Medical Partners

COVID-19 Protocols For Healthcare

The Ministry of Health has implemented guidelines with regards to protecting the health and safety of Ontario's Healthcare Facilities during COVID-19. These are recommendations as well as descriptions of mandatory safety and health standards and are intended to assist employers in providing a safe and healthy workplace.

No Wait Medical Partners focuses on the need to follow appropriate guidelines during work shifts and while at home.


General Responsibilities



Assess the hazards to which your staff, patients, and visitors may be exposed; evaluate the risk of exposure and select, implement, and ensure workers use controls to prevent exposure.


1. Implementing Basic Infection Prevention Measures



-Hand Hygiene


  • Promote frequent and thorough hand washing, including providing employees and customers with a place to wash their hands. If soap and running water are not immediately available, foam alcohol-based hand rubs containing 60-90% alcohol should be provided. Regular hand washing or using of alcohol-based hand rubs are necessary. Hands should be washed when they are visibly soiled and after removing any Personal Protective Equipment (PPE).


  • Provide resources and environment that promotes personal hygiene, including tissues, no-touch trash cans, hand soap, disinfectants, and disposable towels to clean surfaces. Post hand washing signs in restrooms. Ensure clean toilet and hand washing facilities. Fill hand sanitizer dispensers regularly. Disinfect frequently touched items, including door pulls and toilet seats often.


-Respiratory Etiquette


  • The importance of covering coughs and sneezes with a tissue should be emphasized. Afterwards, throw the tissue away into the trash and perform hand hygiene.


  • Avoid touching the face, especially with unwashed hands.


-Source Control


  • Staff, patients, and visitors should wear non-medical masks over their nose and mouth to prevent them from spreading the virus, though it is not PPE. Cloth face coverings should not be placed on children younger than 2 years old, anyone who is incapacitated or otherwise unable to remove the cloth face covering without help, and people who cannot tolerate them based on underlying health and/or behavioral issues. Ontario's universal masking document explains the safe use, limitation, and care of non-medical masks.


-Enhanced Sanitation


  • Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the environment. When cleaning tools and equipment, staff should consult manufacturer recommendations for proper cleaning techniques and restrictions (e.g., concentration, application method and contact time, PPE).


  • Develop a disinfection schedule or routine plan, especially for high contact areas like restrooms. Ensure sufficient stocks of cleaning and disinfecting supplies to accommodate ongoing cleaning and disinfection. High touch areas should be cleaned and disinfected (e.g. doorknobs, display cases, equipment handles) more frequently. Plexiglass barriers should be cleaned routinely (e.g. daily) using a cleaning agent that will not compromise the structural integrity or function of the barrier.

Donation

2. Preparation



-Organizational Risk Assessment


  • Implement a system for virtual and/or telephone consultations and use this whenever possible to determine whether a virtual/telephone consultation is sufficient, or an in-person appointment is necessary to support physical distancing.


  • Minimize the amount of staff needed in the facility; consider tasks that can be done at home or outside of regular hours.


-Point of Care Risk Assessment


  • All health care workers (HCWs) should be trained to assess the risk of each patient interaction and implement appropriation precautions (e.g. routine, contact, droplet, airborne).


-Hazard Controls


  • Elimination/Substitution


    • When feasible, replace in person visits with virtual or telephone ones to avoid face-to-face interaction.


  • Engineering/System Controls


    • Install partition barriers such as plexiglass.


    • Minimize traffic flow in common spaces (e.g. hallway markers, limit number of people in elevators).


    • Space out waiting room chairs to facilitate physical distancing.


    • Remove non-essential items such as magazines and toys from patient care areas.


  • Administrative Controls


    • Minimize the need for waiting by spreading out appointment times, and/or ask the clients to wait in their car.


    • Ensure patients do not leave personal affects and masks in waiting rooms.


    • If feasible, take note of persons present during the office/clinic to facilitate contact tracing if necessary.


  • PPE


    • PPE can be used by trained personnel to lower the risk of transmission.


