-19 symptom checker chat box help?

The COVID-19 symptom checker chat box is designed to help with screening, care

navigation, and patient education. It makes COVID-19 information easily accessible to

patients and the community. Below are the main functions of the chat box:

The symptom checker chat box also supports our current triage messaging by

directing patients with mild symptoms to our virtual urgent care screening option.

Those with more severe symptoms are directed to the appropriate triage center or

ER.

• Help people check for COVID-19 symptoms, exposure and risk factors

• Navigate them to appropriate health system resources and care settings

• Provide general information on symptoms, prevention, and preparedness

• Answer common questions about COVID-19

This tool is being used by many other leading hospital systems in the United States as

well, and is supported by the digital team at CommonSpirit Health. The pilot in the

Pacific Northwest has been met with great success.

of 125

FAQ: New COVID-19 Symptom CheckerChat Box

If you have questions about the new symptom checker chat box, please contact

[email protected].

No, it is not a replacement for healthcare visits or your care team. In fact, the

symptom checker chat box feature was created to support all clinicians and

caregivers in taking care of patients. In this time of heightened concern, we designed

it to help manage the increased volume of patients in our ERs and clinics and provide

immediate guidance for those who may be fearful or concerned. Community

members will be directed to the appropriate clinical location depending upon their

symptoms.

Can the COVID-19 symptom checker chat box provide a medical

diagnosis, advice, or treatment options?

The COVID-19 symptom checker chat box is not intended for diagnostic purposes. All

diagnoses must be given by a healthcare professional. It is here to help patients

understand their symptoms and risk factors, and navigate them to the most

appropriate care setting.

Is the COVID-19 symptom checker chat box free?

How were the COVID-19 protocols developed?

The educational information within the symptom checker chat box was developed

from CDC guidelines and reviewed by divisional and national physicians and clinical

advisors. It will be updated as guidelines change.

Yes, it is provided to patients and community members free of charge.

Is the COVID-19 symptom checker chat box meant to replace doctor visits?

of 125

Coronavirus (COVID-19) – Cleaning

Instructions Clinical Support and Patient Safety Department


Revised 04/09/2020

Exam Room Cleaning

If you treat an “at-risk” patient, Health Care Personnel (HCP) must clean the exam room and

non-disposable medical equipment in accordance with the DHMF SOP – CDS: Exam Rooms,

Patient Areas, and Keyboards. After cleaning, the exam room can be used immediately unless an

aerosolizing procedure was done (e.g. nebulizer treatment) was performed in the exam room (see

below).

Exam Room Cleaning – Aerosolizing Procedures

If you treat an “at-risk” patient and perform an aerosolizing procedure, the exam room must be

vacated and the door closed for 1 hour. After 1 hour, the exam room is to be cleaned (see above)

wearing clean Personnel Protective Equipment (PPE) (surgical mask, gown, gloves, goggles/face

shield) prior to use.

of 125

https://saml.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=2cdcaa55-c427-40f0-a041-87e8897085e4

https://saml.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=2cdcaa55-c427-40f0-a041-87e8897085e4

The spread of COVID-19 has raised several questions about how to care for hospital linens, personal clothing, and work clothing and footwear. Employees have also asked questions about whether they should bathe or shower upon returning home from work. This message is applicable to all employees, regardless of where you work in relation to CSH hospitals, clinics, or offices.

Please note: Community spread of COVID-19 is ongoing throughout the United States, therefore anyone may potentially come in contact with someone having the virus as part of their everyday movement in the community or in their place of work. Additionally, information from various government and scientific sources continues to change rapidly.

What is Known:• COVID-19 survivability on surfaces ranges, and its survivability depends upon the type of surface. Various

surfaces have shown a survivability range of a few hours to three days, according to a recent articlepublished in The New England Journal of Medicine. However, other scientists caution that more research isneeded.

• Very little scientifically-based information currently exists about COVID-19’s ability to survive on fabric.

• The CDC recommends that hospital linen be treated in the same manner as in other circumstances.

Considerations and Guidance Include:• There is no definitive information regarding the need for any enhanced personal hygiene practices during

this time. Individuals are encouraged to perform proper handwashing and maintain regular skin and haircare during regular bathing or showering.

• As standard hygiene practice, many health care workers prefer to bathe or shower before coming into closecontact with their families.

• Wearing appropriate personal protective equipment (PPE) in the workplace when caring for isolationpatients, and when performing care or procedures with the risk of splash or spatter, reduces exposure ofhealth care workers and their clothing to biological pathogens found in blood and body fluids.

• Routine laundering of general work clothes and scrub attire worn in hospitals and health care environmentsis considered good practice.

• Consider bagging and carrying your work clothes or scrub attire into your hospital or health care location,and changing into your work attire before starting your shift.

• Upon completion of your shift, consider removing and bagging your work clothes or scrub attire at yourhospital or health care location, and then changing into your personal clothing to return home.

• Launder your work clothes or scrub attire upon arrival home.

• If you are unable to launder your work clothes or scrub attire immediately, consider keeping them baggedand separate from other items.

• Recommendations for water temperatures and the use of chlorine bleach for laundering vary widely,depending on the source. Recommendations for water temperatures of 140 to 160 degrees, use ofdetergents, use of chlorine bleach, high-temperature drying cycles, and longer cycles as opposed to shortercycles are noted in a number of sources.

Care of Personal Clothing, Work Clothing, and Hospital Linen with Regard to COVID-19

of 125

• Read and follow instructions on clothing labels and laundry product labels with regard to the manufacturer’srecommendations for water temperatures, detergent use, bleach use, cycle time, drying temperatures anddrying cycle times.

• Regarding dry cleaned items, the Dry Cleaning and Laundry Institute International offers the following“COVID-19 Guidance” based on CDC guidelines. “Cleaning Garments From The General Public: There is no need to take any special precautions at this time. The CDC advises that the dry cleaning process, which includes cleaning and pressing, is effective on most viruses. If hot water and chlorine bleach are not safe for the items, then laundering with a disinfectant product is an option. The CDC states that laundering with detergent alone is an effective method.”

• There is no robust evidence to determine that industrial laundering is more effective at eliminating blood or pathogens than appropriately performed home laundering of general attire, scrub attire, or lab coats.

• Additionally, shoes worn at work don’t appear to require more disinfection than the disinfection a personperformed prior to the current COVID-19 outbreak. Shoe covers are not necessary outside of the currentlydesignated guidelines or outside of areas indicated as requiring shoe covers.

• Sanitizing personal devices regularly, such as cell phones, pagers, ear phones, ear buds, chargers,keyboards, computer mouse, desk phone, etc. is recommended. Refer to the item’s manufacturer guidelinesfor proper procedures and methods to sanitize such devices.

Resources• Specific CDC guidance can be found at: https://www.Cdc.gov/coronavirus/2019-ncov/hcp/guidanceprevent-

spread.html and https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/laundry.html

• Occupational Health and Safety Administration (OSHA) guidance can be found at https://www.osha.gov/SLTC/etools/hospital/laundry/laundry.html

• Cleaning product and detergent guidance may be found at the American Chemistry Council. Novel Coronavirus (COVID-19) Fighting Products. Updated March 20, 2020 https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf

• Dry Cleaning and Laundry Institute International. COVID 19 Guidance, March 13, 2020. https://www.dlionline.org/coronavirus-covid-19-guidance

• Expert Guidance: Healthcare Personnel Attire in Non-Operating Room Settings, Infection Control andHospital Epidemiology, 2014; 35(2): 107-121. Available at https://www.cambridge.org/core/journals/infection-control-and-hospitalepidemiology/article/healthcare-personnel-attire-in-nonoperatingroomsettings/9F36A1561FAB959FA65D0B539F7A1719

• Neeltje van Doremalen, Trenton Bushmaker, Dylan H. Morris, Myndi G. Holbrook, Amandine Gamble, Brandi N. Williamson, Azaibi Tamin, Jennifer L. Harcourt, Natalie J. Thornburg, Susan I. Gerber, James O. Lloyd-Smith, Emmie de Wit, Vincent J. Munster. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine, 2020; DOI: 10.1056/NEJMc2004973

Questions? Call your local Infection Prevention Department or Ambulatory Quality Lead

Distrbuted By: Roy Boukidjian, System Vice President Infection PreventionOriginal Developer: Arizona Division

DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly. March 24, 2020

of 125

http://dx.doi.org/10.1056/NEJMc2004973

Coronavirus (COVID-19) – DHMF Acceptable Surface

Disinfectants For Use Against COVID-19

Clinical Support and Patient Safety Department


Revised 04/27/2020

Disinfectants with an emerging viral pathogen claim/human coronavirus claim/acceptable non-

enveloped viral claims.

Manufacturer Product Name Surface Contact Time

PDI Super Sani-Cloth Germicidal Wipes

2 minutes

PDI Sani-Cloth Bleach Germicidal Wipes

4 minutes

PDI Sani-Cloth AF3 Germicidal Wipes

3 minutes

PDI Sani-Prime Germicidal Wipes

1 minute

PDI Sani-24 Germicidal Spray

5 minutes

PDI Sani-HyPerCide Germicidal Spray

5 minutes

PDI Sani-Prime Germicidal Spray

1 minute

of 125





Revised 04/27/2020

McKesson Dry Surface Lint Free Wipes to be

used with Spray Disinfectant

Metrex Cavicide3 Disinfecting Spray or Pump

Spray

3 minutes

Metrex CaviWipes3

3 minutes

Metrex CaviWipes1 and Cavicide1

Disinfecting Spray

1 minute

Metrex CaviWipes Bleach

3 minute

McKesson Disposable Germicidal Surface Wipes

2 minute

of 125

https://www.metrex.com/sites/default/files/content/product/teaser-thumb/13-5100_CW1_160_Canister_US_Black_Lid.jpg

https://www.metrex.com/sites/default/files/content/image/image-upload/13-5024-cavicide1-24-oz-spray.jpg

https://www.metrex.com/sites/default/files/CaviWipes-Bleach-408x408.jpeg

https://images.search.yahoo.com/images/view;_ylt=Awr9NEnIdp9eVx4Agx.JzbkF;_ylu=X3oDMTIyNWlxdjhuBHNlYwNzcgRzbGsDaW1nBG9pZANiYTdiOTkyNjFlMTNjZTcxY2RmYTRmY2RlNTRjYmM2OARncG9zAzIEaXQDYmluZw--?back=https://images.search.yahoo.com/search/images?p%3Dmckesson%2Bdisinfecting%2Bwipes%26vm%3Dr%26fr%3Dyfp-t%26tab%3Dorganic%26ri%3D2&w=470&h=470&imgurl=cdns.webareacontrol.com/prodimages/470-X-470/2/5/23122017408wipes-675-P.png&rurl=https://www.healthproductsforyou.com/p-mckesson-surface-disinfectant-premoistened-wipes.html&size=+9.4KB&name=McKesson+Surface+Disinfectant+Premoistened+Wipes&p=mckesson+disinfecting+wipes&oid=ba7b99261e13ce71cdfa4fcde54cbc68&fr2=&fr=yfp-t&tt=McKesson+Surface+Disinfectant+Premoistened+Wipes&b=0&ni=120&no=2&ts=&vm=r&tab=organic&sigr=12s7lhmi1&sigb=13albicsf&sigi=12bf8pd06&sigt=11go51rr4&sign=11go51rr4&.crumb=AMm1U29Kz6t&fr=yfp-t&vm=r





Revised 04/27/2020

Clorox Clorox Hydrogen Peroxide Cleaner

Disinfectant Wipes / Spray

5 minute

Clorox Clean-Up Disinfectant Cleaner with

Bleach

5 minutes

Clorox Bleach Germicidal Wipes

3 minutes

Clorox Dispatch with Bleach (List N EPA)

3 minutes

of 125

Coronavirus (COVID-19) – EH General

Information Employee Health Department


Revised 04/09/2020

Health Care Personnel (HCP) – Prevention Strategies

HCP must stay home when they are sick. This is particularly important for health care workers

who can inadvertently expose other HCP and immune comprised patients. HCP need to work

directly with their DHMF Leader on communication and unscheduled absences. DHMF Leaders

should work directly with Employee Health on any issues related to HCP illness, potential

exposure, etc. In addition, HCP should not shake hands or otherwise engage in unessential

physical contact with other HCP or patients.

Health Care Personnel (HCP) – Travel or Exposure

CommonSpirit Health (CSH) and all Employee Health Departments have established guidelines

for HCP who have travel outside the US within the last 14 days, or who will be returning from a

foreign country. DHMF Employee Health would work with DHMF Leaders and HCP on the

process if any HCP are exposed to anyone who is suspected and/or confirmed to have COVID-

19. Should you have any immediate concerns, please contact Employee Health at either of the

methods below:



of 125


Coronavirus (COVID-19) – EH Response

Questions Employee Health Department


Revised 04/06/2020

Please respond to the [email protected] mailbox

Please type COVID-19 “Confidential” in the Subject Line

Please “Limit the Audience” due to privacy and to protect PHI

Please provide the following information:

EMPLOYEE/CLINICIAN INFORMATION

1. Full name and title of employee/Clinician:

2. Location and Department:

3. Telephone Contact Number:

4. Reason for out office (i.e. self-quarantine, age related, health risk, exposure):

5. Date of known exposure (if applicable):

6. Exposed within the work environment? ____, Exposed outside the work environment? ____

7. Was the employee/Clinician tested for COVID-19? If so, on what date?

8. Where was the test completed?

9. What were employee/Clinician test results?

10. Was the employee/Clinician wearing PPE at the time of exposure? If so what?

11. Were there others in the office/department potentially exposed? If so, who?

12. Was Public Health notified? If so, which county?

13. Is the employee/Clinician currently at work or at home? If at home beginning date?

14. Is the employee/Clinician asymptomatic?

15. Is the employee/Clinician symptomatic? If so, what are the symptoms?

16. If off work, was Matrix contacted? If so, when?

SOURCE PATIENT INFORMATION

17. Full name and MRN # of the source patient (if applicable)

18. Was the source patient tested for COVID-19?

19. When were they tested?

20. Where was testing completed?

21. What were the source patient’s test results?

of 125


Coronavirus (COVID-19) – EH Hotline Employee Health Department


Revised 05/15/2020

Purpose

To establish a central location for Health Care Personnel (HCP) to call in to report travel and/or

possible exposure/illness related to COVID-19.

Overview

HCP are to report to their DHMF Leader and the Employee Health Department if HCP have

traveled to the level 3 countries identified by the CDC, experience COVID-19 related symptoms,

or have been exposed to COVID-19. The exposure is defined by the CDC and CDPH criteria’s.

Procedure 1. EH staff will answer the EH hotline. The hotline will be checked on a daily basis between

the hours of 7:00 a.m. – 4:00 p.m.

2. EH staff will listen to the hotline detailed message provided.

3. If HCP is in quarantine and reporting their temperature for the day, EH staff will record the

temperature on the appropriate log. The logs are currently saved by EH.

4. If HCP is self-monitoring and calling in to report new symptoms, EH staff will contact

HCP and gather further information.

EH COVID-19 Hotline number:

(916)-844-1567

EH COVID-19 Fax number:

(916)-859-1962

of 125

Coronavirus (COVID-19) – EH If/Then

Guidelines Employee Health Department


Revised 04/07/2020

The Employee Health Department has gathered some frequently asked questions regarding

COVID-19. Here are some guidelines to help assist staff on when to report illness and some

online resources as it relates to self-care. Employee Health will notify the employee and manager

via email when an employee is removed from work and when they can return to work.

Steps to Follow:

If Then If you have any symptoms relating to COVID-

19 (flu like symptoms, a sore throat, a cough,

or shortness of breath).

OR

You have been identified as being exposed to

COVID-19 at work.

OR

I was in contact with a person outside of the

workplace who tested positive for COVID-19

or is symptomatic and is pending COVID-19

test results.

Contact your Manager AND Employee

Health.

If you are symptomatic or become

symptomatic then you need to stay home and

contact your Manager/Employee Health.

Return to work guidance will be provided by

Employee Health.

(Reference: CDC criteria for return to work for healthcare personnel

with confirmed or suspected COVID-19)

Employee Health Hotline

(916)-844-1567

Employee Health Email

[email protected]

Resources for Employees:

Signs and symptoms of COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

How do I protect myself? https://www.cdc.gov/coronavirus/2019-ncov/prepare/protect-family.html

If you are sick or caring for someone: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

How to talk to kids about COVID 19? https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-

and-crisis/health-crisis-resources/talking-to-children-about-covid-19-(coronavirus)-a-parent-resource.

Resource for virtual visits: https://dignityhealth.box.com/s/4aaqyll81iyz456xviphkhgvkzlcd1zf

of 125


https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

https://www.cdc.gov/coronavirus/2019-ncov/prepare/protect-family.html

https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/talking-to-children-about-covid-19-(coronavirus)-a-parent-resource

https://www.nasponline.org/resources-and-publications/resources-and-podcasts/school-climate-safety-and-crisis/health-crisis-resources/talking-to-children-about-covid-19-(coronavirus)-a-parent-resource

https://dignityhealth.box.com/s/4aaqyll81iyz456xviphkhgvkzlcd1zf

Coronavirus (COVID-19) –

Leadership Talking Points – Workplace Exposure

Human Resources Department


Revised 05/06/2020

Under the direction of the Centers for Disease Control and Prevention (CDC) and in consultation

with public health authorities, Dignity Health Medical Foundation (DHMF) has established a

comprehensive review process to protect the safety of our patients, Health Care Personnel

(HCP), and Clinicians from exposure with COVID-19. This process involves representatives

from different departments including Operations, Employee Health, Infection Prevention,

Clinical Support and Patient Safety, Materials Management and Human Resources. This group

meets daily to develop and review existing guidelines to ensure we are reacting swiftly with

changes to government regulations or when best practices are shared to combat this pandemic.

Daily screening at all DHMF locations

o The purpose of this initiative is to ensure that we do not have HCP or Clinicians

report to work when they have known symptoms of COVID-19. As healthcare

professionals, it is imperative that we take care of ourselves and we take care of

our coworkers by not unnecessarily exposing them to any illness that we may be

spreading.

Universal Masking Policy

o Despite challenges with procuring Personal Protective Equipment (PPE), DHMF

made a calculated decision to implement a Universal Masking Policy to minimize

the risk of exposure to our HCP and Clinicians. It is critical that we adhere to the

policy consistently, especially in patient care areas and when interacting with

coworkers. Also, physically distancing yourself, when possible, will drastically

reduce your exposure.

HCP who test positive for COVID-19

o When Employee Health is made aware of a HCP who has tested positive for

COVID-19 or has been identified as a Person Under Investigation (PUI), the HCP

is immediately removed from the workplace.

o On the same day, a “contact tracing” task force meet to identify anyone else who

may have been exposed to the HCP.

o Depending on the circumstances (i.e. masking, physical distance, prolonged

exposure, etc.), anyone who has had any exposure will fall into a category of

Low, Medium, and High Risk. These HCP will be notified by Employee Health

about the exposure and will be provided with follow-up instructions.

o It’s vital that we protect the privacy and PHI of our HCP and Clinicians.

Therefore, unless there is an imminent and serious threat to the health or safety of

a person or the public, we will not share information with anyone that has not

been exposed at the workplace.

To adequately and effectively handle this pandemic, we are relying on the partnership of

our Clinicians and all of you. We need you to speak up and share your concerns as well

as your ideas on how we can prepare for the next phase and how we can take care of each

other.



of 125


Today’s date: Employee ID:

Employee Name:

Phone: Email:

Manager’s Name: Department:

Phone: Pager or Email:

Gender M F D.O.B:

Does the Employee have the following signs and symptoms (check all that apply)? Y N

Date first symptoms started:

Allergy symptoms

Chills (with or without repeated shaking)

Cold-like symptoms / runny nose

Cough

Fever (>100.4°F or 38°C)

Headache



New onset of gastrointestinal symptoms, nausea, vomiting or diarrhea

Recent or current shortness of breath

Sore throat

Other Specify

Evaluated by: Dept: Date:

(If symptoms are identified please notify the below) Facility Infection Control Notified: Name: Date: Time:

Active Monitoring Please refer to Employee Screening Form if the employee requires active monitoring per the recommendation of local public health and facility leadership. For any identified symptom, please communicate with Infection Control immediately.

DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly. May 13, 2020

COVID-19 (Coronavirus Disease) Employee Screening Form

of 125

Name:

Phone number:

For more information, visit https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/ steps-when-sick.html

When to seek Medical AttentionIf you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency signs include:• Trouble breathing• Persistent pain or pressure in the chest• New confusion or inability to arouse• Bluish lips or face• Other severe or concerning symptoms

Employee Self-Monitoring for Symptoms

List date of each symptom review in the space below

Enter dates of the monitoring period. Day 1= date of last exposure and runs consecutively for 14 days

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Date

In the morning

Symptom Review below: Y (yes) or N (no)

Allergy symptoms

Chills (with or without repeated shaking)Cold-like symptoms / runny nose

Cough

Fever (>100.4°F or 38°C)

Headache



New onset of gastrointestinal symptoms, nausea, vomiting or diarrheaRecent or current shortness of breath

Sore throat

In the evening


Allergy symptoms

Chills (with or without repeated shaking)Cold-like symptoms / runny nose

Cough

Fever (>100.4°F or 38°C)

Headache



New onset of gastrointestinal symptoms, nausea, vomiting or diarrheaRecent or current shortness of breath

Sore throat

Dis

trib

ute

d b

y P

atie

nt

Safe

ty N

atio

nal

Offi

ceD

ISC

LAIM

ER

: CO

VID

-19

info

rmat

ion

is r

apid

ly c

han

gin

g a

nd

do

cu

me

nts

will

be

up

dat

ed

acc

ord

ing

ly.

May

13, 2

020

of 125

Distributed by Patient Safety National Office 2

Sample Log

List date of each symptom review in the space below

Enter dates of the monitoring period. Day 1= date of last exposure and runs consecutively for 14 days

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14

Date 4/15 4/16 4/17 4/18 4/19 4/20 4/21 4/22 4/23 4/24 4/25 4/26 4/27 4/28

In the morning


Allergy symptoms Y Y Y Y Y Y N N N N N N N NChills (with or without repeated shaking) Y Y Y Y Y Y Y Y Y Y N Y N NCold-like symptoms / runny nose Y Y Y Y Y N N N N N N N N NCough Y Y Y Y Y Y Y N Y N N N N NFever (>100.4°F or 38°C) Y Y Y Y Y Y Y Y N N N N N NHeadache Y Y Y Y Y Y Y Y N N Y Y N NMuscle pain / body aches Y Y Y Y Y N N N N N N N N NNew loss of taste or smell Y Y Y Y Y Y Y N Y N N N N NNew onset of gastrointestinal symptoms, nausea, vomiting or diarrhea

Y Y Y Y Y Y Y N Y N N N N NRecent or current shortness of breath Y Y Y Y Y Y Y Y N N Y Y N NSore throat Y Y Y Y Y N N N N N N N N N

In the evening


Allergy symptoms Y Y Y Y Y Y Y Y N N N N N NChills (with or without repeated shaking) Y Y Y Y Y Y Y Y N N Y Y N NCold-like symptoms / runny nose Y Y Y Y Y N N N N N N N N NCough Y Y Y Y Y Y Y N Y N N N N NFever (>100.4°F or 38°C) Y Y Y Y Y N Y N Y N N N N NHeadache Y Y Y Y Y Y N N N N N N N NMuscle pain / body aches Y Y Y Y Y Y Y Y Y Y N Y N NNew loss of taste or smell Y Y Y Y Y Y Y N Y N N N N NNew onset of gastrointestinal symptoms, nausea, vomiting or diarrhea

Y Y Y Y Y Y N N N N N N N NRecent or current shortness of breath Y Y Y Y Y Y Y Y N N Y Y N NSore throat Y Y Y Y Y N N N N N N N N N

of 125

Home Care Instructions for Employees Potentially Exposed to COVID-19

The following home care measures should be taken by employees who have had an exposure to COVID-19. The actions are intended to protect household members and reduce the risk of transmission, should an employee develop signs and symptoms. The prevention measures are applicable to employees who have had low-medium-or high-risk exposure. The following recommendations are designed for the safety of employees and their family members.

Distributed by Patient Safety National OfficeDISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly.

May 13, 2020

1. Separate yourself from other people in your home

a. Use separate bathroom, if available

b. Stay in specific “sick room” if possible

c. Eat separately

d. Avoid sharing dishes, towels or bedding

e. Restrict contact with pets

f. Avoid any nonessential visitors

2. If you must be in the same room as household member, maintain a six footdistance and wear a cloth facemask

a. If you have unprotected face-to-face contact with a household member(e.g. when you cough, sneeze, sign, talk or shout), respiratory droplets maytravel several feet, to land on your household member's mouth, nose or eyes.This is how COVID-19 is most commonly spread

b. Medical-grade facemasks are reserved for protecting healthcare workers frominfected patients. Fabric masks, while not as effective as surgical masks, reducethe spread of droplets by providing a physical barrier at the source

c. If at all possible, it is best to limit or avoid being in the same room with ahousehold member

3. Keep the environment clean

a. Every day, clean and disinfect all high-touch surfaces, such as doorknobs,table tops, TV remote, bathroom fixtures, personal devices such ascell phone or tablet

i. To clean, use soap and water or detergent to remove any dust, dirt,secretions, etc. Follow with a household disinfectant to destroy anyremaining viral particles. Follow the instructions on the label to ensuresafe and effective use of the product

of 125


ii. Many products recommend:

1. Keeping surface wet for a period of time (see product label)

2. Precautions such as wearing gloves and making sure you havegood ventilation during use of the product

iii. Use EPA-registered disinfectants. All products on this list meet EPA’scriteria for use against COVID-19: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

iv. Diluted household bleach solutions may also be used if appropriate forthe surface. Check to ensure the product is not past its expiration date.Unexpired household bleach will be effective against coronaviruses whenproperly diluted. Follow manufacturer’s instructions for application andproper ventilation. Never mix household bleach with ammonia or anyother cleanser

Leave solution on the surface for at least 1 minute

To make a bleach solution, mix:

• 5 tablespoons (1/3rd cup) bleach per gallon of water

OR

• 4 teaspoons bleach per quart of water

b. Wash dishes and utensils using gloves and hot water. Handle any used dishes,cups/glasses, or silverware with gloves. Wash them with soap and hot water or ina dishwasher. Clean hands after taking off gloves or handling used items

c. For electronics, such as tablets, touch screens, keyboards, and remote controls,consider putting a wipeable cover on electronics and follow manufacturer’sinstruction for cleaning and disinfecting. If no guidance, use alcohol-basedwipes or sprays containing at least 70% alcohol. Dry surface thoroughly

4. Practice Hand Hygiene and Cough Etiquette

a. Clean hands after you cover your cough or sneeze, go to the bathroom andbefore eating or preparing food

i. Wash all hand surfaces with soap, water and friction for at least 20 seconds

ii. An alcohol handrub containing at least 60% alcohol is an acceptablealternative to handwashing with soap and water. Cover all surfaces and rubtogether until dry

b. Cover coughs and sneezes

i. Dispose of used tissue in a lined trash can

ii. Wash hands immediately after covering cough or sneeze

of 125


5. Wash laundry properly

a. Launder items according to the manufacturer’s instructions. Use the warmestappropriate water setting and dry items completely

b. Do not shake dirty laundry

c. Avoid household members from handling used linen. If they must, they shouldwear disposable gloves and keep the soiled items away from their body. Handsshould be washed immediately after removing gloves

d. Clean and disinfect clothes hampers according to guidance above for surfaces

e. For additional information refer to the Care of Personal Clothing, Work Clothing,and Hospital Linen with Regard to COVID-19

6. Monitor signs/symptoms twice daily for 14 days after last contact withCOVID-19 patient

a. Check temperature and review symptoms: cough, shortness of breath, troublebreathing, sore throat, chills, repeated shaking with chills, muscle pain,headache, vomiting, diarrhea, and new lost of smell/taste

b. Document results on the Daily Self-Monitoring Log. Follow local policy onreporting results to Employee Health

c. If temperature check or symptom review are positive, DO NOT REPORT TOWORK. Notify manager and Employee Health department

7. Stay Home

a. When not at work, stay home

b. Avoid public transportation, taxis or ride-sharing and other social gatherings

c. If you must be in public, wear a cloth face mask and stay at least 6 feet awayfrom others

d. Call ahead before visiting your health care providers office

If you have any questions, please contact your manager or Employee Health department. For more information, visit https://www.cdc.gov/coronavirus/ 2019-ncov/if-you-are-sick/steps-when-sick.html

References

CDC Coronavirus Disease 2019 If You Are sick: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html

of 125

https://show.dignityhealth.org/publish/DHPatientSafety/COVID19%20Shared%20Documents/Acute%20Care/Employee%20Health/CSH%20Laundering%20Personal%20Clothing.pdf

https://show.dignityhealth.org/publish/DHPatientSafety/COVID19%20Shared%20Documents/Acute%20Care/Employee%20Health/CSH%20Laundering%20Personal%20Clothing.pdf



Coronavirus (COVID-19) – Training Resources Clinical Support and Patient Safety Department


Revised 05/01/2020

MyJourney/Knowledge Hub training

CommonSpirit Health (CSH) has developed a training module titled CSH Novel Coronavirus

Response – FY20. This training is optional and can be assigned by the DHMF Leader. Some

DHMF Leaders may want to view the training together as a team (during a staff meeting), or

have Health Care Personnel (HCP) take the training when there is downtime in the Clinics.

Other Training Videos

Dignity Video: Donning/Doffing PPE

https://dignityhealth.ent.box.com/s/c6md5ov73pzh4ab5r8vnzjvbj9chnwrh

Dignity Video: Procedure for Donning and Doffing Coveralls and N95 Respirator

or Facemask

https://dignityhealth.ent.box.com/s/4fkvuszicslioq60qsmf2ocby4ufeiq3

Mask Face Shield Training Video:

https://www.youtube.com/watch?v=syh5UnC6G2k

Nasopharyngeal Swab Training Video:

https://www.youtube.com/watch?v=mzs9c37N9RY

N95 Donning/Doffing/Reuse Video:

https://www.youtube.com/watch?v=Cfw2tvjiCxM

Social Distancing Video:

https://www.youtube.com/watch?v=wKX1PQTz5_M&feature=emb_title

Supplemental COVID-19 Response Videos (link to PDF with all videos below):

COVID-19 Reprocessing of eye protection

COVID-19 Reuse of Face Mask with Eye Cover

COVID-19 Doffing Gown and Gloves Inside the Room

of 125

https://dignityhealth.ent.box.com/s/c6md5ov73pzh4ab5r8vnzjvbj9chnwrh

https://www.youtube.com/watch?v=syh5UnC6G2k

https://www.youtube.com/watch?v=mzs9c37N9RY

https://www.youtube.com/watch?v=Cfw2tvjiCxM

https://www.youtube.com/watch?v=wKX1PQTz5_M&feature=emb_title

https://dignityhealth.box.com/s/q2m8jan5g679xchavxmcqhewrifoxupw

https://youtu.be/zT4mk-7Km40

https://youtu.be/sDgK3U0uZws

https://youtu.be/2zoObawEIqc

Coronavirus (COVID-19) – Respiratory

Etiquette Stations Clinical Support and Patient Safety Department


Revised 05/06/2020

Respiratory Etiquette Stations in all Clinics

DHMF Leader should ensure Clinic has Respiratory Etiquette stations in all waiting areas with

adequate supply of the following (see DHMF SOP – Respiratory Protection and Hygiene).

Please ensure you post the DHMF “Cover Your Cough” flyer until further notice (click here):

Hand sanitizer

Tissues

Trash receptacle(s)

Note: Please do not include Surgical Masks at respiratory stations at this time. With the

implementation of Source Control, all persons will be screened upon entering the building and

provided a mask if they do not have one, you do not need to include surgical masks at free-

standing respiratory stations at this time.

of 125

https://saml.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=57969cf9-2f75-4591-b6c0-986c59a1a29b

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ba001dd1-26c4-4284-93bb-defaac6a63ef

Coronavirus (COVID-19) – Universal Masking Clinical Support and Patient Safety Department


Revised 05/06/2020

Universal Masking

CommonSpirit Health (CSH) has provided guidance to implement Universal Masking in all of

the patient care areas. For DHMF, this means that Health Care Personnel (HCP) and Clinicians

working in a Clinic would wear a Surgical Mask (mask) upon entering the facility. For DHMF,

this will include Medical Office Receptionists (MORs). The ability to implement this must be

balanced to ensuring enough Personal Protective Equipment (PPE) across the organization. The

policy may be adjusted as needed based on any concerned shortages. As of today, there are

enough masks in stock to implement this policy and DHMF Leaders need to work to obtain

enough inventory for this new policy. However, due to the uncertainly of supply, HCP and

Clinicians are responsible for making every effort to extend the use of their mask by careful

handling of these limited items. See the attached documents from CSH:

CSH Guidelines for Universal Masking

CSH Universal Masking Policy – Frequently Asked Questions

There are several issues that all HCP and Clinicians must understand:

Universal masking does not replace droplet/contact precautions for HCP and Clinicians

treating patients with respiratory symptoms or known COVID-19 symptoms (N95 or

Surgical Mask, face shield/goggles, gown, and gloves).

DHMF Leaders must provide education to HCP and Clinicians how to put on, remove,

and store the mask for reuse (see CSH Guidelines for Universal Masking) to minimize

the risk.

Masks should not be shared amongst HCP or Clinicians. While the mask can be reused,

it must only be reused by the same person.

HCP and Clinicians should not touch the mask when it is on their face while wearing

gloves or with unwashed hands to reduce the risk of contamination.

Hand hygiene is the most important way to prevent the spread of infection. Proper hand

hygiene must be performed before and after putting on a mask and taking off a mask, as

well as after accidentally touching the mask while wearing. DHMF Leader must ensure

HCP know how to perform proper hand hygiene as some non-patient care HCP (e.g.

MOR) may not know the proper technique for hand hygiene (see DHMF SOP – Hand

Hygiene).

Every effort should be made to keep the mask clean and dry.

The mask must be discarded immediately if soiled, wet, damaged or if contaminated by

use in direct contact with symptomatic patient.

DHMF recommends that all persons wear a mask when in a public areas around other

people. Therefore, HCP not in patient area areas/buildings and therefore not provided a

mask by DHMF are permitted to use personally obtained masks (e.g. cloth masks,

bandana’s, non-DHMF provided N95’s to wear (see DHMF Cloth Masks). HCP who

may not regularly work in a patient care area/building, but have to go there for work

assignments (e.g. Clinical Educator, facilities personnel, IT, etc.), will need to wear a

surgical mask provided by DHMF in the same manner as the other HCP while in the

building/Clinic. As information, there are many videos on how to make a cloth mask

available through YouTube as well as other types of masks available at stores/online.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=614ba3af-ea6d-43a7-b92b-b37fb8d15b2e

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=6c28b608-6e78-4bc3-955d-ccf1b18b0eb5

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=614ba3af-ea6d-43a7-b92b-b37fb8d15b2e

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=d5e9db74-f8c0-4bc0-82eb-95eb15cf1616

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=d5e9db74-f8c0-4bc0-82eb-95eb15cf1616

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=08e12bdd-2758-49a6-b787-22528c0bf0c4

Coronavirus (COVID-19) – Universal Masking Clinical Support and Patient Safety Department


Revised 05/06/2020

Physical Distancing / Other Preventative Measures

The most important measures to protect HCP and Clinicians are strict adherence physical

distancing, proper and frequent hand hygiene, early identification of symptomatic patients, use of

recommended PPE for direct patient care, not coming to work if not feeling well, and good

environmental cleaning, especially shared workplaces. Even with the implementation of

universal masking, it is imperative to continue these other preventative strategies, especially

physical distancing in our day to day operations.

of 125

Coronavirus (COVID-19) – Cloth Masks Clinical Support and Patient Safety Department


Revised 05/06/2020

Dignity Health Medical Foundation (DHMF) is committed to the proper use of Personal

Protective Equipment (PPE) to effectively protect patients, Clinicians, and Health Care

Personnel (HCP). In keeping with that commitment:

Masks should be worn in accordance with current CDC guidance, and for the purpose

they are intended. For additional information, please refer to the CDC FAQs associated

with PPE.

The key step to preventing the spread of illness and limiting exposure is to mask all

patients with respiratory symptoms immediately upon arrival.

DHMF issued and approved PPE must be worn when caring for patients with respiratory

symptoms.

PPE should not be worn outside of an Exam Room or outside restricted areas. Double

masking is not appropriate. Doing so traps moisture, which decreases mask effectiveness.

N95 respirator masks should be used by HCP when caring for all patients who are in

airborne isolation (such as tuberculosis patients) or when performing aerosol

generating procedures on COVID-19 patients (e.g. nebulizer treatment, Nasopharyngeal

Swab).

Mandated wearing of masks for HCP who did not receive a flu vaccine has been

suspended.

Use of Personal Non-FDA-Approved Cloth Masks

Personal Protective Equipment (PPE) in healthcare settings is heavily regulated in the United

States, particularly related to items used to protect against spread of infectious diseases. Now,

due to the COVID-19 pandemic, interest in using these social comfort, non-FDA-approved cloth

masks is increasing.

Personal Non-FDA-Approved Cloth Mask Guidance

When HCP prefer to wear non-FDA-approved cloth masks for their social comfort, they will be

allowed to do so with the following in mind:

Caution should be exercised as non-FDA-approved cloth masks are not considered PPE,

and their ability to protect HCP is not known.

HCP will be allowed to wear non-FDA-approved cloth masks for social comfort in public

areas, but such masks may not be worn for direct patient care.

DHMF issued PPE must be worn when caring for patient with respiratory issues.

As cloth masks are considered personal wardrobe and should follow the dress code

policy; cloth masks should be professional and in good taste, in neat and clean condition.

Cloth masks should not feature characters or logos.

HCP must read and sign the Just in Time Education – Use of Personal Non-FDA-

Approved Cloth Masks Attestation (click here for form).

When used improperly, masks of any type can increase the risk of transmission of COVID-19

and other infections. It is important to:

Use proper donning/doffing technique in order to minimize risk.

A cloth mask cannot be touched with gloves or unwashed hands (since the mask is close

to the face/mouth). Also, a cloth mask cannot be worn under a standard surgical mask.

Do not touch the mask when it is on your face.

of 125

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=34150b26-59db-480b-974f-cc7de3b10d5b

Coronavirus (COVID-19) – Cloth Masks Clinical Support and Patient Safety Department


Revised 05/06/2020

Hand hygiene is the most important way to prevent the spread of infection; proper hand

hygiene must be performed after donning/doffing or accidentally touching the mask.

All cloth masks must be machine washed before using and in between uses. Laundering

masks is the responsibility of the individual; this is not a service that will be provided by

the organization.

Cloth masks must be removed immediately if soiled or if it becomes wet. They must be

taken off and placed into a plastic bag, and not used until appropriately laundered.

When a cloth mask is removed, carefully fold outer surface held inward and against itself

to reduce contact with outer surface during storage. Store folded mask in between uses in

a clean breathable bag.

Donning cloth masks during the COVID-19 pandemic does not sanction its continued use

after the pandemic is declared over by the CDC or the WHO.

Cloth Masks for Non-DHMF HCP

With Source Control guidelines established, individuals coming into the building/Clinics may be

wearing their own face covering. Some DHMF Leaders have secured cloth masks from

volunteer organizations to distribute to individuals that may not have their own face covering

(e.g. patients, visitors, vendors, etc.). Any cloth mask donated and provided to an individual

becomes the personal property of that individual and should not be returned upon their exit from

the building. No cloth masks are to be collected and then reused by someone else.

of 125

Coronavirus (COVID-19) – PPE and Supply



Revised 04/13/2020

PPE Supplies in all Clinics

DHMF Leader needs to ensure Clinic has appropriate (item and sizes) of PPE required for

patient’s at-risk for Coronavirus or presenting with cough/fever. PPE includes:

Gowns

Exam Gloves

N95 masks (see Coronavirus (COVID-19) – N95 and Surgical Masks in toolkit for further information).

Surgical Masks

Eye protection (goggles or face shield)

PPE Orders / Shortages

There is a leadership team led by SSRM to manage all issues related to PPE supplies and

shortages. Currently this team is meeting daily. Updates will be provided on the DHMF Safety

huddle as needed. For any issues related to PPE supplies/shortages, please click here for a

PowerPoint with contact and general information.

Surgical or Procedure Masks

MASK PROC WITH EARLOOP LAWSON # 291561

SURGICAL MASK (PATIENTS) LAWSON # 275942

Gown/Goggles/Face Shields

OVER-THE-HEAD PROTECTIVE PROCEDURE GOWN LAWSON # 128528

GLASSES EYE SHIELD LAWSON # 428341

FACE SHIELD LAWSON # 141140

N95 Masks

MASK N95 FLATFOLD REG LAWSON # 373559

MASK RESP N95 STD MD/LG LAWSON # 286443

MASK RESP N95 STD SM LF LAWSON # 452513

Single-Use Gloves (Exam Gloves)

GLOVE EXAM ICE NITR BLU XL LAWSON # 448848

GLOVE EXAM ICE NITR BLU XS LAWSON # 448845

GLOVE EXAM NITR PF W/FILM LG LAWSON # 448847

GLOVE EXAM NITR PF W/FILM MED LAWSON # 448846

GLOVE EXAM NITR PF W/FILM SM LAWSON # 448844

GLOVE EXAM NITR PF W/FILM XLG LAWSON # 448848

GLOVE EXAM NITR PF W/FILM XS LAWSON # 448845

Alcohol-Based Hand Sanitizer

SANITIZER ANTISEPTIC HAND 32OZ PUMP LAWSON # 233040

SANITIZER HAND W/PUMP 15OZ LAWSON # 190236

WIPE SANI-HAND ALC INDIV PACKET LAWSON # 266775

WIPE SANI-HAND ALC 6X7.5” (blue top) LAWSON # 264009

Disinfectant Cleaning

WIPE GERMICIDAL SANI-CLOTH AF3 (gray top) LAWSON # 337633

WIPE GERMICIDAL SANICLOTH SUPR (purple top) LAWSON # 318123

WIPE GERMICIDAL SANI-CLOTH AF3 XLG (gray top) LAWSON # 337745

WIPE SANI-CLOTH BLEACH LG (orange top) LAWSON # 327204

WIPE SANICLOTH DISINF HB LG (green top) LAWSON # 108895

WIPE SANICLOTH SUPER 7.5X15IN (purple top) LAWSON # 110272

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=317057f2-ec00-40c2-b847-e972db3be726

Coronavirus (COVID-19) – PPE and Supply



Revised 04/13/2020

Misc.

Box of disposable tissue (Kleenex) LAWSON # 339788

Single-use towels (paper towels) LAWSON # 169843

No-touch wastebasket order through Clinic Development

BAG LINER NATURAL TRASH 16MIC 40X48IN LAWSON # 111125

BAG LINER NATURAL TRASH 24X33IN LAWSON # 147917

BAG LINER NATURAL TRASH 33X40IN LAWSON # 142500

MOP HEAD WET LOOP BLU MD 1IN LAWSON # 435718

BUCKET MOP W/WRINGER 35QT YEL LAWSON # 400456

of 125

Coronavirus (COVID-19) – N95 Respirators and

Surgical Masks Clinical Support and Patient Safety Department


Revised 04/11/2020

Important Message: Utilizing Personal Protective Equipment (PPE) judiciously is critical in

ensuring constant protection of Health Care Personnel (HCP).

N95 Supplies: N95s provide a higher level of respiratory protection than standard masks.

However, the Centers for Disease Control and Prevention (CDC) considers N95s and standard

masks to be in the same risk category for exposure. If no N95 respirators are available, a

standard mask must be worn in addition to the other PPE. There continues to be reports that there

are Clinics with limited or no N95 respirators in stock. DHMF Leaders must immediately work

with supply chain to address and obtain N95 respirators.

When to Wear a N95 Respirator

HCP should wear a Surgical Mask in addition to the other PPE when entering the exam room or

interacting with at-risk patients and maintain a 6ft. separation from the patient as much as

possible. An N95 respirator is to be worn when collecting NP swabs for laboratory specimen

testing or during aerosol generating procedures (e.g. nebulizer treatment) of at-risk patients.

N95 Respirator Fit Testing

All Clinical Staff and Clinicians that utilize N95 respirators should be fit-tested upon hire and

annually thereafter. However, during this pandemic there is a suspension of annual fit testing.

Clinical Staff or Clinicians who are not sure if they have ever been fit-tested for an N95

respirator should address this with the DHMF Leader. If the DHMF Leader is not sure how to

obtain fit testing, DHMF Leader can reach out to DHMF Employee Health. Dignity Health has

a MyJourney training module titled “DH N-95 Mask Fit Training” for further guidance on

performing N95 respirator fit testing. DHMF has also created a Clinical Competency for

Occupation Health Clinics titled CC: Mask Fit Test - N95 Respirator (click here for document). Occupational Safety & Health Administration (OSHA) released a Temporary Enforcement

Guidance for Respirator Fit-Testing in Healthcare during COVID-19 Outbreak allowing the

suspension of fit-testing.

Wearing a N95 Respirator

HCP must follow DHMF procedures for putting on and the removal of PPE (including N95

respirators - click here for link to DHMF SOP – Personnel Protection Equipment (PPE)). It is

important to wear a N95 respirator correctly. Click here for information on putting a respirator

on including the seal check process. If HCP notice any difficulty breathing while wearing the

mask, HCP should leave the area where there is an at-risk patient; remove the mask following

the PPE removal process; and let the DHMF Leader know they are unable to wear the mask.

HCP Not Fit Tested for N95 Respirator

Due to the continued concerns with exposure risks, DHMF and the Medical Group Physician

leaders have determined that if there is a N95 respirator available, and the HCP has not been fit

tested, it is still preferable to wear the N95 respirator using the seal check process during these

heightened concerns with COVID-19.

of 125

mailto:[email protected]?subject=N-95%20Fit%20Testing

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=05f0e7b1-4a70-4afb-a3ee-0c7a6bf76e96

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=391debac-9d9f-4212-b1e1-f1a3d295c94a

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ce7e58d8-b995-4113-b6ac-7aa22932f60f

Coronavirus (COVID-19) – N95 Respirators and

Surgical Masks Clinical Support and Patient Safety Department


Revised 04/11/2020

N95 Respirator - Reuse N95 respirators are intended for single-use and if a Clinic has an adequate supply, N95

respirators are to be discarded after each use. If N95 respirators are limited in a Clinic, while

awaiting more inventory, the utilization of standard masks is required. If standard masks are not

available and limited availability of N95s are present, consider adopting the reuse guidelines for

N95s that CDC has provided (click here for a full summary of CDC guidelines). The guidelines

below are designed to provide practical advice so that N95 respirators are discarded before they

become a significant risk for contact transmission or the functionality is reduced. Below are

guidelines for the reuse:

See DH Conserve PPE Reuse Guide (click here).

N95 respirators are for single wearer, and must not be shared with other HCP.

N95 respirators contaminated with blood, respiratory or nasal secretions, or other bodily

fluids from patients are to be discarded in a waste container and not reused.

HCP to write initials on the bag and place in a designated storage unit for reuse.

of 125

https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=02936e13-94e0-4838-9dae-91245d8e83ca

Coronavirus (COVID-19) – Types of Masks Clinical Support and Patient Safety Department


Revised 05/15/2020

Surgical N95 Respirators

PPE for HCP and Clinicians to help protect from germs by

blocking out small and large airborne particles both inhaled

and expelled by wearer, plus masks are fluid resistant. Best

Practice PPE to be used during aerosol generating procedures.

*NIOSH and FDA approved as a surgical mask (noted on

front of mask with the words NIOSH and surgical mask).

Excludes any N95 with external valves on the front.

N95 Respirators

PPE for HCP and Clinicians to help protect from germs by

blocking out small and large airborne particles inhaled and

expelled by wearer.

*NIOSH approved (noted on front of mask with the word

NIOSH).

Excludes any N95 with external valves on the front.

KN95 (Only if approved by DHMF)

Must be approved by DHMF as many fraudulent companies

promoting KN95. Can be used as a Surgical Mask only.

Surgical Mask

PPE for HCP and Clinicians to help reduce large particles

inhaled and expelled by wearer into environment, plus masks

are fluid resistant.

Cloth Mask

Face coverings are recommended for everyone in the US by the

CDC, for use in public places. Not used as PPE. Cloth masks can

be sewn, cut, or fashioned from material, per the CDC. Reusable if

washed properly.

Dust / Industrial Masks

Face coverings are recommended for everyone in the US by the

CDC, for use in public places. Not used as PPE. Dust masks (also

known as industrial masks) are often purchased through hardware

stores, Amazon, etc. and are generally used for dust particles,

pollen, etc. This includes industrial N95 (not for use in

healthcare). *Not NIOSH approved (not noted on front of mask).

Patients, visitors, vendors should not wear industrial N95

masks with external valves on the front.

of 125

Coronavirus (COVID-19) – Masking Priority Clinical Support and Patient Safety Department


Revised 05/13/2020

Ensuring the safety of our patients, HCP, and Clinicians is DHMF’s top priority. As PPE begins

to become more readily available, it’s important to move out of conservation and back to best

practice for patients suspected or confirmed COVID-19. Below is the summary of masking

guidelines from first choice (best practice) to alternatives in the order of preference. This also

includes the choices for patients/visitors to ensure preservation of the needed PPE for HCP and

Clinicians.

HCP SICK

Direct Pt Care

HCP WELL

Direct Pt Care

HCP (Not direct

patient

care e.g. MOR)

PATIENTS /

VISITORS

Best

Practice SURGICAL N95

SURGICAL

MASK SURGICAL MASK

CLOTH MASKS (Do not use on persons

under the age of 2, or

those experiencing

respiratory issues)

USE

SECOND N95

EXPIRED N95 -

SURGICAL/NON-

SURGICAL

EXPIRED N95 -

SURGICAL/NON-

SURGICAL

DUST / INDUSTRIAL

MASK (Do not use if person is

experiencing respiratory

problems)

USE

THIRD

EXPIRED N95'S

THAT ARE

MODELS • 3M 1860

• 3M 1870

• 3M 8210

• 3M 9010

KN95 KN95

ALL OTHER

EXPIRED N95's (Do not use if person is

experiencing respiratory

problems)

USE

FOURTH SURGICAL MASK N/A CLOTH MASK SURGICAL MASK

of 125

Conserve PPE- Reuse Guide

Distributed by: Patient Safety National Office March 23, 2020

N95

Face Shield

Goggles

Setup1 2 3

4 5 6 7

8 9 10 11 12

12

13

13

14

14

15

8 9 10 11

Wipe both ear pieces.

Wipe table. Place goggles on clean table to dry.

Sanitize gloves.

Remove gloves.

Wash hands with soap and water.

Wipe front and back of lens.

Sanitize gloves.

Remove gloves.

Wash hands with soap and water.

Wipe elastic band.

Wipe foam band.

Wipe table. Place shield upside down to dry.

Wipe front and back of shield.

Sanitizegloves.

Remove N95, lower strap and then upper. Store mask in container or bag. If container used, disinfect container between use.

Sanitizegloves.

After gown and glove removal...

Remove eyewear and place on wipe.

Sanitize hands. Put on fresh gloves.

Place wipe on table.

or

Questions? Contact your local Infection Prevention Department DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly. of 125

Coronavirus (COVID-19) – N95 Respirator

Preparation for Reprocessing Clinical Support and Patient Safety Department


Revised 05/01/2020

In anticipation of having the ability to reprocess N95s, DHMF is implementing the following

process to store and hold specific N95s that can be reprocessed in the near future.

1) At this time, storing N95s should only occur at DHMF Sick/COVID Clinics.

2) N95s that can be reprocessed are ONLY those listed in the table below.

3) N95s to be reprocessed must be:

a. Clean (not dirty or stained)

b. No holes

c. No makeup

d. Ties intact

4) Each N95 must be stored as follows:

a. Place in paper bag

b. Label bag with person’s name

i. Reprocessed N95s must be worn by the same person upon return from

reprocessing

ii. Each person can put multiple N95s in the same bag with their name for

storing.

5) Store paper bags with N95s ready for reprocessing in a designated location in the Clinic.

6) If HCP or Clinicians were previously holding used N95s, and the N95 is not listed below,

or you have not documented the person’s name, please discard the N95 as it cannot be

reprocessed.

Mfg. Item Description Model #

3M MASK SURG PARTICULATE N95 REG 1860

3M MASK SURG PARTICULATE N95 SMX2 1860S

3M MASK SURG PARTICULATE N95 AURA 1870+

CARDINAL MASK N95 PARTICULATE FLTR REG USA-N95-R

CARDINAL MASK RESP N95 STD MD/LG N95A-ML

CARDINAL MASK N95 FLATFOLD SM USA-N95-S

CARDINAL MASK RESP N95 STD SM LF N95A-S

of 125

Distributed by: Patient Safety National Office on April 23, 2020

Personal Protective Equipment (PPE) Frequently Asked Question (FAQ) - For Internal Use Only

Current as of: April 24, 2020 DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly.

PPE General Questions 1. Who should wear an N95 respirator? ....................................................................... 3

2. What should be worn when collecting a nasopharyngeal swab for COVID-19

testing? ..................................................................................................................... 3

3. Are cloth isolation gowns an acceptable alternative to disposable isolation gowns? 3

4. Can I wear a homemade cloth mask? ...................................................................... 3

5. Can Healthcare Workers Wear PPE brought from home? ........................................ 3

6. Can an expired respirator be used? ......................................................................... 3

7. When can isolation precautions be discontinued? .................................................... 4

8. Can I wear PPE (i.e., goggles, gloves, or gown) in a non-clinical setting such as the

cafeteria? .................................................................................................................. 4

9. What PPE should be worn by environmental services (EVS) personnel who clean

and disinfect rooms of hospitalized patients with COVID-19? .................................. 4 10. How are we carefully managing our supply of PPE? ................................................ 5 11. What type of PPE should be worn when transporting a COVID-19 patient? ............ 5 12. Are two masks better than one? ............................................................................... 6 13. Are we implementing extended use and/or reuse for N95s? .................................... 6 14. Can PPE be reprocessed by disinfection or sterilization? ........................................ 6 15. Where do I go to find out more about employee health and human resources

questions? ................................................................................................................ 6 16. Can EVS immediately terminally clean an isolation room after a suspect or

confirmed COVID-19 patient has been discharged without waiting the allotted time

for air clearance? ...................................................................................................... 6 17. What is the difference between “blue plastic” and the more traditional yellow gowns

that are used for isolation/PPE? ............................................................................... 6

of 125

Pg. 2 of 9

Distributed by Patient Safety National Office on April 23, 2020

PPE Reprocessing

A. When will CommonSpirit begin reprocessing N95 masks? ...................................... 7 B. What will happen to the masks collected that were intended for Medline? ............... 7 C. Why is CommonSpirit pursuing reprocessing of surgical masks? ............................ 7 D. Can all masks from patients and employees be reprocessed? ................................ 7 E. How many times can a mask be reprocessed, and how will they be removed from

usage? ...................................................................................................................... 7 F. Will the reprocessed masks have an odor or smell? ................................................ 8 G. Are other options available for reprocessing N95 masks? ........................................ 8 H. What chemicals are used by ASP, Steris and Battelle? ............................................ 8 I. Is vaporous hydrogen peroxide safer than the Ethylene Oxide (EtO) that is used by

Medline? ................................................................................................................... 8 J. Is CommonSpirit considering gown reprocessing given the shortage? .................... 8 K. Medline reprocessing includes the use of Ethylene Oxide (EtO), a known

carcinogen. Does this process expose healthcare workers to EtO? ......................... 8 L. How does Medline guarantee that EtO is removed from the masks? ....................... 8 REFERENCES ................................................................................................................ 9

of 125

Pg. 3 of 9


1. Who should wear an N95 respirator?

When taking care of a suspect or confirmed COVID-19 patient that is undergoing an

aerosol generating procedure (e.g., intubation, extubation, sputum induction,

breathing treatment, open oral suctioning) all healthcare workers must wear an N95

respirator. 2. What should be worn when collecting a nasopharyngeal swab for COVID-19

testing?

The healthcare worker should wear an N95 respirator (or facemask if a respirator is

not available), eye protection, gloves, and a gown. 3. Are cloth isolation gowns an acceptable alternative to disposable isolation

gowns?

Yes, reusable (i.e., washable) isolation gowns are an acceptable alternative. Gowns

made of these fabrics can be safely laundered according to routine procedures and

reused. 4. Can I wear a homemade cloth mask?

Yes, however a homemade cloth mask is not medical grade PPE and should not be

worn while providing care for patients in isolation. Facility policy may allow cloth

masks outside of patient care areas or when a facemask is not required for isolation

precautions. Homemade cloth masks must be safely handled to avoid unintentional

exposure and transmission of infection. Safe handling includes:

Clean hands before removing or touching mask Cloth masks should be in clean condition and washed after each shift Remove cloth masks immediately if soiled or becomes wet Do not wear cloth mask under a standard/surgical mask

5. Can Healthcare Workers Wear PPE brought from home?

Yes, however respirators and other personal equipment brought from home are

considered non-medical grade and should be treated the same as homemade cloth

masks. Their use is dictated by facility policy and may not be used when caring for

patients in isolation.

6. Can an expired respirator be used?

Yes, the CDC/NIOSH believes that respirators should provide protection past their

manufacturer-designated shelf life. Recommendations for their use include

of 125

Pg. 4 of 9


precautionary measures that should be taken prior to donning such as visual

inspection, strap integrity and a seal check. Follow facility guidelines regarding the

use of expired N95 respirators. 7. When can isolation precautions be discontinued?

A. For Patients with Confirmed COVID-19:

In the hospital setting, negative test results are preferred when considering

discontinuation of isolation precautions for patients with confirmed COVID-19. This

includes:

Negative tests results from at least two specimens collected ≥24 hours apart

(total of two negative specimens) If testing is not readily available, facilities may use a non-test-based strategy

for discontinuation of transmission-based precautions or extend the period of

isolation on a case by case basis in consultation with local public health

authorities.

B. For Patients Suspected of Having COVID-19

The decision to discontinue isolation precautions relies on assessment by the

physician and one negative test for COVID-19.

8. Can I wear PPE (i.e., goggles, gloves, or gown) in a non-clinical setting such as the cafeteria?

No, under typical conditions, all used PPE should be removed prior to leaving the

patient room. If the supply of PPE becomes severely restricted, facilities may allow

for extended use of facemasks. Gloves, gown, and eye protection should not be

worn in a non-clinical setting. Care should be taken to avoid touching the outside

surface of the mask which may be contaminated. Removal of facemasks prior to

eating in any area should be done carefully and hand hygiene performed right after

removal.

9. What PPE should be worn by environmental services (EVS) personnel who clean and disinfect rooms of hospitalized patients with COVID-19?

Healthcare facilities should consider assigning daily cleaning and disinfection of

high-touch surfaces to nursing personnel who will already be in the room providing

care to the patient. If this responsibility is assigned to EVS personnel to clean the

room when the patient is there, they should wear the same recommended PPE

when in the room as would physicians and nurses.

of 125

Pg. 5 of 9


Upon patient discharge, entry into the room should be delayed until a sufficient time

has elapsed for enough air changes to remove potentially infectious particles (see

below). EVS personnel may enter the room and should wear a gown and gloves

when performing terminal cleaning. A facemask and eye protection should be added

if splashes or sprays during cleaning and disinfection activities are anticipated or

required based on the chemical they are using.