3. Personal Protective Equipment



Before shortages occur, optimize the use of Personal Protective Equipment (PPE) so that HCWs may be able to protect themselves. To identify additional supplies, Ontario has created a PPE Supplier Directory website. When providing services to a person with suspected or confirmed COVID-19, use PHO's Technical Brief and applicable directives from the Chief Medial Officer of Health.


  • Conduct a point-of-care risk assessment for every patient interaction for determining the level of precautions. Due to the level of community transmission in Ontario, it is recommended that HCWs in direct contact with patients wear surgical/procedure masks for the full duration of their shift.


  • Sanitize hands before and after contact with the patient or their environment, and after removing PPE.


  • While caring for and being within 2 metres of patients that screen negative, wear a surgical or procedure mask and consider the use of eye protection.


  • While caring for and being within 2 metres of patients that screen positive, use droplet and contact precautions such as wearing a surgical mask, isolation gown, gloves, and eye protection.


  • When an aerosol generating procedure is planned or anticipated, use contact, droplet, and airborne precautions such as a minimum of a properly fitted N95, eye protection, isolation gown, and gloves. Use an airborne infection isolation room, or negative pressure room if available.


4. Screening



  • Everyone regardless of symptoms should wear a cloth face covering at check in until leaving the facility.


  • Instruct patients to call ahead before entry so preparations may be made for their arrival or triage to another setting.


  • Post screening information on a website, send an email containing screening requirements, or consider mailing by post if the client does not have access to the other methods.


  • Active Screening


    • Before entering the treatment are, facilities should identify individuals with fever or symptoms consistent with COVID-19. This guidance document for screening patients contains symptoms and risk factors.


    • Screeners should be behind an engineering barrier such as a plexiglass screen. If that is not possible, they should maintain a 2 metre distance from the person they are screening and wear droplet/contact precaution PPE such as gloves, gown, surgical mask, and eye protection.


    • For clients, conduct active screening over the telephone when possible. Report to the local public health unit if the client has symptoms or health history compatible with COVID-19.


  • Passive Screening


    • Post signage for passive screening at entry points for people to self-identify if they screen positive according to the case definition.


  • Positive Screens, Over Phone


    • If possible, clients should be offered alternative care that does not require an in-person visit. If the situation is urgent, refer to an emergency department.


  • Positive Screen, In Person


    • If droplet/contact measures are implemented, staff may continue to treat the client.


    • Patient should be given a surgical mask and hand sanitize. They should be placed in a separate room with the door closed.


    • If symptoms are severe, arrange for safe transportation to the emergency department and let the operator know of their COVID-19 consistent symptoms.


5. Testing



More instructions can be found at the COVID-19 Provincial Testing Guidance Update.


  • Symptomatic


    • When ever symptoms consistent with COVID-19 are present, a test is recommended.


  • Asymptomatic and Risk Based


    • Should be done when the person is in contact with someone who tests positive for COVID-19, is part of an outbreak investigation.


  • Specimen Collection


    • Collect a single upper respiratory tract specimen, such as nasopharyngeal (NP) swab (preferred), deep nasal swab (second preference), or a viral throat swab.


    • NP swabs can be performed with droplet/contact measures since it is not considered an aerosol generating procedure.


    • Pre-label the swab to avoid further handling after obtaining a specimen. Place specimens in the specimen bag with a completed COVID-19 virus test requisition placed in the attached pouch to prevent contact with the specimen. Send specimens to a PHO Laboratory or other appropriate laboratory with testing capacity.


No Wait Medical Partners enables safe and timely triage, antibody testing, monitoring, contact tracking and containment of suspected or confirmed COVID-19 positive employees. No Wait Medical Partners contributes to limiting exposure and risk management and enables contact tracing for suspected COVID-19 positive employees.

6. Reporting



COVID-19 is a disease that is significant to public health and is therefore reportable.


  • Confirmed: If there is a confirmed case of COVID-19, report to the local public health unit.