Air exchanges per hour

Time (mins.) required for removal 99%

efficiency

Time (mins.) required for removal 99.9%

efficiency 2 138 207 4 69 104

6+ 46 69 8 35 52

10+ 28 41 12+ 23 35 15+ 18 28 20 14 21 50 6 8

10. How are we carefully managing our supply of PPE?

This unprecedented public health crisis has stretched PPE supply chains like never

before. As a result, we are closely managing our PPE supply and working around

the clock to secure additional supplies. This includes ordering masks from other

countries, as well as accepting donations from other organizations and the

community. Please continue to be diligent and judicious in your use of PPE in order

to conserve supplies, and if you have questions about proper usage, please direct

them to your supervisor. 11. What type of PPE should be worn when transporting a COVID-19 patient?

Healthcare workers transporting patients that are suspect or known positive for

COVID-19 need to wear appropriate PPE (e.g., standard mask, gown, gloves, and

eye protection) if anticipating direct patient assistance may be needed upon

transferring the patient. 12. Are two masks better than one?

No, layering masks does not provide any additional protection and may cause self-contamination upon removal if handled inappropriately.

of 125

Pg. 6 of 9


13. Are we implementing extended use and/or reuse for N95s?

Yes, extended use and reuse guidelines have been established by the Centers for

Disease Control and Prevention (CDC). Implementing extended use and reuse is

based on multiple variables within the facility, please refer to your local facility

leadership to determine current protocol. 14. Can PPE be reprocessed by disinfection or sterilization?

Yes, CommonSpirit Health has been working with multiple vendors that are

achieving FDA approval in reprocessing N95 respirators, standards masks, and eye

protection. The health system is working to immediately launch these efforts to

increase PPE supply to all facilities. 15. Where do I go to find out more about employee health and human

resources questions?

Many staff members have raised questions regarding travel restrictions, paid time

off, working from home and other significant topics. These questions are addressed

in a frequently asked questions format and is constantly being updated. The

employee health and human resources can be found by clicking here. 16. Can Environmental Services (EVS) immediately terminally clean an

isolation room after a suspect or confirmed COVID-19 patient has been

discharged without waiting the allotted time for air clearance?

Yes, however all PPE must be worn (e.g., mask, face shield, gown, gloves) similar to daily room cleaning if EVS has taken on this task. 17. What is the difference between “blue plastic” and the more traditional

yellow gowns that are used for isolation/PPE?

Traditionally in CSH hospitals we have seen the traditional yellow gowns that are

used by doctors, nurses, environmental services (EVS) and others as PPE. With the

increased need for PPE supplies, CSH has been resourceful in ordering gowns,

often resorting in securing other options besides the yellow gowns. The “blue

plastic” gowns are also certified for medical PPE and can be used as isolation

gowns as well. Both are protective for COVID-19 positive patients and for cleaning

patient rooms.

of 125

https://cshhr.service-now.com/esc?id=kb_article&sys_id=87336c90db3fc810d8ad4408059619d0&spa=1

Pg. 7 of 9


PPE Reprocessing Frequently Asked Question (FAQ) - For Internal Use Only

A. When will CommonSpirit begin reprocessing N95 masks?

CommonSpirit hospitals can begin reprocessing N95s now if they have an ASP and/or Steris unit within their Sterilization Processing Department. Only non-cellulose N95s can be decontaminated. Instructions have been provided to hospitals. The previous mask reprocessing program with Medline will no longer be considered an option. Additionally, CommonSpirit finalized a contract with Battelle for third party N95 reprocessing by utilizing vaporous hydrogen peroxide.

B. What will happen to the masks collected that were intended for Medline

reprocessing?

The masks will be sent to Medline for reprocessing using EtO and donated as dust

masks to first responders. They will be not designated as N95 masks.

C. Why is CommonSpirit pursuing reprocessing of surgical masks?

CommonSpirit Health is pursuing all channels for securing PPE for healthcare

workers. Given the national concerns for adequate PPE, CommonSpirit is partnering

with vendors to reprocess whenever possible. At this time hospitals at CommonSpirit

Health have options. If a hospital has an ASP and/or Steris unit on site, they are able

to reprocess non-cellulose N95s. CommonSpirit Health is also pursuing other

options for reprocessing PPE. Additional information will be shared as it is available.

D. Can all masks from patients and employees be reprocessed?

No, only masks that are used by employees can be reprocessed. If a mask has

makeup, lipstick or other visible blemishes the mask will be rejected. Likewise, any

mask with a hole, tear, torn strap or other damage will be rejected.

E. How many times can a mask be reprocessed, and how will they be removed

from usage?

The FDA emergency use authorization specifies the number of reprocessing cycles

allowed per vendor. Steris is approved for 10 cycles, whereas ASP is for two and

Battelle for 20. A marking will be established on the mask to determine the current

cycle number. Masks should be disposed of regardless of cycle number if they do

not fit properly (does not pass seal check) or if any physical damage is seen.

of 125

Pg. 8 of 9


F. Will the reprocessed masks have an odor or smell?

No, the tie masks and ear loops won’t have a smell. The respirators maintain the

original smell (similar to rubber). G. Are other options available for reprocessing N95 masks?

In addition to internal ASP and/or Steris reprocessing, CommonSpirit finalized a

contract with Battelle, an outside vendor, to reprocess non-cellulose N95 masks.

Consult with your local leadership to determine current reprocessing methods

utilized

H. What chemicals are used by ASP, Steris and Battelle?

Both companies use vaporous hydrogen peroxide in their decontamination process. I. Is vaporous hydrogen peroxide safer than the Ethylene Oxide (EtO) that is

used by Medline?

No, it is also a substance that is known a carcinogen, similar to EtO. However, each

company – Medline, Battelle, ASP and Steris – takes additional measures to remove

the chemical agent from the masks once they are decontaminated. J. Is CommonSpirit considering gown reprocessing given the shortage?

Yes, due to the ongoing demand for PPE, CommonSpirit is looking to ensure

constant availability of gowns by procuring new product and identifying options for

reprocessing as a last resort. This includes reprocessing of gowns via Medline using

EtO. Any reprocessing of PPE is considered as a last resort with a primary focus on

procuring new PPE.

K. Medline reprocessing includes the use of Ethylene Oxide (EtO), a known

carcinogen. Does this process expose healthcare workers to EtO?

The use of EtO has been a standard for sterilization in the industry, as over half of all

sterile devices in industry are sterilized via EtO. L. How does Medline guarantee that EtO is removed from the reprocessed

gowns?

Medline is able to remove the EtO from products through an aeration process that

takes place after reprocessing. This process is, at a minimum, a 9-hour long “air

wash” cycle which takes place in large, industrial sized chambers. The chamber

of 125

Pg. 9 of 9


size and length of the aeration process is what allows the successful removal of EtO

compared to the smaller EtO cabinets/modules with much shorter cycles that are

commonly used in hospitals.

References

Collection of Diagnostic Respiratory Specimens:

https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html#collection Strategies for Optimizing Supply of Gowns:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html A cluster randomized trial of cloth masks compared with medical masks in

healthcare workers. MacIntyre, C.R., et al. (2015). BMJ Open. Retrieved from:

https://bmjopen.bmj.com/content/bmjopen/5/4/e006577.full.pdf Release of Stockpiled N95 Filtering FacePiece Respirators Beyond the

Manufactured-Designated Shelf-Life: https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html Discontinuation of Transmission-Based Precautions and Disposition of Patients

with COVID-19 in Healthcare Settings (Interim Guidance):

https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html

of 125

https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html#collection

https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html#collection

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html

https://bmjopen.bmj.com/content/bmjopen/5/4/e006577.full.pdf

https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html

https://www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html



CS 315838-C 03/23/2020

cdc.gov/COVID19

COVID-19 Personal Protective Equipment (PPE) for Healthcare Personnel

Acceptable Alternative PPE – Use FacemaskPreferred PPE – Use N95 or Higher Respirator

N95 or higher respiratorWhen respirators are not available, use the best available alternative, like a facemask.

FacemaskN95 or higher respirators are preferred but facemasks are an acceptable alternative.

Isolation gownIsolation gown

One pair of clean, non-sterile gloves

One pair of clean, non-sterile gloves

Face shieldor goggles

Face shieldor goggles

of 125

Preventing Skin Injury with N95 Mask Use During COVID-19

1

Lauren Bulin RN, MBA System VP, Clinical Excellence and Nursing Operations

of 125

2

WHY is this occurring?

1. Prolonged duration and frequency of use is unprecedented

2. Skin exposed to friction, pressure and moisture

3. Experiencing redness, itching, burning, rash and maceration in areas over the bridge of the nose, cheeks, forehead and ears

THE PROBLEM

of 125

3

THE SOLUTION Minimizing moisture and friction

1. Maintain clean and dry face. Limit the use of facial cosmetics on the forehead, cheeks, nose and chin.

2. Replace mask, if moist, wet or soiled.

3. Consider removing mask for periods of time (15 minutes every 2 hours), when outside of patient contact. Adhere to facility doffing practices.

4. Apply skin liquid sealants/protectants to intact or broken skin.

5. Avoid products containing petroleum, mineral oil or lubricants, which could cause mask slippage and misplacement. Allow to dry fully before applying the mask.

Preventing Skin Injury from Prolonged N95 Mask Use during COVID-19

THE PROBLEM

During the COVID-19 pandemic, healthcare workers are experiencing skin injury related to friction, pressure and moisture from the prolonged use of N95 masks and other personal protection equipment (PPE), including face shields and goggles. Skin injuries have been described as redness, itching, burning, rash and maceration in areas over the bridge of the nose, cheeks, forehead and ears. In the absence of strong research-supported studies, clinicians should consider the following skin injury prevention and management strategies as outlined by the National Pressure Injury Advisory Panel (NPIAP) and other professional bodies (e.g., CDC, NIOSH), including CHI/Dignity Health Wound Care Leaders.

THE SOLUTION

Minimize skin injury from moisture and friction o Maintain good skin care practices, keeping the face clean and dry.

o Limit the use of facial cosmetics on the forehead, cheeks, nose and chin.

o Replace mask, if moist, wet or soiled. o Consider removing mask for a period of time throughout the shift to relieve pressure (optimal 15

minutes every 2 hours), when outside of patient contact. Ensure doffing practices adhere to facility practices.

o Apply skin liquid sealants on intact or broken skin (i.e., 3M Cavilon™ Advanced Skin Protectant, 3M Cavilon™ No Sting Barrier Film, S&N No-Sting Skin Prep, Medline Marathon® No Sting or Medline Sureprep® No-Sting Skin Prep). When applying products, avoid close contact with eyes and mucous membranes (lips and inside of nose).

o Apply protectant products containing dimethicone on intact or broken skin (i.e., Medline Remedy® Skin Repair Cream). Avoid skin protectant products containing petroleum, mineral oil or lubricants, which could cause mask slippage and misplacement.

o Allow skin sealants/protectants to dry fully before applying the mask.

Minimize skin injury from duration and intensity of pressure o Use a thin prophylactic dressing cut into strips for the nasal bridge, cheek bones and behind

ears (i.e., duoderm, hydrocolloid dressings).

o Avoid “stacking” multiple dressings, which could increase pressure.

o Use foam dressings with a non-permeable outer layer. Porous dressings may allow transfer of fluids or microorganisms to the skin.

o Following the application of any prophylactic dressing, confirm the seal of the N95 mask by blowing out and checking for leaks.

o Treat all dressings as potentially contaminated. Perform hand hygiene and don clean gloves prior to removal. Take care not to contaminate eyes, nose, or mouth.

NOTE: It is the responsibility of each healthcare worker to consult with Infection Prevention and/or Employee

Health at their facility before taking measures to prevent or manage PPE-related skin injury. Caution must be

taken to ensure that any efforts implemented do not alter

of 125

4

THE SOLUTION Minimizing skin injury from duration and intensity of pressure

1. Use a thin prophylactic dressing cut into strips for the nasal bridge, cheek bones and behind ears (i.e., duoderm, hydrocolloid dressings).

2. Avoid “stacking” multiple dressings, which could increase pressure.

3. Use foam dressings with a non-permeable outer layer. Porous dressings may allow transfer of fluids or microorganisms to the skin.

4. Following the application of any prophylactic dressing, confirm the seal of the N95 mask by blowing out and checking for leaks.

5. Treat all dressings as potentially contaminated. Perform hand hygiene and don clean gloves prior to removal. Take care not to contaminate eyes, nose, or mouth.

of 125

5

NOTE: It is the responsibility of each healthcare worker to consult with

Infection Prevention and/or Employee Health at their facility before

taking measures to prevent or manage PPE-related skin injury.

Caution must be taken to ensure that any efforts implemented do not

alter the efficacy of the fit-tested N95 mask and comply with the facility

policy and procedure

THE SOLUTION

of 125

NPIAP INFOGRAPHIC

6

https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/NPIAP_-_Mask_Injury_Infograp.pdf

tps://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/NPIAP_-_Mask_Injury_Infograp.pdfhttps://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/NPIAP_-_Mask_Injury_Infograp.pdfchttps://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/NPIAP_-_Mask_Injury_Infograp.pdfdn.ymaws.com/npiap.com/resource/resmgr/position_statements/NPIAP_-_Mask_Injury_Infograp.pdf

of 125





Resources

7

Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.

(2010). How to properly put on and take off a disposable respirator. Retrieved from

https://www.cdc.gov/niosh/docs/2010-133/pdfs/2010-133.pdf

Centers for Disease Control and Prevention and National Institute for Occupational Safety and Health.

(2020). Understanding the difference: Surgical mask and N95 respirator. Retrieved from

https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf.

National Pressure Injury Association Panel. (2020, April 02). NPIAP position statements on preventing injury with N95 masks. Retrieved from https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdf

U.S. Department of Labor, Occupational Safety and Health Administration. (2020). COVID-19. Retrieved from https://www.osha.gov/SLTC/covid-19/

of 125







https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf



https://cdn.ymaws.com/npiap.com/resource/resmgr/position_statements/Mask_Position_Paper_FINAL_fo.pdf



https://www.osha.gov/SLTC/covid-19/



Questions? [email protected]

8 of 125


Coronavirus (COVID-19) – Donated Personal

Protective Equipment (PPE) Evaluation Supply & Service Resource Management Department


Revised 04/13/2020

Background

During the COVID-19 pandemic, many of you are receiving Personal Protective Equipment

(PPE) from donations. In order to ensure Health Care Personnel (HCP), Clinician and patient

safety, all donated PPE must be evaluated and approved prior to implementation into the supply

chain and subsequent utilization.

Usage Consideration

To assist Clinics in evaluating donated PPE for usage a checklist (click here) has been created. A

copy of the checklist must be completed and emailed to [email protected] prior

to initiating use of the donated PPE.

Do Not Use

Safety is our number one priority and the following donated items must NOT be used under any

circumstances:

• Products that do not include labeling indicating the PPE is safe to use for infection

prevention or reduction, or sufficiently reduces the risk of liquid/body/hazardous fluids.

• Products in boxes that have been opened, shuffled through, or torn.

• Products that are dirty or stained.

• Products that contain any odor such as diesel fuel or paint.

• Products that do not look like an N95 respirator or surgical mask.

If it is determined donated supplies may not be utilized, dispose of supplies and notify Ranae

Forbes at [email protected] of what is being discarded and why.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=9d5a5c94-dd9b-4515-8c9e-30c1cd7459b4



Coronavirus (COVID-19) – Donated PPE Checklist Supply & Service Resource Management Department


Revised 04/14/2020

Clinic Name and Address:

Supply Name/Type Inspected:

Total Number of Supplies:

Supplies Inspected By:

Date of Inspection:

PLEASE COMPLETE THIS CHECKLIST PRIOR TO PLACING ANY DONATED SUPPLY INTO

USE. KEEP ONE COPY OF COMPLETED FORM IN DHMF LEADER OFFICE AND ATTACH ONE

COPY TO SUPPLY WHEN DETERMINED OKAY TO USE.

SEND AN EMAIL COPY OF THE CHECKLIST TO: [email protected]

During the COVID-19 pandemic, many of you are receiving Personal Protective Equipment (PPE) from

donations. In order to ensure Health Care Personnel (HCP), Clinician and patient safety, please utilize the below

checklist to BEFORE using any donated PPE.

General PPE

Requirements:

Yes No Comments:

Face Protection

1. Is the manufacturer a

recognized supplier?

Examples include:

3M Foss Performance Moldex-Metric

Alpha Pro Tech Gerson Precept Med.

AMMEX GSK Prestige Amer

Cardinal Health Honeywell Protective Ind

CVS Kimberly-Clark Pyramex Safety

Dentec Livingstone Safety Zone

Dynarex Magid Sperian

Emerald Makrite

First Aid Direct Medline

Write name of manufacturer:

_______________________________

If no, please contact Ranae Forbes at

[email protected] or cell (916) 947-4092 for

further assistance. Do not use until approval is received.

2. Is this product identified

as “Healthcare” and NOT

labeled for industrial or

commercial use?




of 125




Coronavirus (COVID-19) – Donated PPE Checklist Supply & Service Resource Management Department


Revised 04/14/2020

3. Does the product have an

expiration date?

Expiration Date: __________________

Masks only started receiving expiration dates 3 years ago.

If no, please see question 3a.

3a. The CDC has indicated

that some masks are ok to

use after expiration. If

expired, is your mask one of

these products?

3M 1860

3M 1870

3M 8210

3M 9010

3M 8000

Gerson 1730

Medline/Alpha Pro Tech NON27501

Moldex 1512

Moldex 2201

If yes, follow CDC guidelines and use as appropriate.




If product not appropriate, please dispose and send a copy of the disposed report to Ranae

Forbes.

Disposed by:

If approved, approved by:

Any special instructions:

(disinfect before use, etc.)

of 125


Coronavirus (COVID-19) – Requests for

COVID-19 Testing Clinical Support and Patient Safety Department


Revised 04/10/2020

Overview

COVID-19 diagnostic testing, authorized by the Food and Drug Administration under an

Emergency Use Authorization (EUA), is becoming available in clinical laboratories. This

additional testing capacity will allow Clinicians to consider ordering COVID-19 testing for a

wider group of symptomatic patients. Several commercial laboratories will be able to provide

COVID-19 testing on specimen samples submitted from Clinicians, including Quest and

LabCorp.

CDC Guidelines

CDC has published guidelines for testing. Click here for the full summary. The CDC guidelines

are for symptomatic patients. At this time, there is not a recommendation from the CDC to test

asymptomatic people.

Clinician Guidelines for COVID-19 Testing

Clinicians should use their judgment to determine if a patient has signs and symptoms

compatible with COVID-19 and whether the patient should be tested. Most patients with

confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g.,

cough, difficulty breathing). Priorities for testing include:

PRIORITY 1

Ensure optimal care options for all hospitalized patients, lessen the risk of nosocomial

infections, and maintain the integrity of the healthcare system

Hospitalized patients

Symptomatic healthcare workers

PRIORITY 2

Ensure that those who are at highest risk of complication of infection are rapidly identified

and appropriately triaged

Patients in long-term care facilities with symptoms

Patients 65 years of age and older with symptoms

Patients with underlying conditions with symptoms

First responders with symptoms

PRIORITY 3

As resources allow, test individuals in the surrounding community of rapidly increasing

hospital cases to decrease community spread, and ensure health of essential workers

Critical infrastructure workers with symptoms

of 125

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html




Revised 04/10/2020

Individuals who do not meet any of the above categories with symptoms

Health care workers and first responders

Individuals with mild symptoms in communities experiencing high COVID-19

hospitalizations

NON-PRIORITY

Individuals without symptoms

There are epidemiologic factors that may also help guide decisions about COVID-19 testing.

Documented COVID-19 infections in a jurisdiction and known community transmission may

contribute to an epidemiologic risk assessment to inform testing decisions. Clinicians are

strongly encouraged to test for other causes of respiratory illness (e.g., influenza). If the

Clinician feels the patient qualifies for COVID-19 swab testing, a POCT for Rapid Influenza is

recommended to rule out a differential diagnosis (a POCT Strep-A/RSV if indicated). The

patient would then be sent home to self-isolate pending results.