  • Suspected, Results Pending: If there is as suspected case of COVID-19, the person does not need to be admitted to the hospital, and a test has been administered with results pending, consult the hospital Infection Prevention and Control Department and the local public health unit before the individual leaves the acute care setting.


  • Results: Will be communicated through routine processes for positive and indeterminate cases of COVID-19. Results will be reported to the ordering healthcare provider.


7. Support for Employees



  • Mental health support should be provided to all employees, including access to an employee (and family) assistance program (EAP/EFAP) if available. Additional comping resources include the Centre for Addiction and Mental Health and Canadian Mental Health Association. Emergency communications plans should be developed, including a forum for answering employees' concerns and internet-based communications, if feasible. Other support factors to consider include parenting, meals, and non-punitive sick policies.


No Wait Medical Partners is available to provide psychological supports, including mental health support, and psychoeducation." with "No wait medical could help retail business find a third-party mental health provider upon request.


8. Education



-General Education

  • Post signs covering social distancing, hand hygiene, respiratory hygiene, and cough etiquette.


  • Instruct patients to call ahead if they have fever or symptoms consistent with COVID-19.


  • Educate patients on how they can protect themselves by adhering to social distancing, performing hand hygiene, and wearing cloth face covering for source control.


-Staff Training

  • Provide staff with up-to-date education and training on COVID-19 risk factors and protective behaviors (e.g., cough etiquette, proper hygiene practices, and care of PPE).


  • Train staff who need to use protecting clothing and equipment, and on how to examine it, put it on, use/wear it, and take it off correctly, within the context of their current and potential duties. Content should emphasize having clean hands before facial contact. Training should be conducted virtually or maintain social distancing.


  • Staff should be trained on the signs and symptoms of COVID-19 with an explanation of how the disease is potentially spread, including the fact that infected people can spread the virus even if they do not have symptoms.


  • Emphasis should be placed on the need for staff to report any safety and health concerns.


9. Absenteeism



  • Flexible sick leave policies should allow staff to stay at home in the event of sickness, possible exposure, or caring for someone who is sick. Evaluate whether the work duties can be done through telework.


  • Administration should inform and encourage staff to self-monitor for signs and symptoms of COVID-19 if they suspect possible exposure.


  • Staff who have symptoms should notify their supervisor and be encouraged to stay home, and a note from their healthcare provider does not need to be provided in order to validate illness, or their ability to return to work. Sick leave policies should be flexible and consistent with public health guidance and with No Wait Medical Partners, and employees should be made aware of these policies. Employees should not return to work until the criteria to discontinue home isolation are met, in consultation with No Wait Medical Partners. Prompt identification and isolation of potentially infectious individuals is a critical step in protecting employees and customers.


  • Staff who are well but who have a sick family member at home with COVID-19 should notify their supervisor and consult with No Wait Medical Partners regarding the mandatory precautions. Policies should permit employees to stay home to care for sick family members, including sick children or children who are in schools or day care centers that have been closed, or who have immunocompromised family members, and are afraid to come to work because of fear of possible exposure. Staff concerns about pay, leave, safety, health, and other issues that may arise during infectious disease outbreaks should be addressed, and employers are encouraged to work with insurance companies (e.g., those providing employee health benefits) and state and local health agencies to provide information to staff and families about medical care in the event of a COVID-19 outbreak.


No Wait Medical Partners will provide daily follow up on employees who are self-isolating at home, and on what their expected return to work dates will be.


Community Care



A. Community Laboratory and SCC Guidance



Have written procedures for infection prevention and control developed with joint health and safety committee or health and safety representative guidance.


  • Positive screening over phone: The urgency of the test should be determined by the healthcare provider on the phone. If possible, the patient should be asked to rebook once the are no longer symptomatic and/or after 14 days. They should be advised to call their family physician or to speak with a registered nurse at Telehealth Ontario at 1-866-797-0000. Patients with a positive screening should not show up unannounced.


  • Positive screening at the community laboratory: Patients with a positive screening should be advised to go home and self-isolate. Also, they should be advised to call their family physician or to speak with a registered nurse at Telehealth Ontario at 1-866-797-0000. If their lab test is urgent, they should be separated from other patients so that they are at least 2 metres apart and given a surgical/procedure mask. The surfaces that they touch should be disinfected as soon as possible following Routine Practices and Additional Precautions.


  • Continuing care: If the lab requisition is urgent, lab staff should wear droplet/contact PPE for obtaining the test. Should the lab not have this ability, the patient should call the healthcare provider who ordered the test for a referral to an appropriate hospital lab.


  • N95 masks are not necessary for specimen collection.


B. Consumption and Treatment Services (CTS) Sites



  • Physical Space: Within the CTS space, consider ways to increase physical distance to 2 meters apart (e.g. spacing the consumption booth, using every 2nd booth, staggering attendance) to maintain social distancing.


  • HCWs: To minimize risk and optimize use of resources, have designated HCWs who are trained in PPE, IPAC, and resuscitation to respond to overdoses whenever possible. All HCWs need to conduct a point-of-care risk assessment before every patient/client interaction.


  • Self-monitoring: Instruct staff and volunteers to self-monitor for signs and symptoms (e.g. fever, cough, shortness of breath, etc.) of COVID-19, as well as exposure risks that would require self-monitoring. If isolating or with other symptoms of an acute respiratory infection, HCWs, staff, and workers must stay at home.


  • Positive Screening: Provide guidance for when it is appropriate to stop self-isolation for anyone with respiratory symptoms or postpone their visit after 14 days for anyone travel history, or exposure to a case. For positive screenings, instruct the client to wear a surgical/procedure mask, encourage respiratory etiquette, hand hygiene, and place the client in a room with a closed door separate from other clients. If a room is not available, place the client in a separate area.


  • Suspected or Confirmed COVID-19 Positive Client: Use droplet/contact precautions if providing services to a client with suspected or confirmed COVID-19.


C. Home and Community Care Providers



For additional information refer to Emergency Homecare Protocols.


  • Self-monitoring: Care providers should conduct self-monitoring at least twice daily and follow employer screening practices.


  • Screening: The screening process should be established and consistently performed by a personal support worker, scheduler, or manager. The client should be screened over the phone before in person visits, or at a minimum of 2 metres way if that is not possible due to client circumstances. Screen any other person(s) that will be in the home during the appointment.


  • Source Control: If tolerated and available (provide one if they do not have one), clients should wear a mask or face covering.


  • Self-monitoring: Care providers should conduct self-monitoring at least twice daily and follow employer screening practices.


  • Positive Screening, for Care Provider: Notify supervisor immediate and go to an assessment centre for testing.


  • Positive Screening, for Client: Care providers should instruct clients to go to an assessment centre for testing. If the client is severely ill, the care provider should call 911 and notify the operator that symptoms of COVID-19 are present in the client.


  • Health and Safety: Employees should be trained in the use of PPE (e.g. donning, doffing, safe use, care limitations, disposal).


    • Surgical masks should always be worn during the home visit. If within 2 meters of an unmasked patient, eye protection is required as well.


    • Hand hygiene should be performed before and after PPE usage, and before and after contact with the client and their environment.


    • Disinfect and clean equipment used on the client after each use.


  • Suspected or Confirmed COVID-19 Positive Client: Delay care if possible; only provide essential nursing, therapies, and personal support services. If a home visit must be conducted, use droplet/contact precautions.


D. Immunization Services



  • Planning


    • Immunizations should be conducted by appointment. Communicate (e.g. booking, website, voicemails, signage, active screening) that parents should not come to the appointment if they or their child is sick.


    • Have a dedicated space and time with all equipment in the room. Have the patients come directly to and remain in the immunization room for the assessment, immunization, and 15-minute wait period.


  • Immunization Service


    • When performing immunizations, strongly consider wearing a surgical/procedure mask and eye protection.


    • Gloves do not need to be worn unless skin integrity is compromised, administering an intranasal or oral vaccine due to the increased likelihood of coming into contact with mucous membranes and body fluids, and/or administering a Bacille Calmette-Guerin (BCG) vaccine.