Mildly ill patients should be encouraged to stay home and contact their Clinician by phone for

guidance about clinical management. Patients who have severe symptoms, such as difficulty

breathing, should seek care immediately. Older patients and individuals who have underlying

medical conditions or are immunocompromised should contact their physician early in the course

of even mild illness.

DHMF Procedures for COVID-19 Testing

Any patient calling requesting a COVID-19 test, should be screened using the DHMF Telephone

Screening – Initial Algorithm.

o Following the algorithm and if patient meets criteria (red box), note that the patient is

requesting COVID-19 testing when sending the urgent message to the Clinical Team.

o If the patient does not meet criteria (teal box), do not schedule an appointment.

Inform the patient that you will send a message to their Clinician informing the

Clinician that the patient is asymptomatic but is requesting a COVID-19 test. Inform

the patient that the Clinician will follow-up with them directly to discuss testing.

o Clinician to confirm with Health Care Personnel (HCP) on whether to schedule an

appointment for specimen collection.

Since test specimens need to be collected by Licensed Clinical Staff (LVN or RN) or a Clinician

(MD, DO, NP, PA), patients will need to come to the Clinic to provide the specimen sample (See

attached for Quest Laboratory Testing Instructions for specimen collection).

DHMF Specimen Collection Options

It’s imperative to minimize exposure to HCP and Clinicians, as well as other people in the

waiting room. Therefore, several options for specimen collection is noted below, which can be

operationalized by the Clinic depending on the Clinics unique circumstances.

of 125




Revised 04/10/2020

Option 1: COVID-19 Specimen Collection Station

If the Clinician determines the patient is deemed a good candidate for testing without the

need for a clinical visit (e.g. no specific need for medical treatment—no wheezing, SOB,

sore throat suggesting strep, etc.), HCP will schedule a nurse-only appointment, and

advise patient to come to the Specimen Collection Station (provide directions).

HCP will instruct the patient to wear a mask to the appointment, use hand sanitizer upon

arrival; go directly to the station and do not stop at any other locations (e.g. restroom,

café, etc.); and anyone accompanying the patient must not be sick.

Clinician will enter the COVID-19 order (or MA can propose the order for Clinician to

approve) prior to the appointment.

Testing station will be set up outside the Clinic if possible, or in the lobby as layout may

dictate.

Station will include a table/chair for HCP (e.g. Licensed Nurse, Clinician (if no licensed

nurse) and any needed support staff (e.g. MOR or MA).

Table will have adequate supplies of Surgical Masks, hand sanitizer, and testing supplies.

Consider a pop-up canopy test overhead.

HCP to have appropriate PPE (N95 respirator and gown, face shield, gloves; respirator

changed between patients).

o HCP to wear N95 respirator, face shield, gown and gloves for performing

specimen collection. Change gloves and perform hand hygiene with alcohol hand

sanitizer between patients. The same N95 respirator, face shield and gown can

continue to be worn between for a continuous time. If any PPE becomes visibly

contaminated it needs to be changed between patients.

Patients to present at station for their nurse only-visit.

Licensed Nurse (LVN or RN) or Clinician to collect specimen (NP and OP swab).

Specimen to be immediately labeled, and placed in refrigeration to transport to laboratory

(e.g. Quest, LabCorp, CDPHL) by Medical Assistant.

Patient provided with DH Patient Education – “What to do if you are sick with

Coronavirus” (click here) which provides information regarding self-isolation at home

until test results are confirmed, and then to continue if test is positive until fever free for

24 to 48 hours.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ec128afe-0073-47d3-b5e7-ec1eb1cbc574




Revised 04/10/2020

Option 2: Clinician Appointment

If the Clinician determines the patient needs to have an appointment with the Clinician,

the Clinician will notify HCP to schedule appointment.

Each Clinic determines their process on how to check in at-risk patients using the

Scheduled Patient Check-In Guidelines. Follow the instructions based on the method

used by the Clinic.

HCP and/or Clinicians are to have appropriate PPE as defined Ambulatory Algorithm.

Clinician collects NP/OP specimen—gives to MA to process.

Patient provided with DH Patient Education – “What to do if you are sick with

Coronavirus” (click here) which provides information regarding self-isolation at home

until test results are confirmed, and then to continue if test is positive until fever free for

24 to 48 hours.

Option 3: Outside Building Collection

Licensed Nurse (LVN or RN) or Clinician may collect specimens in patient’s car by

following the guidelines outlined in the DHMF Scheduled Appointment Check-In

Guidelines (see section on Outside Building Triage and Assessment), but adapt the

guidelines for the specimen collection only (e.g. no need to bring thermometer for

example).

o Schedule a nurse only visit.

o Follow guidelines for outside building appointments

o Bring a copy of the DH Patient Education – “What to do if you are sick with

Coronavirus” (click here) and provide to the patient. This document provides

information regarding self-isolation at home until test results are confirmed,

and then to continue if test is positive until fever free for 24 to 48 hours.

If there is a high volume/back to back appointments for specimen collection, Clinic

Leader and Clinicians could consider signage or a “drive-by” line where an area is

identified as a “line” of cars where specimen collections are completed based on the line

of cars (following all other stated guidelines).

of 125



Coronavirus (COVID-19) – Quest Laboratory

Testing Instructions Clinical Support and Patient Safety Department


Revised 04/13/2020

Note: See DHMF Requests for COVID-19 Testing for information on who should be tested and

current information on laboratory requirements as defined by CDC and CDPH.

The only test for COVID-19 is 39444 for both Nasopharyngeal and Oropharyngeal Specimens.

Test Code

39444 – SARS-CoV-2

Specimen Collection

1) Nasopharyngeal (NP) Swab (preferred specimen collection)

Must be collected by Licensed Nurse (LVN or RN) or Clinician

VCM transport tube green cap (refrigerated)

Supply item #S05

OR

2) Oropharyngeal (OP) Swab

May be collected by Licensed Nurse (LVN or RN) or Clinician

VCM transport tube green cap (refrigerated)

Supply item #S06

Note: If Quest VCM #S05 or #S06 transport tubes are unavailable, specimens may be

sent to Quest in Red top viral collection tubes Lawson # 298226.

Specimen Labeling and Storage

Ensure sample labeled with patient’s full name and date of birth (DOB)

Please order 39444 on a separate requisition from any other testing and place it and the

sample in a separate bag from other non COVID-19 specimens.

All specimens COVID-19 and others can be stored in the same refrigerator.

Lab specimens may NOT be stored in a medication refrigerator.

Strict refrigeration – please refrigerate after collection and put in a refrigerated thermal

pouch when placing in the lockbox for the Quest courier to pick-up; or follow other

processes for other commercial laboratories.

Frozen specimens are preferred, but refrigerated specimens are acceptable.

*IMPORTANT* Samples received at ambient temperatures will not be tested.

Quest Laboratory Links:

Fact Sheet for Healthcare Providers

Fact Sheet for Patients

of 125

https://emergency.cdc.gov/han/2020/han00429.asp?deliveryName=USCDC_511-DM22015

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CDPH+Laboratory+Submission+Guidance+-+COVID-19.pdf

https://www.questdiagnostics.com/dms/Documents/covid-19/SARSCoV-2_HCP_Fact_Sheet.pdf

https://www.questdiagnostics.com/dms/Documents/covid-19/SARSCoV-2_Patient_Fact_Sheet.pdf

Coronavirus (COVID-19) – LabCorp Testing



Revised 03/17/2020

Note: See DHMF Requests for COVID-19 Testing for information on who should be tested and

current information on laboratory requirements as defined by CDC and CDPH.

Special Instructions from LabCorp (3/13/2020)

The LabCorp 2019 Novel Coronavirus COVID-19, NAA [139900]. LabCorp does not currently

collect specimens for this test. Patients for whom testing has been ordered should not be sent to a

LabCorp location to have a specimen collected. Instead, an appropriate specimen should be

collected at the health care facility where the patient was seen and the test was ordered. The

specimen should be sent to LabCorp using standard procedures.

Test Code

139900 – SARS-CoV-2

Specimen Collection (click here for LabCorp guidelines)

1) Nasopharyngeal (NP) Swab (preferred specimen collection)

Must be collected by Licensed Nurse (LVN or RN) or Clinician

VCM transport tube purple cap (refrigerated)

Supply item #93307 use swab within kit, #24674 do not use the swabs in this kit,

this is for transport only.

OR

2) Oropharyngeal (OP) Swab

May be collected by Licensed Nurse (LVN or RN) or Clinician

VCM transport tube purple cap (refrigerated)

Supply order #24674, only use one swab.

Specimen Labeling and Storage

Label sample and place in a LabCorp biohazard bag.

Ensure sample labeled with patient’s full name and date of birth (DOB), complete

address, phone number and diagnosis code.

Please order 139900 on a separate requisition from any other testing and place it and the

sample in a separate bag from other non COVID-19 specimens.

All specimens COVID-19 and others can be stored in the same refrigerator.

Lab specimens may NOT be stored in a medication refrigerator.

Strict refrigeration – please freeze after collection and follow vendor standard pick-up

process.

of 125

https://emergency.cdc.gov/han/2020/han00429.asp?deliveryName=USCDC_511-DM22015

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/CDPH+Laboratory+Submission+Guidance+-+COVID-19.pdf

https://files.labcorp.com/labcorp-d8/2020-03/22799%20COVID-19%20%28NP%20%26%20OP%29%20Specimen%20Collection%20Instructions%203-17_FINAL.pdf

Coronavirus (COVID-19) – LabCorp Testing



Revised 03/17/2020

Ship frozen at -°20C (preferred); refrigerated specimens acceptable (if received for

testing within 72 hours of collection); room temperature swabs acceptable (if received

with 24 hours of collection).

*IMPORTANT* Samples received at ambient temperatures will not be tested.

LabCorp Links:

LabCorp Launches Test for Coronavirus Disease 2019 (COVID-19)

LabCorp Letter to Health Care Clients

Q&A – 2019 Novel Coronavirus (COVID-19), NAA

Specimen Collection/Shipping Instructions for – 2019 Novel Coronavirus (COVID-19), NAA

Test Menu 139900 – 2019 Novel Coronavirus (COVID-19), NAA

of 125

https://files.labcorp.com/labcorp-d8/2020-03/FINAL_03_05_20-LabCorp%20Launches%20Test%20for%20Coronavirus%20Disease%202019%20%28COVID-19%29.pdf

https://files.labcorp.com/labcorp-d8/2020-03/22842_COVID-19%20client%20letter_FINAL.pdf

https://files.labcorp.com/labcorp-d8/2020-03/LabCorp_Coronavirus_%28COVID-19%29_Q%26A_March_10_2020.pdf

https://files.labcorp.com/labcorp-d8/2020-03/22799%20COVID-19%20%28NP%20%26%20OP%29%20Specimen%20Collection%20Instructions%203-17_FINAL.pdf

https://www.labcorp.com/tests/139900/2019-novel-coronavirus-covid-19-naa

Coronavirus (COVID-19) – Swab Sampling

Process Clinical Support and Patient Safety Department


Revised 03/18/2020

Nasopharyngeal Swab Sampling (NP) (preferred specimen collection):

• Must be collected by Licensed Nurse (LVN or RN) or Clinician. • All appropriate Personal Protective Equipment (PPE) must be worn.

• Ask the patient to blow their nose before the sampling if possible.

• The Joint Commission video on Nasopharyngeal Swab is available here.

• See DHMF SOP – S.3.20.030 CC: Nasopharyngeal Swab Specimen Collection.

Children Small children may sit on the lap of the parent or assisting Clinical Staff. The assisting Parent or Clinical Staff should brace the child around the shoulders and arms with one arm, and use the other arm to hold the child’s head slightly tilted backwards. If necessary the child’s legs may be placed between the assisting Parent or Clinical Staff legs. The sampling depth should be at least 4-8 cm.

Adults

Adults should be positioned so that it is not possible to pull back the head while sampling. The head

should be tilted backwards. The head may be held still by holding the chin, forehead or supporting it

from the back of the head. The sampling depth should be at least 8-12 cm.

Oropharyngeal Swab Sampling (OP): • Must be collected by Licensed Nurse (LVN or RN) or Clinician. • All appropriate PPE must be worn. • Drinking and eating should be avoided for at least one (1) hour prior to sample collection. • Press tongue down with a tongue depressor. • Roll the swab on the tonsils and the posterior wall of the oropharynx with enough pressure to

dislodge cells from the mucosal surface. • Ensure that the sample is not contaminated by the normal flora of the mouth by avoiding

contact with other surfaces, such as the tongue and cheeks.

of 125

https://www.youtube.com/watch?v=hXohAo1d6tk

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=d4b75612-f8ab-4bb6-adf8-b3dd6eedb3e0

CommonSpirit Health

COVID-19 Antibody Testing Guidelines

May 1, 2020

Fundamentally there are two testing types for COVID-19. Molecular tests utilize polymerase chain

reaction (PCR) techniques to detect the genetic material of the COVID-19 virus. These tests are useful for

diagnosing active infection (when positive) and the resolution of the infection (when negative). In

contrast, antibody (AB) tests use different techniques to detect the presence of antibodies that the immune

system has developed in response to the infection and persist after the infection has cleared. This type of

test is often used to determine the extent or spread of a disease in a community.

Numerous clinical laboratories across the country now offer and promote COVID-19 AB tests. The

appropriate role of AB testing is controversial. Some companies and media reports suggest AB testing

could be used for a variety of clinical and workplace purposes. However, experts in the fields of

infectious diseases and clinical laboratory medicine believe COVID-19 AB testing currently has a very

limited role.

These specialists note the accuracy and reliability of AB tests vary by different companies. Furthermore,

there is as yet, an undiscovered understanding of whether or not the presence of antibodies confer

immunity and protect from re-infection. The timing of when antibodies form (if at all) in people also

varies and the duration of the presence of antibodies is unknown.

These issues raise important questions—what is the appropriate role of COVID-19 AB testing, and should

CommonSpirit provide in-house testing?

Recently, an esteemed panel of infectious diseases and laboratory medicine physicians from across

CommonSpirit Health discussed these issues and reached consensus. In brief, they concluded that because

of the potential for testing inaccuracies and the unknown level of protection of antibodies, COVID-19 AB

tests should not be used to make decisions regarding diagnosis, return-to-work following infection or use

of personal protective equipment (PPE). Moreover, COVID-19 AB tests should not be used to stratify and

deploy employees to specific COVID-19 (cohort) units. These positions are congruent with

recommendations from the Infectious Diseases Society of America (IDSA).1

The attached Frequently Asked Questions (FAQs) provides additional, specific information.

Prepared by:

Robert Wiebe, MD, Chief Medical Officer

Heather Miller, MBA, Director, Physician Engagement

May 1, 2020

Are COVID-19 antibody (AB) tests FDA-approved?

1 https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf

of 125

https://www.idsociety.org/globalassets/idsa/public-health/covid-19/idsa-covid-19-antibody-testing-primer.pdf

FREQUENTLY ASKED QUESTIONS

The Food and Drug Administration (FDA) has used its Emergency Use Authorization (EUA) process to

make several AB tests available to the public. Through this pathway, the FDA holds that the test is

reliable and accurate, however, the traditional vigorous FDA approval process has not been enforced. AB

tests by Ortho, Cellex, Chembio, Mount Sinai, Autobio and DiaSorin are now available. FDA publishes a

current list at https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-

use-authorizations#covid19ivd.

How accurate are the AB tests?

To be accurate, the test must recognize antibodies specific to the virus responsible for COVID-19,

without reacting to similar antibodies that people may carry if they have been infected by related

coronaviruses. Scientists assess the accuracy of diagnostic tests in two ways. Sensitivity is the ability of a

test to correctly identify those with the disease (true positive rate), whereas specificity is the ability of the

test to correctly identify those without the disease (true negative rate). There are varying degrees of

specificity and sensitivity among the tests. Although reputable manufactures may claim their own product

accuracy, none of these tests, even those with EUAs, have had their accuracy evaluated by the FDA.

Should AB tests be used to diagnose/detect active infection?

No. Because antibodies may not be produced in early infection, and some patients may not develop a

detectable response due to underlying immune conditions, the presence of antibodies should not be used

to indicate active infection. Molecular/polymerase chain reaction (PCR) testing is the preferred method of

testing for COVID-19 as it measures presence of viral genetic material (i.e., antigen) rather than the

body’s immune response (i.e., antibodies).

Does the presence of ABs indicate immunity to COVID-19?

It is not clear. Based on studies of other viruses, the presence of antibodies suggests some level of

immunity exists, but definitive studies for COVID-19 are pending. Also unknown is the level of antibody

(titer) required for any immunity, and how long the suspected immunity lasts.

Should we use the AB test to make return-to-work decisions?

No. Since the degree and duration of immunity conferred by antibodies are unknown, AB tests should not

be used for return-to-work decisions. There are suggestions that people might still shed virus and be

contagious despite the presence of antibodies. Likewise, there are false positive and false negative results

associated with the AB tests that limit their usefulness.

What should the AB test be used for?

Currently, the major role of AB testing is for epidemiologic studies to determine the prevalence or spread

of the disease in a community. AB testing can also be used to screen convalescent plasma for possible

therapeutic transfusions. Due to the uncertainties surrounding accuracy and unknown level of protection

of immunity, AB tests should not be used to make decisions regarding use of PPE or return-to-work.

People should continue to avoid risk of exposure to COVID-19 regardless of AB test results.

Should we have in-house AB testing capability at CommonSpirit Health?

Yes. In-house testing will allow us to support epidemiologic and other research studies. Second, it will be

beneficial to have this capability in anticipation of new knowledge regarding the COVID-19 antibodies

and possible future national guidelines. As the tests improve we may be able to use for retrospective

diagnosis and immunity status.

of 125

https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd

https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd

Coronavirus (COVID-19) – Billing and Coding Clinical Support and Patient Safety Department


Revised 05/13/2020

“COVID” Procedure Code for internal tracking

• A new procedure code has been created for internal tracking of patients being tested and/or

treated for COVID-19.

• If you are billing for a patient encounter that includes screening, testing or treatment of

COVID-19 this code should be added

• Code your encounter for the actual services being provided and then add “COVID”

• Code is being used across all of CommonSpirit Physician Enterprise

Co-Pay Collection for Patients

If a patient visit (in person or via Video Visit) is known to be for the purpose of screening and/or

testing for COVID-19 it is appropriate at this time for the Health Care Personnel (HCP) not to

collect a Co-Pay. No promise or commitment should be made to the patient that they will not

receive a bill nor have any liability for the visit.

The California Department of Managed Health Care issued a directive to all Health Plans and

Medi-Cal GMC’s to update their systems to eliminate Co-Pay’s, Co-Insurance and Deductible

for Clinician office visits where the purpose of the visit is to be screened and/or tested for

COVID-19.

Additional Billing and Coding Guidelines (click links below)

Billing and Coding - CernerPCA Non-Clinic Encounter Charge Submission Tip Sheet

Billing Coding Guidelines - COVID-19 ICD-10-CM Coding

Billing Coding Guidelines - COVID Tracking Code Selection

Billing Coding Guidelines - Non-Face-To-Face Services COVID-19

Copy of CMS Covered Telehealth Services for PHE for the COVID-19 pandemic effective

March 1 2020

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=015456f7-0dfe-4e6e-b2d5-0563a9ff0779

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=cc0322e6-f71a-4224-9cb4-16b7494ee45e

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=79f556e6-35c1-4794-bc0d-ecf64e4e0cd6

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=2869293f-23d7-44e9-9235-1d520945d2cd

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=523565ce-1cc9-4b95-bd8b-2ff01a9124b5

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=523565ce-1cc9-4b95-bd8b-2ff01a9124b5

Virtual Care Visit Request Form

As part of our COVID-19 response, we continue to evaluate our ability to practice quality health care in a way that is supported and safe for our patients, our Physicians, Advanced Practice Providers (APPs), and Health Care Personnel (HCP). Part of that effort includes leveraging virtual care services to enable access to care in non-traditional ways.

In light of our current COVID-19 environment and in response to the interest from Physicians and APPs in maintaining a flexible work environment while still meeting patient care needs at our Clinic locations, Physician Enterprise has provided our divisions with a set of guidelines to implement virtual visits from home. Please see the attached document for review.

If your department is interested in this arrangement, please work with your local leadership to fill out the virtual care request form and gain approval. Please note that during a crisis, working from home may not be your only assignment. As the crisis evolves, Clinicians may be asked to work in other critical areas as well.

Thank you for your commitment, and for everything that you do.

If you have questions, please don’t hesitate to contact me.

Signature Mark Behl, MHA, MBA SVP Physician Enterprise West Division CommonSpirit Health™ 916.851.2832 (O) 818.856.5753 (M) [email protected]

of 125


Virtual Care Services We have three types of Virtual Care Services: 1) Prescreen, 2) Virtual Visit, and 3) Home Monitoring.

Email [email protected], to learn if a service is available in your area. Prescreen Notable — Notable is a text message service that patients receive 48 hours prior to their scheduled appointment. Notable is integrated with Cerner and serves as an appointment reminder and also triages patients at risk for COVID-19. Patients are sent a mobile link to a screening questionnaire to be completed before their scheduled visit, and based on their responses, an algorithm determines if patients are at high or low probability for having COVID-19, and directs high-probability patients through the appropriate care pathways. For more information on Notable, click here. Gyant — Gyant is an automated chat-bot solution. Scripted responses are based on patient answers to risk factor questions. The chatbot will provide advice regarding care options (video, ER, urgent care, primary care, etc.). If you have questions, please email [email protected]. Virtual Visit Zoom Video Visit — DHMF’s preferred video visit platform is through Zoom’s professional licenses (not the free version). Zoom video visits are supported by Dignity Health IT and are HIPAA compliant. Zoom is available to all Dignity Health Medical Foundation clinicians. Appointment types THV for follow up and THN for new visit. To learn more, contact [email protected]. Scheduled Video Visit via Amwell — These visits are initiated through Dignity Health Office of Digital. They are scheduled visits with a Dignity Health clinician, and clinicians work with their own patients. To learn more, click here. Appointment types OVV for follow up and NVV for new visit. Virtual Care Anywhere (via Amwell) — Virtual Care Anywhere is a patient-on-demand virtual urgent care service that is available to everyone in our community, and allows patients to be seen remotely via video. This service is provided by Amwell and uses both Dignity Health and Amwell clinicians. Virtual Care Anywhere will be used for patients who are exhibiting mild to moderate symptoms of COVID-19, and will help patients assess their options for treatment and/or testing. For more information on Virtual Care Anywhere, click here. To initiate the onboarding process for Amwell, please email [email protected]. InTouch Health — This is a portable robotic telehealth solution in clinic that supports clinic specialists through initial consults and follow-up care. To learn more, click here or email [email protected]. Home Monitoring Medtronic — Medtronic provides technology at home, helping monitor patients where they’re most comfortable. Medtronic has two different programs, Interactive Voice Response (IVR) and Remote Patient Monitoring (RPM). To learn more, contact [email protected].

1. IVR: Provides a 21-day program designed to remotely monitor and educate a patient with Respiratory Infectious Disease illness, including COVID-19 diagnosis.

2. RPM: Provides ongoing, daily monitoring for high-risk patients, offering chronic disease management through a variety of platforms/devices. As patients are being monitored for peripherals, including biometric screening, we’ll be aware when patients become symptomatic, thus providing timely nursing support.

View Scheduling and Billing and Coding information in PolicyManager, located in the

“Toolkit – DHMF Ambulatory Coronavirus” folder.

Alternate Services. As regulations have evolved in response to COVID-19, it is now acceptable to use additional options, such as Facetime, Google Hangouts, Facebook Video, etc. at the discretion of clinicians, medical groups, and other leadership across the Physician Enterprise and our Divisions. We will make every effort to support these platforms, but they are not our enterprise platforms at this time.

of 125


https://show.dignityhealth.org/epublish/DHMFInsightBlog/SiteAssets/Notable%20Health%20COVID-19%20Solution%20-%20FAQs.pdf?Web=1



https://officeofdigital.zendesk.com/hc/en-us/articles/360045134713-Video-Visits-scheduled-ambulatory-On-Boarding-Process

https://image.s6.sfmc-content.com/lib/fe941272746d047d7c/m/5/5f218008-092e-46b5-9763-9e3076bf22f5.pdf


https://show.dignityhealth.org/epublish/DHMFInsightBlog/SiteAssets/InTouch%20Clinic%20Solutions.pdf?Web=1



https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=25b7f8cc-6e54-49ff-a72b-cb2c7c49cf9e

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ea7212b1-390f-4109-ab40-cebbaaa92626

COVID-19 Virtual Care Agreement: Clinician Working From Home

Operations Division Page 1 of 4

Released 04/01/2020 Revised 03/31/2020

Purpose Recommendations and guidelines for assessing, selecting and implementing Virtual Care Services from a Clinician’s home during the COVID-19 crisis. For the Clinician

1. Qualification: Advise Clinician to review and complete the COVID-19 Virtual Care Agreement form on page 3 with your designated Clinic Leader to ensure qualification.

2. Home Office: Advise Clinician to identify a working space in the home with a closed

door and visual and auditory privacy to conduct virtual care visits. Ensure that you have adequate lighting and sound quality to conduct virtual care visits.

3. Appearance: Clinician to have professional appearance during virtual care visits, e.g.,

similar to in-Clinic visits in accordance with dress code policy.

4. Equipment: Recommend IT-supported Dignity Health devices for virtual visits. Personal devices may be used if necessary in this crisis.

5. Patient Records: Clinician will not transport confidential patient paperwork from the

workplace to the home.

6. Technology/Platform: Contact mailto:[email protected] for virtual care platforms.

7. Visit Type: Clinician is responsible to ensure that a virtual visit format is appropriate for

the patient’s condition.

8. Duration: This telecommute agreement represents a temporary arrangement, based on emerging needs from the COVID-19 pandemic, and the suspension of certain regulatory and billing regulations. It is subject to revision or termination at any time.

Management and Dyad Medical Leadership will determine when Clinicians will return to in-Clinic care.

9. Approval: Decision maker in this process is the PE SVP of Operations. Mitch Destigter

provided the following guidance regarding Clinicians working remotely: a. Clinicians are *not* required to complete a separate legal Telecommute

Agreement, this is covered in current Clinician contracts. b. Please work with local HR on telecommute agreement requirements for any non-

Clinicians.

of 125





For the Designated Clinic Leader

1. Prior to approval: a. Ensure Clinic remains adequately staffed during all scheduled Clinic hours for

Clinic visits including urgent and routine in-person follow-up visits. b. Identify and remediate impact to assigned staff while Clinician is working from

home. c. Consider rotation of telecommute schedule to maintain Clinician equity. d. If Clinician has tested positive for COVID-19, ensure Clinician is able to work. e. Consult with HR regarding whether virtual visits are appropriate ‘light duty’

work.

2. Once approved, update Medicare enrollment with home location as a billing location.

3. Upon agreement termination, confirm change with Finance Department. For the Finance Department

1. Tracking: Weekly tracking of COVID Virtual Care Clinician-from-home visits/Clinician.

2. Payment/Denials: Revenue Cycle team tracking payment and/or denials of these visits.

of 125




Purpose In light of current events and the need to maintain a flexible work environment while still meeting patient care needs, this document is designed to identify Clinicians eligible to participate in a Telecommute arrangement during the COVID-19 pandemic response timeframe. Clinician Information Clinicians should complete this form with their designated Clinic Leader. CLINICIAN INFORMATION Clinician Name: Employee Number: Specialty: Employer and Process Level: Department / Cost Center: Work Location: Designated Clinic Leader: Qualification Questionnaire Please answer the following questions as they related to the position listed above. QUALIFICATION QUESTIONNAIRE 1. Does Clinician agree to work within the recommendations and

guidelines as outlined above? YES NO

2. Can the essential functions related to the provision of virtual care services be performed remotely? YES NO

3. Does the Clinician have access to all necessary computer systems and required equipment/technology to work from home? YES NO

4. This position does not require the transporting of confidential paperwork from the workplace to the home. YES NO

5. Can productivity from home be measured for this position? YES NO 6. If Clinician telecommutes, will the Clinic still have the minimum

levels of Clinicians for maintenance of Clinic operations and in-person access for patients?

YES NO

7. Does the Clinician agree to ensure virtual visits are scheduled, arrived and fully documented within a DHMF-owned and operated Electronic Health Record?

YES NO

If you answered ‘no’ to any of the questions above, home telecommuting is not an appropriate option.

of 125




Agreement I have answered ‘yes’ to all the questions above and agree to adhere to all guidelines and recommendations above. I understand this telecommute agreement represents a temporary, discretionary assignment and does not constitute a long term agreement to allow telecommute arrangements following this disaster response timeframe.

POSITION TITLE SIGNATURE/PRINTED NAME DATE Clinician

Designated Clinic Leader

Approval

POSITION TITLE SIGNATURE/PRINTED NAME DATE VP Operations

of 125

COVID-19 Virtual Care Checklist Operations Division

Page 1 of 2 Released 04/01/2020 Revised 03/31/2020

CLINICIAN INFORMATION Full Name of Clinician: Clinic and Location: Accounting Unit: Director of Clinic Operations/Vice President:

CLINICIAN TASK(S) COMPLETED Review and complete the Remote Virtual Visit Clinician Agreement questionnaire with designated Clinic Leader.

Identify space in the home for the purpose of virtual meeting the following criteria:

• Visual and auditory privacy • Recommend to have a closed door • Professional appearance during virtual visits similar to in-Clinic

visits in accordance with Dignity Health’s professional dress guidance form

• Recommend adequate lighting and sound quality • Recommend working on IT-supported Dignity Health devices to

protect confidential data

Virtual visits to be arrived and fully documented within a Dignity Health owned and operated EHR. Ensure that a virtual visit format is appropriate for the patient’s condition.

Approved/reviewed by Dignity Health Leadership. DIRECTOR’S TASK(S) COMPLETED Ensure Clinic remains adequately staffed during all virtual care services hours for Clinic visits including urgent and routine in-person follow-up visits and on demand visits.

Identify and remediate impact to assigned staff while Clinician is working from home.

Consider rotation of telecommute schedule to maintain Clinician equity. If Clinician has tested positive for COVID-19, ensure Clinician is able to work. Consult with HR regarding whether virtual visits are appropriate ‘light duty’ work.

Update Medicare enrollment with home location as a billing location.

FINANCE DEPARTMENT’S TASK(S) COMPLETED

Tracking of COVID Virtual Care Clinician-from-home visits/Clinician.

Revenue Cycle team tracking payment and/or denials of these visits. ADDITIONAL COMMENTS:

of 125

COVID-19 Virtual Care Checklist Operations Division

Page 2 of 2 Released 04/01/2020 Revised 03/31/2020

This telecommute agreement represents a temporary arrangement, based on emerging needs from the COVID-19 pandemic, and the suspension of certain regulatory and billing regulations. It is subject to revision or termination at any time at the sole discretion of DHMF.

POSITION TITLE SIGNATURE/PRINTED NAME DATE VP Operations

Designated Clinic Leader

of 125

of 125

Coronavirus (COVID-19) – Virtual Care

Services Scheduling Business Systems Configuration


Revised 04/03/2020

Purpose

Recommendations for scheduling Virtual Care Services during the COVID-19 crisis.

Telephone Visits (Audio Communication)

May be scheduled (recommended)

Visit type = Phone Medical Visit (PMV: established or new)

If not scheduled, will require Non-Clinic encounter to submit a charge

Online EHR Communication (Patient Portal)

Not scheduled

Will require a Non-Clinic encounter to submit a charge

Video Visits (Interactive Audio & Video Communication)

Office of Digital Video Visits using American Well platform: Clinician must be setup

using the Video Visit On-boarding Process

o Scheduled with Unique visit type = Office Video Visit (OVV: established, NVV:

new)

Variety of other application options available (i.e., Zoom)

o Scheduled visit = Telehealth Visit (THV: established, THN: new)

Note to schedulers: Use “Detail Search” rather than “First Available.”

Please refer to Billing and Coding - DHMF Coronavirus for proper billing and coding for virtual

visits.

of 125

https://officeofdigital.zendesk.com/hc/en-us/articles/360045134713-Video-Visits-On-boarding-Process

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ea7212b1-390f-4109-ab40-cebbaaa92626

Coronavirus (COVID-19) – Virtual Care Service

(VCS) Guidance/Resources Operational Support & Analytics


Revised 05/01/2020

Guidance and resources for utilizing and setting up Virtual Care Services during the COVID-19

crisis.

Virtual Care Service (VCS) Guidance/Resources: General

VCS – Multiple Monitor Setup

VCS – Video Visit Scheduling

Virtual Care Service (VCS) Guidance/Resources: Amwell

VCS – Provider Enrollment Steps

Additional Amwell Training Material Links:

Provider Training - https://officeofdigital.zendesk.com/hc/en-us/articles/360044648814-

Provider-Training-Resources

Staff Training: Adult Patients - https://officeofdigital.zendesk.com/hc/en-

us/articles/360045245653-Staff-Training-Resources-Adult-Patients

Staff Training: Pediatrics - https://officeofdigital.zendesk.com/hc/en-us/articles/360044841334-

Staff-Training-Resources-Pediatrics

Virtual Care Service (VCS) Guidance/Resources: Zoom

VCS – CSH - Quick Guide Zoom Account Setup Tip Sheet Provider

VCS – CSH-Zoom Training Document

VCS – CSH - Zoom Video Calendar Invite

VCS – CyraCom – Zoom Video Visits for Interpreters

VCS – Daily Zoom ID Setting Check

VCS – How to Grant Access to a Shared Calendar or Mailbox Outlook 2013

VCS – Troubleshooting Speaker Issues Zoom

VCS – Zoom Training Guide Slide Deck

If links are not working, all documents are accessible to the right in Content Linkage within

PolicyManager via this standalone summary page.

of 125

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=18afd21c-e4fa-4aac-9df1-3e1774e2a1ca

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=e6b0d482-3d2d-496e-9268-dc53d5cdd149

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=a3252375-5a9d-449b-8a3d-a067a7c181fb

https://officeofdigital.zendesk.com/hc/en-us/articles/360044648814-Provider-Training-Resources

https://officeofdigital.zendesk.com/hc/en-us/articles/360045245653-Staff-Training-Resources-Adult-Patients

https://officeofdigital.zendesk.com/hc/en-us/articles/360044841334-Staff-Training-Resources-Pediatrics

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=dda712bc-f9bf-45ac-868b-323cb377a127

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=3e875617-d74a-409b-b537-42ed9f8820f6

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=5345cb72-c813-4614-8946-24e4188ef219

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ac36a666-222d-420b-a69e-1cb0d0c56e73

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=34559772-62da-41c7-ae46-f9f0657432a8

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=5ebedb62-9c44-49c3-b780-e2800be0c7fc

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=22115ea3-dd6a-415e-8da9-d0b186b71264

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=60839e40-6a9d-4ae8-9a2d-7745221669b7

Coronavirus (COVID-19) – Patient Education



Revised 04/07/2020

It is important to remember that it is flu season and patients experiencing fever, cough,

respiratory issues, etc. need appropriate clinical assessment and treatment. In addition, many

patients have questions related to COVID-19. To assist in the education process, DH has created

several flyers that can be provided to patients or HCP for education.

Flu vs. Coronavirus

o Click here for English

o Click here for Spanish

o Click here for Mandarin

It’s Cold & Flu Season – Protecting Yourself




Coronavirus (COVID-19) Overview


What you need to know about Coronavirus




What to do if you are sick with Coronavirus




Clinician Guidelines – Patients for Home Isolation

If a Clinician triages a patient for home care/home isolation, Clinical Staff or Clinician should

educate the patient using the DH Patient Education flyer “What to do if you are sick with

Coronavirus disease 2019 (COVID-19) (see above or click here for English).

of 125

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=2b1b5569-e7dc-48fa-8a13-7604d532094a

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=c7f78799-94fa-452c-9696-24b4cfc9fd46

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=3470f6b1-dc94-4d09-9ced-cc3c6beb5f19

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=0f432ac7-4f54-4bc7-aa87-872791239de7

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=362b88d7-1333-46ac-85e2-4e578c24fdb9

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=beba5a44-8de9-48c8-a987-b5177f76390d

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=e15452e1-d0f0-4742-9f65-79dcc37af5d7

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=86926eae-1dc8-4780-b2e5-dcefac16beda

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=5a3658a4-f2a4-4cd4-b6d6-132f712b6952

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=56ab0132-b5f4-4618-bb40-d6e8f10d6ca9

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ec128afe-0073-47d3-b5e7-ec1eb1cbc574

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=e0a167b5-2845-4080-b8c8-771e106e2c20

https://pmrtm.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=56ab0132-b5f4-4618-bb40-d6e8f10d6ca9

https://dignitydhmf.policymedical.net/policymed/registered/docViewer?stoken=9bd08988-f5fe-42cd-9262-eacec6bc427d&dtoken=ec128afe-0073-47d3-b5e7-ec1eb1cbc574

FLU (INFLUENZA)

The �u is a common, contagious respiratory illness caused by �u viruses. The �u is different from a cold.

Flu can cause mild to severe illness, and complications can lead to death. Millions of citizens get in�uenzawithin the United States each year.

SIGNS AND SYMPTOMS OF FLU

The signs and symptoms of �u usually develop within two days after exposure. Symptoms come on quickly and all at once.

• Fever or feeling feverish• Headache• Muscle or body aches• Cough• Feeling very tired (fatigue)• Sore throat• Runny or stuffy nose

HOW FLU GERMS ARE SPREAD

The �u is spread mainly by droplets made when people who have �u cough, sneeze, or talk. Viruses can also spread on surfaces, but this is less common.

People with �u can spread the virus before, during, and after they are sick.

WHO GETS THE FLU?

Anyone can get the �u.

Some people—like very young children, older adults, and people with some health conditions—are at high risk of serious complications.

“CORONAVIRUS”

“Coronavirus” is a new infection that can cause mild to severe respiratory illness. There has been community spread within the United States but the risk of getting “Coronavirus” is still considered low.

SIGNS AND SYMPTOMS OF “CORONAVIRUS”

Signs and symptoms can appear two to 14 days after exposure.

• Fever• Cough• Dif�culty breathing• Shortness of breath

HOW “CORONAVIRUS” GERMS ARE SPREAD

It is thought to be spread by:

• Coughing/sneezing or other close contact with aperson infected with “Coronavirus.”

- Close contact means being within 6 feet of an infected person for a period of time.

• It may also spread by touching items that aninfected person has used, like tissues or linen.

WHO GETS “CORONAVIRUS”?

In the United States, people at risk are:

• Travelers from outside theUnited States

• An individual who hadclose contact with aperson infectedwith “Coronavirus.”

For more information about the �u and COVID-19,visit www.cdc.gov/�u and www.cdc.gov/coronavirus/2019-nCoV.

Is it Flu or COVID-19 “Coronavirus Disease”?

DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly.March 3, 2020

of 125

¿Es gripe o es la “enfermedad por el nuevo coronavirus” (COVID-19)?

La gripe es una enfermedad respiratoria frecuente y contagiosa causada por los virus de la influenza. La gripe es diferente de un resfriado.

La gripe puede causar una enfermedad que va de leve a grave y las complicaciones pueden llevar a la muerte. Cada año, millones de personas contraen influenza en los Estados Unidos.

El “coronavirus” es una infección nueva que puede causar una enfermedad respiratoria que va de leve a grave. Ha habido una propagación comunitaria dentro de los Estados Unidos, pero el riesgo de contraer el "coronavirus" se considera todavía bajo.

Los signos y síntomas de la gripe suelen desarrollarse dentro de los dos días posteriores a la exposición. Los síntomas aparecen rápidamente y todos juntos.

• Fiebre o sensación de fiebre • Dolor de cabeza • Dolores musculares o corporales • Tos • Sentirse muy cansado (fatiga) • Dolor de garganta • Secreción o congestión nasal

Los signos y síntomas pueden aparecer de 2 a 14 días después de la exposición.

• Fiebre • Tos • Falta de aire • Dificultad para respirar

La gripe se propaga principalmente a través de gotitas que se producen cuando las personas que la tienen tosen, estornudan o hablan. Los virus también pueden propagarse en las superficies, pero esto es menos frecuente.

Las personas con gripe pueden propagar el virus antes, durante y después de enfermase.

Se cree que se propaga a través de:

• Tos o estornudos u otro contacto cercano con una persona infectada con “coronavirus”.

- Un contacto cercano significa estar a menos de 6 pies de una persona infectada durante un periodo de tiempo.

• También puede propagarse al tocar artículos que una persona infectada ha utilizado, como pañuelos de papel o ropa.

Cualquier persona puede contraer la gripe. Algunas personas, como los niños muy pequeños, los adultos mayores y las personas con algunos problemas de salud, corren un riesgo alto de sufrir complicaciones graves.

En los Estados Unidos, las personas que están en riesgo son:

• Los viajeros que vienen del exterior de los Estados Unidos

• Cualquier persona que haya tenido

contacto cercano con otra infectada con el “coronavirus”.

Para obtener más información sobre la gripe y el COVID-19, visite www.cdc.gov/flu y www.cdc.gov/coronavirus/2019-nCoV.

EXENCIÓN DE RESPONSABILIDAD: La información sobre el COVID-19 cambia rápidamente y los documentos se actualizarán en consecuencia. 3 de marzo de 2020

¿QUIÉN PUEDE CONTRAER EL “CORONAVIRUS”? ¿QUIÉN PUEDE CONTRAER LA GRIPE?

CÓMO SE PROPAGAN LOS GÉRMENES DEL “CORONAVIRUS”

CÓMO SE PROPAGAN LOS GÉRMENES DE LA GRIPE

SIGNOS Y SÍNTOMAS DEL “CORONAVIRUS”

SIGNOS Y SÍNTOMAS DE LA GRIPE

“CORONAVIRUS” GRIPE (INFLUENZA)

of 125

http://www.cdc.gov/flu

http://www.cdc.gov/coronavirus/2019-nCoV

是流感还是 COVID-19 “冠状病毒病”？

流感是一种常见的传染性呼吸道疾病，

由流感病毒引起。流感不同于感冒。流感可以引发轻度到重度疾病，并发

症可能导致死亡。每年，美国境内有

数百万市民感染流行性感冒。

“冠状病毒”是一种新型的感染，可以导致轻度到重度呼吸道疾病。

美国境内已出现社区传播的现象，

但感染“冠状病毒”的风险仍被认为

较低。

流感的迹象和症状通常在接

触病毒后两天内出现。症状是快速突然出现的。

• 发烧或感觉发热 • 头痛 • 肌肉或身体疼痛 • 咳嗽 • 感觉非常乏累（疲劳） • 喉咙痛 • 流鼻涕或鼻塞

迹象和症状可能在接触病毒后二到 14 天出现

• 发烧 • 咳嗽 • 呼吸困难 • 呼吸短促

流感主要是通过流感患者咳嗽、

打喷嚏或说话时产生的飞沫传播

的。病毒也可以在表面传播，但这并不常见。

流感患者可以在患病之前、期间和之后传播病毒。

据认为，传播方式如下：

• “冠状病毒”感染者咳嗽/打喷嚏，或其他密切接触。 - 密切接触是指，在一段时间内，在感染者 6 英尺范围内。

• 也可以通过接触感染者使用过的物品（如纸巾或

床上用品）传播

任何人都可能感染流感。一些如小孩、老人和有健

康问题的人，患有严重并

发症的风险较高。

在美国，风险人群有：

• 来自美国以外的旅行者

• “冠状病毒”感染者的密切接触者。

欲了解关于流感和 COVID-19 的更多信息，请访问 www.cdc.gov/flu 和 www.cdc.gov/coronavirus/2019-nCoV。

免责声明： COVID-19 信息变化迅速，文件将会相应更新。2020 年 3 月 3 日

谁是“冠状病毒”易感人群？谁是流感易感人群？

“冠状病毒”病菌的传播方式流感病菌的传播方式

“冠状病毒”的迹象和症状流感的迹象和症状

“冠状病毒” 流感（流行性感冒）

of 125

http://www.cdc.gov/flu

http://www.cdc.gov/coronavirus/2019-nCoV

The start of each year is often met with the peak of cold and flu season. This year is no different except that we are facing the new strain of coronavirus, COVID-19, and the widespread media attention this public health outbreak is causing. It is understandable that many are feeling overwhelmed by the thought of catching coronavirus and are concerned about how to best care for ourselves and our loved ones during this challenging time. Take comfort in knowing there are simple things you can do each and every day to help ensure your health is protected.

• Scrub a dub! Wash your hands! As simple as this sounds, it truly is the mosteffective way to stop the spread of germs. Be sure to use soap, and to make sureyou are being thorough enough, sing the “Happy Birthday” song which is just theright length to ensure a thorough cleaning of your hands. Wash all parts of yourhands, including the “webs” between your fingers and thumbs.

• When without, use a squeeze! If you are unable to get to a sink for soap andwater to thoroughly wash your hands, use hand sanitizer. While handwashing isbest, hand sanitizer helps to reduce the spread of germs when you are out andabout. Have hand sanitizer in several locations so you can always have some onhand – think about placing some bottles in your car, your purse, your suitcase, thediaper bag, or even in your coat pocket.

• Don’t rub, don’t touch! As tempting as it is to rub those scratchy eyes duringallergy season or to rub a runny nose, don’t. In fact, if you can, try to avoidtouching your face as much as possible, especially with unclean hands. Our eyes,nose, and mouth are easy access points for germs to enter our bodies.

• When in doubt, don’t go out! If you are feeling under the weather, stay home.If your child is feeling sick, keep them home. It is so important to not only restwhen you are starting to get sick or are already under the weather, but also stayinghome and away from others helps to keep people from also getting sick.

• Don’t Spray It! Sneezing this time of year is part of life, especially if you sufferfrom allergies or do have the cold or flu. To help minimize the spread of germsfrom sneezing or coughing, use a Kleenex or your elbow to protect against roguespray and to help keep your hands clean.

And remember, most people will have a runny nose, coughs and sneezes these days either from seasonal allergies, the cold or the flu, but if you do feel ill or feel like you need some help to feel better, please contact your Primary Care Provider to determine the best course of treatment for you which may include home care for mild cases or making an appointment to be seen to address more moderate needs. To find a PCP near you, please visit www.dignityhealth.org.

It’s Cold and Flu Season – How are you protecting yourself?

March 6, 2020 of 125

Estamos en temporada de resfriados y gripe: ¿cómo se está protegiendo? Al comienzo de cada año, hay un pico de temporada de resfriados y gripe. Este año no es diferente, excepto que nos enfrentamos a la nueva cepa de coronavirus, COVID-19, y a la amplia atención de los medios de comunicación que este brote de salud pública está causando. Es entendible que muchos se sienten abrumados por la idea de contagiarse de coronavirus y están preocupados sobre cómo cuidarse y cuidar a nuestros seres queridos durante este momento desafiante. Consuélese sabiendo que hay un par de cosas que puede hacer a diario que lo ayudarán a mantener su salud protegida.

• ¡A frotar! ¡Lávese las manos! Así de simple, es la manera más efectiva de detener la propagación de los gérmenes. Asegúrese de usar jabón y de ser minucioso, cante la canción del “Feliz cumpleaños” que dura el tiempo justo para garantizar una limpieza profunda de las manos. Lave todas las partes de las manos, incluidas las partes entre los dedos.

• ¡Si no tiene jabón, desinféctese! Si no tiene un lavabo cerca para lavarse las manos con agua y jabón, use un desinfectante para manos. Aunque lo mejor es lavarse las manos, los desinfectantes para manos ayudan a reducir la propagación de gérmenes cuando va de un lado a otro. Deje un desinfectante para manos en varios lugares para siempre tener uno a mano. Considere dejar algunas botellas en el auto, la cartera, el maletín, la mochila pañalera, o incluso en el bolsillo del abrigo.

• ¡No frote, no toque! Por muy tentador que sea frotarse los ojos irritados durante la temporada de alergias o frotarse la nariz con escurrimiento nasal, no lo haga. De hecho, si puede, trate de no tocarse la cara en la medida de lo posible, en especial, con las manos sucias. Los ojos, la nariz y la boca son puntos de acceso fácil para que los gérmenes entren en el cuerpo.

• ¡Ante la duda, no salga! Si se siente mal, quédese en casa. Si sus hijos se sienten enfermos, haga que se queden en casa. Es muy importante descansar cuando empieza a enfermarse o ya se siente mal y también quedarse en casa y mantenerse alejado de los demás para evitar que los demás se enfermen.

• ¡No lo desparrame! Estornudar en estos momentos del año es parte de la vida, en especial si sufre alergias o tiene un resfriado o gripe. Para disminuir la propagación de los gérmenes a través del estornudo o la tos, use un pañuelo descartable o cúbrase con el codo para protegerse contra las partículas indeseadas y para mantener las manos limpias.

Y recuerde, la mayoría de las personas tendrá escurrimiento nasal, tos y estornudos en estos días ya sea por alergias estacionales, el resfriado o la gripe, pero si se siente enfermo o siente que necesita ayuda para sentirse mejor, comuníquese con el profesional de atención primaria para determinar el mejor tratamiento para usted, que pueden ser cuidados a domicilio para casos leves o pedir una cita para que lo atiendan y traten necesidades más moderadas. Para encontrar un médico de atención primaria (PCP, por sus siglas en inglés) cerca de usted, visite el sitio web www.dignityhealth.org.

6 de marzo de 2020 of 125

http://www.dignityhealth.org/

现在是感冒和流感季节 – 您如何保护自己？

每年年初通常是感冒和流感的高发季。今年也是如此。除此之外，我们还面临着一种新型冠状病

毒毒株 — COVID-19，这次公共卫生事件引起了媒体的广泛关注。可以理解，很多人因担心感染冠

状病毒的念头而感到不堪重负，关心如何在这个充满挑战的时期最好地照顾自己和亲人。了解您

每天可以做一些简单事情来帮助确保保护您的健康，会让您感到安慰。

• 洗刷刷！勤洗手！听起来简单，但这确实是阻止病菌传播最有效的方式。确保使

用肥皂并彻底清洗，唱“生日快乐歌”，这首歌的时长恰好确保您能充分清洗双

手。清洗手的所有部位，包括手指和拇指间的“褶皱部分”。

• 没有上述条件时，使用手部消毒剂！如果您找不到水槽用肥皂和水彻底洗

手，请使用手部消毒剂。虽然最好的方法是洗手，但当您外出时，手部消毒剂有

助于减少病菌传播。在多个地点放置手部消毒剂，以便您可以随时给手部消毒，

考虑在汽车、钱包、手提箱、尿布包或者甚至是外套口袋里放几瓶手部消毒剂。

• 不要揉，不要碰！虽然过敏季节让人忍不住揉发痒的眼睛和流鼻涕的鼻子，但请不要这样做。实际上，如果您能做到，请尽量避免触摸面部，特别是在没洗

手时。病菌很容易通过我们的眼、鼻、口进入我们体内。

• 有问题时，不要出门！如果您感觉身体不适，待在家中。如果您的孩子感到

不适，让他们留在家中。当您开始生病或已经感到不适时，不仅要休息，还要待

在家中并远离他人，这一点至关重要，这有助于防止他人患病。

• 不要喷出飞沫！每年这个时间打喷嚏是很常见的，特别是当您过敏或确实患有

感冒或流感时。为了尽量减少打喷嚏或咳嗽时喷出的病菌传播，使用 Kleenex 或手

肘防止有害飞沫的影响及帮助保持双手清洁。

切记，目前大多数人会因季节性过敏、感冒或流感而流鼻涕、咳嗽及打喷嚏，但如果您确实感到

不适或感觉需要帮助才能感觉好一些，请联系您的初级护理提供者以确定适合您的最佳治疗方案，

这可能包括轻症病例的家庭护理或预约医生以解决更多中度需求。如需寻找您附近的初级护理提

供者 (PCP)，请访问 www.dignityhealth.org。

2020 年 3 月 6 日

of 125

http://www.dignityhealth.org/

Q. What are coronaviruses?A: Human coronaviruses were first identified in the mid-1960s. They are a respiratory virus named for the crown-like spikes on their surface. We are currently aware of seven different types of human coronaviruses, four of which are associated with mild to moderate upper-respiratory tract illnesses, like the common cold. Other types of the virus include severe acute respiratory syndrome (SARS), the Middle East Respiratory Syndrome, (MERS) and Coronavirus Disease (COVID-19), which is responsible for the latest outbreak. Although COVID-19 is similar to the other types of coronaviruses, it is unique in many ways and we are still learning more each day.

Q. How do you get infected with COVID-19?A: COVID-19 is spread by close person-to-person contact from droplets from a cough or sneeze, which can get into your mouth, nose, or lungs. Close contact is defined as being within approximately 6 feet of another person.

Q. How do I know if I have COVID-19?A: If you were recently exposed to someone with a confirmed case of COVID-19 or have been in a place where an outbreak has occurred

within the last two weeks the following symptoms could indicate you have contracted COVID-19:

- fever;

- cough; or

- shortness of breath.

Unless your symptoms are severe, it is recommended

you call your healthcare provider first before entering a healthcare facility. When speaking with a healthcare provider in-person or on the phone, be sure to note your symptoms, travel history, or if you were exposed to a person diagnosed with the virus.

Q. How severe is this illness?A: The World Health Organization says 80% of people with COVID-19 have a mild form of the illness with cold- or flulike symptoms. The people most likely to get seriously ill from this virus are people over 60 and/or those with pre-existing health conditions. It is estimated that for every 100 cases of COVID-19, between two and four people would die. This is very different from a coronavirus like SARS, where nearly ten in 100 sick people died from the illness.

Q. I see people wearing masks, should I be doing that?A: Yes, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission. The cloth face coverings recommended are not surgical masks or N-95 respirators.

Q. What can I do to prevent getting sick from COVID-19?A: The following tips will help to prevent COVID-19 as well as other respiratory viruses:

• Wash your handsoften with soapand water for atleast 20 seconds.If soap and waterare not available, use an alcohol-based hand sanitizer with at least60% alcohol.

• Don’t touch your eyes, nose, ormouth, especially with unwashedhands.

• Avoid close contact with people whoare showing symptoms of illness.

• Clean and disinfect frequentlytouched objects and surfaces.

• Cover your cough or sneezes witha tissue or sneeze into your elbow.Throw the tissue in the garbageand make sure to clean your handsafterwards.

• Stay home when you are sick.

Coronavirus Disease (COVID-19)

Information from Association for Professionals in Infection Control and Epidemiology (APIC) April 9, 2020

of 125

Symptoms• Fever

• Cough

• Shortness of breath

Call your healthcare provider if:

• You have symptoms and have been to an area thathas experienced an outbreak within the last 2 weeksof your trip.

• You have symptoms and have been in close contactwith a person with a confirmed case of COVID-19.

Prevention• Wash your hands often.

• Cover your cough/sneeze with a tissue.

• Don’t touch your eyes, nose, or mouth.

• Avoid close contact with sick people.

• Clean and disinfect high-touch surfaces often.

• Stay home when you are sick.

Coronavirus Disease (COVID-19)

Information from Association for Professionals in Infection Control and Epidemiology (APIC) April 9, 2020

SpreadsThrough close personalcontact with a sick person.

SYMPTOMS MAY SHOW UP 2-14 DAYS LATER

• Wear a cloth mask in public settings where othersocial distancing measures are difficult to maintain(e.g., grocery stores and pharmacies).

of 125

What is coronavirus disease 2019 (COVID-19)?Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China.

Can people in the U.S. get COVID-19?COVID-19 is spreading from person to person in several countries, and community transmission has been noted within the United States. Risk of infection is dependent on exposure. Close contacts of people who are infected are at greater risk of exposure, for example health care workers and close contacts of people who are infected with the virus that causes COVID-19. CDC continues to closely monitor the situation.

Have there been cases of COVID-19 in the U.S.?Yes. The first case of COVID-19 in the United States was reported on January 21, 2020. The current count of cases of COVID-19 in the United States is available on CDC’s webpage at https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html.

How does COVID-19 spread?The virus that causes COVID-19 probably emerged from an animal source, but now it seems to be spreading from person to person. It’s important to note that person-to-person spread can happen on a continuum. Some diseases are highly contagious (like measles), while other diseases are less so. At this time, it’s unclear how easily or sustainably the virus that causes COVID-19 is spreading between people. Learn what is known about the spread of newly emerged coronaviruses at https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html.

What are the symptoms of COVID-19?Patients with COVID-19 have had mild to severe respiratory illness with symptoms of• fever• cough• shortness of breath

What are severe complications from this virus?Many patients have pneumonia in both lungs.

How can I help protect myself?The best way to prevent infection is to avoid being exposed to the virus that causes COVID-19.

There are simple everyday preventive actions to help prevent the spread of respiratory viruses. These include• Avoid close contact with people who are sick.• Avoid touching your eyes, nose, and mouth with

unwashed hands.• Wash your hands often with soap and water for at least

20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

If you are sick, to keep from spreading respiratory illness to others, you should• Stay home when you are sick.• Cover your cough or sneeze with a tissue, then throw

the tissue in the trash.• Clean and disinfect frequently touched objects and

surfaces.

What should I do if I recently traveled outside of the United States?If you were outside the United States within the past 14 days and feel sick with fever, cough, or difficulty breathing, you should seek medical care. Call the office of your health care provider before you go, and tell them about your travel and your symptoms. They will give you instructions on how to get care without exposing other people to your illness. While sick, avoid contact with people, don’t go out and delay any travel to reduce the possibility of spreading illness to others.

Is there a vaccine?There is currently no vaccine to protect against COVID-19. The best way to prevent infection is to avoid being exposed to the virus that causes COVID-19.

Is there a treatment?There is no specific antiviral treatment for COVID-19. People with COVID-19 can seek medical care to help relieve symptoms.

What you need to know about coronavirus disease 2019 (COVID-19)

For more information: www.cdc.gov/COVID19

DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly. March 6, 2020 of 125

www.cdc.gov/COVID19



https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html


Lo que debe saber sobre la enfermedad por el nuevo coronavirus 2019 (COVID-19)

¿Qué es la enfermedad por el nuevo coronavirus 2019 (COVID-19)? La enfermedad por el nuevo coronavirus 2019 (COVID-19) es una enfermedad respiratoria que se contagia de persona en persona. El virus que causa COVID-19 es un nuevo coronavirus que se identificó por primera vez durante una investigación sobre un brote en Wuhan, China.

¿Pueden las personas en Estados Unidos contraer el COVID-19? El COVID-19 se está propagando de persona en persona en varios países y se ha observado una transmisión comunitaria dentro de los Estados Unidos. El riesgo de infección depende de la exposición. Las personas en contacto cercano con personas infectadas corren un mayor riesgo de exposición, por ejemplo, los trabajadores de atención médica y las personas en contacto cercano con personas infectadas con el virus que causa el COVID-19. Los Centros para el Control y la Prevención de Enfermedades (CDC, por sus siglas en inglés) siguen controlando de cerca la situación.

¿Hubo casos de COVID-19 en los Estados Unidos? Sí. El primer caso de COVID-19 en los Estados Unidos se reportó el 21 de enero de 2020. El conteo actual de los casos de COVID-19 en los Estados Unidos está disponible en el sitio web de los CDC: https://www.cdc.gov/coronavirus/2019-ncov/ cases-in-us.html.

¿Cómo se propaga el COVID-19? El virus que causa COVID-19, probablemente surgió de una fuente animal, pero ahora parece que se está propagando de persona a persona. Es importante resaltar que la propagación de persona en persona puede ocurrir progresivamente. Algunas enfermedades son altamente contagiosas (como el sarampión) mientras que otras no lo son tanto. En este momento, no está claro con qué facilidad o sostenibilidad el virus que causa el COVID-19 se está propagando entre las personas. Obtenga más información sobre qué se sabe de la propagación de los coronavirus recién surgidos en https://www.cdc.gov/ coronavirus/2019-ncov/about/transmission.html.

¿Cuáles son los síntomas del COVID-19? Los pacientes con COVID-19 han tenido enfermedades respiratorias de leves a graves con los siguientes síntomas: • Fiebre • Tos • Dificultad para respirar ¿Cuáles son las complicaciones graves de este virus? Muchos pacientes tienen pulmonía en ambos pulmones.

¿Cómo me puedo proteger? La mejor forma de prevenir la infección es evitar estar expuesto al virus que causa el COVID-19.

Hay acciones preventivas simples que puede tomar a diario para evitar el contagio de los virus respiratorios. Estas incluyen: • Evite el contacto cercano con personas que están enfermas. • Evite tocarse los ojos, la nariz o la boca si no se lavó las manos. • Lávese las manos con frecuencia con agua y jabón durante al menos

20 segundos. Use un desinfectante de manos a base de alcohol que contenga al menos un 60 % de alcohol si no dispone de agua y jabón.

Si está enfermo, para evitar contagiar la enfermedad respiratoria a otras personas, usted debe hacer lo siguiente: • Quédese en casa si está enfermo. • Cúbrase con un pañuelo cuando tosa o estornude y luego tirar

el pañuelo a la basura. • Limpie y desinfecte con frecuencia los objetos y las superficies

con contacto frecuente.

¿Qué debo hacer si viajé recientemente al exterior de los Estados Unidos? Si estuvo fuera de los Estados Unidos en los últimos 14 días y se siente enfermo con fiebre, tos, o dificultad para respirar, debe buscar atención médica. Llame al consultorio de su proveedor de atención médica antes de ir, y dígale sobre su viaje y sus síntomas. Le darán instrucciones sobre cómo obtener atención médica sin exponer a otras personas a su enfermedad. Mientras esté enfermo, evite el contacto con personas, no salga y postergue cualquier viaje para reducir la posibilidad de propagar la enfermedad a otros.

¿Existe una vacuna? Actualmente, no existe una vacuna de protección contra el COVID-19. La mejor forma de prevenir la infección es evitar estar expuesto al virus que causa el COVID-19.

¿Existe algún tratamiento? No existe un tratamiento antiviral específico para el COVID-19. Las personas con COVID-19 pueden buscar atención médica para ayudar a aliviar los síntomas.

Para obtener más información visite: www.cdc.gov/COVID19

EXENCIÓN DE RESPONSABILIDAD: La información sobre el COVID-19 cambia rápidamente y los documentos se actualizarán en consecuencia. 6 de marzo de 2020 of 125





http://www.cdc.gov/COVID19

2019 年冠状病毒病 (COVID-19) 须知

什么是 2019 年冠状病毒病 (COVID-19)? 2019 年冠状病毒病 (COVID-19) 是一种可以人传人的呼吸道

疾病。导致 COVID-19 的病毒是一种新型冠状病毒，首次发

现于对中国武汉疫情爆发的调查过程中。

在美国的人会感染 COVID-19 吗？ COVID-19 正在一些国家在人与人之间传播，美国境内也发

现了社区传播。感染的风险取决于接触情况。患者的密切

接触者风险较高，例如，医疗保健工作人员和感染导致 COVID-19 的病毒之人的密切接触者。CDC （疾病控制与预

防中心）继续密切相关情况。

美国是否有 COVID-19 病例？是。美国首例 COVID-19 病例报告于 2020 年 1 月 21 日。美

国目前的 COVID-19 病例总数发布于 CDC 的网页上，网址为 https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html。

COVID-19 如何传播？导致 COVID-19 的病毒可能来自于动物源，但现在似乎在人

与人之间传播。需要注意的是，人际传播可能持续发生。

一些疾病的传染性较高（如麻疹），而其他疾病的传染性

则较低。目前，尚不清楚导致 COVID-19 的病毒在人际之间

传播的难易程度和可持续性如何。访问以下网址，了解关

于新型冠状病毒的已知事实： https://www.cdc.gov/ coronavirus/2019-ncov/about/transmission.html。

COVID-19 有哪些症状？ COVID-19 患者会有轻度到重度呼吸道疾病，症状有 • 发烧 • 咳嗽 • 呼吸短促

这种病毒的严重并发症有哪些？许多患者的双肺会出现感染。

我如何保护自己？避免感染的最佳方式是避免接触导致 COVID-19 的病毒。

有一些简单的日常预防措施有助于阻止呼吸道病

毒传播。这些措施包括 • 避免密切接触病人。 • 避免用未洗过的手触摸眼、鼻、口。 • 勤洗手，用肥皂和水至少洗 20 秒。如果没有肥皂和水，

使用至少含有 60% 酒精的手部消毒剂。

如果您生病了，为了避免将呼吸道疾病传播给

他人，您应该 • 生病时待在家中。 • 在咳嗽或打喷嚏时用纸巾掩住口鼻，

然后将纸巾扔到垃圾桶中。 • 清洁经常接触的物体和表面并消毒。

如果我最近去过美国以外的地方旅行，我应该怎么做？如果您在过去的 14 天内去过美国以外的地方，并出现发烧、

咳嗽或呼吸困难等病状，您应该就医。在您出发前，致电您

医疗保健提供者的办公室，并告知他们您的旅行史和症状。

他们将指导您如何在避免他人接触您的疾病的情况下就医。

生病时，避免接触他人，不要外出，并推迟任何旅行，以降低把疾病传播给他人的可能性。

有疫苗吗？目前没有疫苗能预防 COVID-19。避免感染的最佳方式是避免

接触导致 COVID-19 的病毒。

有治疗方案吗？对于 COVID-19，没有特定的抗病毒治疗方案。COVID-19 患者

可以就医以帮助缓解症状。

了解更多信息：www.cdc.gov/COVID19

免责声明：COVID-19 信息变化迅速，文件将会相应更新。 2020 年 3 月 6 日

of 125






Stay home except to get medical careYou should restrict activities outside your home, except for getting medical care. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis.

Separate yourself from other people and animals in your homePeople: As much as possible, you should stay in a specific room and away from other people in your home. Also, you should use a separate bathroom, if available.

Animals: Do not handle pets or other animals while sick. See COVID-19 and Animals for more information.

Call ahead before visiting your doctorIf you have a medical appointment, call the healthcare provider and tell them that you have or may have COVID-19. This will help the healthcare provider’s office take steps to keep other people from getting infected or exposed.

Wear a facemaskYou should wear a facemask when you are around other people (e.g., sharing a room or vehicle) or pets and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then people who live with you should not stay in the same room with you, or they should wear a facemask if they enter your room.

Cover your coughs and sneezesCover your mouth and nose with a tissue when you cough or sneeze. Throw used tissues in a lined trash can; immediately wash your hands with soap and water for at least 20 seconds or clean your hands with an alcohol-based hand sanitizer that contains at least 60 to 95% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty.

Avoid sharing personal household itemsYou should not share dishes, drinking glasses, cups, eating utensils, towels, or bedding with other people or pets in your home. After using these items, they should be washed thoroughly with soap and water.

Clean your hands oftenWash your hands often with soap and water for at least 20 seconds. If soap and water are not available, clean your hands with an alcohol-based hand sanitizer that contains at least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry. Soap and water should be used preferentially if hands are visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands.

Clean all “high-touch” surfaces every dayHigh touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also, clean any surfaces that may have blood, stool, or body fluids on them. Use a household cleaning spray or wipe, according to the label instructions. Labels contain instructions for safe and effective use of the cleaning product including precautions you should take when applying the product, such as wearing gloves and making sure you have good ventilation during use of the product.

Monitor your symptomsSeek prompt medical attention if your illness is worsening (e.g., difficulty breathing). Before seeking care, call your healthcare provider and tell them that you have, or are being evaluated for, COVID-19. Put on a facemask before you enter the facility. These steps will help the healthcare provider’s office to keep other people in the office or waiting room from getting infected or exposed.

Ask your healthcare provider to call the local or state health department. Persons who are placed under active monitoring or facilitated self-monitoring should follow instructions provided by their local health department or occupational health professionals, as appropriate.

If you have a medical emergency and need to call 911, notify the dispatch personnel that you have, or are being evaluated for COVID-19. If possible, put on a facemask before emergency medical services arrive.

Discontinuing home isolationPatients with confirmed COVID-19 should remain under home isolation precautions until the risk of secondary transmission to others is thought to be low. The decision to discontinue home isolation precautions should be made on a case-by-case basis, in consultation with healthcare providers and state and local health departments.

If you are sick with COVID-19 or suspect you are infected with the virus that causes COVID-19, follow the steps below to help prevent the disease from spreading to people in your home and community.

What to do if you are sick with coronavirus disease 2019 (COVID-19)

For more information: www.cdc.gov/COVID19

DISCLAIMER: COVID-19 information is rapidly changing and documents will be updated accordingly. March 6, 2020 of 125

www.cdc.gov/COVID19

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#2019-nCoV-and-animals

Qué hacer si tiene la enfermedad por el nuevo coronavirus 2019 (COVID-19) Si tiene COVID-19 o sospecha que ha contraído el virus que causa COVID-19, siga los siguientes pasos para evitar contagiar la enfermedad a las personas de su casa y su comunidad.

Quédese en casa excepto si necesita atención médica Debe evitar las actividades fuera de su casa, excepto si necesita atención médica. No vaya a al trabajo, la escuela o lugares públicos. Evite usar el transporte público, los vehículos compartidos o los taxis.

Aléjese de las personas y animales de su casa Personas: En la medida de lo posible, debe quedarse en una habitación específica y mantenerse lejos de las demás personas en su casa. Además, debe usar otro baño, si es posible. Animales: No toque a las mascotas u otros animales mientras esté enfermo. Para obtener más información, vea El COVID-19 y los animales.

Llame antes de visitar a su médico Si tiene una cita médica, llame a su proveedor de atención médica para decirle que tiene o es posible que tenga el COVID-19. Esto ayudará a que el personal del consultorio del proveedor de atención médica tome medidas para evitar que otras personas se infecten o queden expuestas.

Use un barbijo Debe usar un barbijo cuando esté con otras personas (por ejemplo, en una misma habitación o en un vehículo) o con mascotas y antes de entrar al consultorio del proveedor de atención médica. Si no puede usar un barbijo (por ejemplo, porque le causa problemas para respirar), las personas que viven con usted no deben quedarse en la misma habitación con usted, o deben usar un barbijo si entran en su habitación.

Cúbrase cuando tose y estornuda Cúbrase la boca y la nariz con un pañuelo cuando tose o estornuda. Tire los pañuelos usados en un tacho de basura; lávese inmediatamente las manos con agua y jabón durante al menos 20 segundos o límpiese las manos con un desinfectante para manos a base de alcohol que contenga al menos entre el 60 % y el 95 % de alcohol, cubriendo toda la superficie de las manos y frotando las manos hasta que se sientan secas. Si las manos están visiblemente sucias, es mejor lavarse con agua y con jabón.

Evite compartir artículos personales de la casa No debe compartir los platos, vasos, tazas, utensilios, toallas o sábanas con otras personas o con las mascotas en su casa. Después de usar estos artículos, se deben lavar bien con agua y detergente.

Límpiese las manos con frecuencia Lávese las manos con frecuencia con agua y jabón durante al menos 20 segundos. Si no dispone de jabón y agua, límpiese las manos con un desinfectante para manos a base de alcohol que contenga al menos el 60 % de alcohol, cubriendo toda la superficie de las manos y frotando las manos hasta que se sientan secas. Si las manos están visiblemente sucias, es mejor lavarse con agua y con jabón. Evite tocarse los ojos, la nariz o la boca si no se lavó las manos.

Limpie las superficies con mayor contacto todos los días Las superficies con mayor contacto son los mostradores, las sobremesas, las perillas de las puertas, los accesorios de baño, los inodoros, los teléfonos, los teclados, las tabletas y las mesas de luz. Además, limpie cualquier superficie que pueda tener sangre, heces o fluidos corporales encima. Use un aerosol o un paño de limpieza para la casa según las instrucciones de la etiqueta. Las etiquetas contienen instrucciones para el uso seguro y efectivo del producto de limpieza, incluidas las precauciones que debe tomar al usar el producto, como usar guantes y asegurarse de tener una buena ventilación cuando lo usa.

Controle sus síntomas Busque atención médica inmediata si su enfermedad empeora (por ejemplo, si tiene dificultad para respirar). Antes de buscar atención médica, llame a su proveedor de atención médica y dígale que tiene COVID-19 o que lo están evaluando para detectar si contrajo la enfermedad. Póngase un barbijo antes de entrar en el centro. Estos pasos ayudarán a que el personal del consultorio del proveedor de atención médica tome medidas para evitar que otras personas en el consultorio o en la sala de espera se infecten o queden expuestas. Pídale a su proveedor de atención médica que llame al departamento de salud estatal o local. Las personas que están bajo vigilancia activa o autovigilancia facilitada deben seguir las instrucciones dadas por su departamento de salud local o por los profesionales de salud ocupacional, según corresponda. Si tiene una emergencia médica y necesita llamar al 911, avise al personal de despacho que tiene COVID-19 o que lo están evaluando para detectar si contrajo la enfermedad. Si es posible, póngase un barbijo antes de que el servicio de emergencias médicas llegue.

Cuándo descontinuar el aislamiento domiciliario Los pacientes con COVID-19 confirmado deben permanecer en precauciones de aislamiento domiciliario hasta que se considere que el riesgo de transmisión secundaria a otros es bajo. La decisión de descontinuar las precauciones de aislamiento domiciliario se deben tomar caso por caso, consultando a los proveedores de atención médica y a los departamentos de salud estatales o locales.

Para obtener más información visite: www.cdc.gov/COVID19

EXENCIÓN DE RESPONSABILIDAD: La información sobre el COVID-19 cambia rápidamente y los documentos se actualizarán en consecuencia.

6 de marzo de 2020 of 125

https://www.cdc.gov/coronavirus/2019-ncov/faq.html%232019-nCoV-and-animals

https://www.cdc.gov/coronavirus/2019-ncov/faq.html%232019-nCoV-and-animals


如果您感染了 2019 年冠状病毒病 (COVID-19) 怎么办如果您感染了 COVID-19 或疑似感染了导致 COVID-19 的病毒，请遵循以下步骤，以帮助阻止疾病传播给您的家人和社区。

除了就医以外，待在家里除了就医以外，您应该限制户外活动。不要去上班、上学或前

往公共区域。避免使用公共交通工具、拼车或出租车。

自我隔离，远离家里的其他人和动物人：您应该尽可能待在特定的房间里，并远离家中的其他人。

而且，如果可以，您应该使用单独的卫生间。

动物：生病时，不要接触宠物或其他动物。参见 COVID-19 和动

物了解更多信息。

在看医生前，提前致电如果您有医疗预约，致电医疗保健提供者并告知他们您已经感

染或可能感染了 COVID-19。这将有助于医疗保健提供者的办公

室采取措施，以防止他人感染或接触病毒。

佩戴口罩当您周围有人（如共处一室或共乘车辆）或宠物时，以及在您

进入医疗保健提供者的办公室前，您应该佩戴口罩。如果您不

能佩戴口罩（例如，因口罩引起呼吸困难），则与您同住的人

不应该跟您共处一室，或者他们应该在进入您的房间时佩戴口罩。

咳嗽或打喷嚏时掩住口鼻当您咳嗽或打喷嚏时，用纸巾掩住口鼻。将用过的纸巾扔到有

内衬的垃圾桶中；立即用肥皂和水洗手 20 秒或用至少含有 60-95% 酒精的手部消毒剂清洁双手，涂满双手的所有表面并一

起揉搓，直至变干。如果双手明显脏了，应优先使用肥皂和水。

避免共用个人家居用品您不应该与家中的其他人或宠物共用盘子、水杯、杯子、餐具、

毛巾或床上用品。使用这些物品后，应该用肥皂和水彻底清洗。

经常清洁双手勤洗手，用肥皂和水至少洗 20 秒。如果没有肥皂和水，用至少

含有 60% 酒精的手部消毒剂清洁双手，涂满双手的所有表面并

一起揉搓，直至变干。如果双手明显脏了，应优先使用肥皂和

水。避免用未洗过的手触摸眼、鼻、口。

每天清洁所有“高频接触”的表面高频接触表面包括柜台、桌面、门把手、卫浴挂件、马桶、电话、键盘、平板电脑和床头柜。此外，清洁可能沾染血液、

粪便或体液的任何表面。根据标签说明，使用家用清洁喷雾或

湿巾。标签包括对安全有效使用清洁产品的说明，包括您在使

用产品时的注意事项，例如，使用产品时佩戴手套并确保通风

良好。

监测您的症状如果病情加重（例如，呼吸困难），立即就医。在就医前，致电您的医疗保健提供者并告知他们您已经患有 COVID-19 或正

在接受评估。进入医疗机构前，戴上口罩。这些措施将有助于

医疗保健提供者的办公室防止他人感染或接触病毒。

请您的医疗保健提供者致电地方或州卫生部门。处于主动监测

或有引导的自我监测的人员应该酌情遵守其地方卫生部门或职

业卫生专业人士的指示。

如果您有医疗紧急状况并且需要拨打 911，通知派遣人员您已

经患有 COVID-19 或正在接受评估。若可能，在急救医疗服务人

员到达前戴上口罩。

停止居家隔离在二次传播给他人的风险被认为较低前，COVID-19 确诊患者应

继续采取居家隔离预防措施。停止居家隔离的决定应视情况而

定，并咨询卫生保健提供者以及州和地方卫生部门。

了解更多信息：www.cdc.gov/COVID19

免责声明：COVID-19 信息变化迅速，文件将会相应更新。 2020 年 3 月 6 日

of 125




The COVID-19 pandemic is affecting people in different ways. For those struggling with addiction

and mental illness, this can be a hard time. Here are six things to keep in mind right now.

Keep your distance without feeling isolated

Social distancing measures are meant to save lives and

limit the spread of COVID-19. For people working toward

or in recovery, being alone can be hard. But even

though we’re physically apart, support is still available.

For example, AA and NA have remote meetings.

Don’t ignore the impact of this traumaThe COVID-19 pandemic is a public health and economic

crisis. This experience can be traumatizing for some

people. It can make us fearful, lonely and anxious.

Trauma can be a trigger for people with substance use

disorder, pushing them to alcohol or drugs. Trauma also

can make an existing mental health disorder worse.

Talking to your doctor or a mental health provider can

help. Don’t be afraid to reach out when you need help.

Take advantage of telehealthTelehealth allows you to speak with a provider using your

phone, tablet or computer. Getting care from home

helps limit the spread of COVID-19. If you’re scheduling

a doctor’s visit, ask about telehealth.

Learn about options for smoking cessationIf you smoke or use e-cigarettes, you may be at an

increased risk for complications from COVID-19. Your

doctor may talk to you about these risks. There are

also several therapies that can help you quit. Ask your

doctor to help you find one that’s right for you.

Get help for opioid use disorder.

If you or a loved one is dealing with opioid addiction, help

is available. Doctors can prescribe life-saving medications

and can see you via telehealth or in the office.

Remember that addiction doesn’t stop for a pandemicDuring this public health crisis, people continue to

struggle with addiction to drugs and alcohol. Your doctor

or a mental health provider can help. Don’t hesitate to

contact them for support.

1

2

3

4

5

6

Get the help you needIf you or someone you love is considering harming themselves, the National Suicide Prevention Lifeline can help. Call 800-273-8255.

The opposite of addiction is human connection, not sobriety.”“Get Help for Addiction During COVID-19

of 125