    • After each client perform hand hygiene, and change gloves if required. Clean high touch surfaces after the patient leaves.


  • Groups Requiring Immunization


    • Identify and offer vaccinations to those who are due for any vaccine (prioritizing the primary vaccination series for infants and toddlers), at increased risk for acquiring or transmitting vaccine preventable diseases or at increased risk for their complications, and missed vaccine doses.


  • Timing of Vaccinations


    • Due and overdue vaccinations should be administered according to the Publicly Funded Immunization Schedules for Ontario. Multiple immunizations may be immunized with exceptions in the Canadian Immunization Guide (e.g. inactivated vaccines against the same disease at different visits, live injection wait period of 4 weeks, live oral and intranasal of cholera and typhoid should be 8 hours apart).


    • Know the vaccination schedule for school age children outlined in the Immunization of Schools Pupils Act.


    E. Mental Health and Addiction in the Community



    • Policies: Consider implementing policies that limit one support person per client.


      • Be aware of local masking/face covering requirements and their consequences on providing mental health services. Workers and volunteers in mental health and addiction facilities should wear non-medical masks or face coverings during their shifts and only remove them during breaks when they are 2 metres away from others. If the client is not able to wear a face mask, have alternative measures for worker protection against droplets (e.g. virtual visits, physical distancing, plexiglass barrier, eye protection).


      • Establish policies for required supplies when making in person visits.


      • Ensure contact information is current and track a daily log of workers, clients, and visitors to facilitate contact tracing if needed.


    • Planning: Continue to offer virtual/telephone services for both individual and group sessions to replace in-person encounters.


    • Screening: Pre-screen prior to appointments and discuss physical distancing and masking. If making home visits, request to minimize the amount of people in the room. Educate workers on active screening procedures for anyone entering the organization.


    • Infection Prevention: Educate clients on hand hygiene practices, respiratory etiquette, source control, and physical distancing, and other ways to protect against COVID-19 such as not sharing personal items. Discuss the risks of COVID-19 with the client and explain steps taken in the organization and community in an easily understandable way.


    • Child and Youth Mental Health Providers: If there is a suspected COVID-19 exposure, notify the program supervisor and submit a Serious Occurrence Report related to COVID-19. Follow direction from the governing body of the organization.


    • COVID-19 Positive: If clients wit suspected or confirmed COVID-19 require care, offer a virtual/telephone appointment to facilitate self-isolation. If a home visit is required, ensure the worker is using PPE properly and always maintains a distance of 2 metres or more.


    E. Pharmacies



    • Positive screening over phone: Refer the patient who screens positive on the phone to a local testing location or emergency department. The Ontario assessment centre locator is a tool for directing patients to the nearest testing centre. Instruct patients to self-isolate until receiving test results and further instruction.


    • Positive screening at the community laboratory: Patients who screen positive at the community pharmacy should be separated from other patients so that they are at least 2 metres apart and given a surgical/procedure mask. If the patient is very ill, an ambulance should be called and the operator should be notified of the possible COVID-19 case. Both mild positive screenings and severe illness should be notified to the local public health unit for travel and further assessment arrangements


    • Continuing care: Medications may be delivered to patients who screen positive or are self-isolating without direct contact, such as having a trusted person outside of the household pick up the medication, or delivery to their mailbox while considering security and storage concerns.


Other Care Settings



A. Acute Care



Factors that a written COVID-19 plan must have include elements for the protection of patients, HCWs, and visitors.


  • Visitation


    • Policies should mitigate risk to visitors and patients while considering their mental, physical, and spiritual needs. They should be adaptable and consider the healthcare setting, community COVID-19 situation, role of the visitor, and patient circumstance. Consider revising existing visitor policies for essential visitors to include family/caregivers.


    • Follow infection prevention and control measures and reinforce protective behaviors such as hand sanitizing.


    • Continue to provide updated information to staff, patients, and visitors. Support the continuous education of the public on COVID-19 risks.


  • Managing Patients


    • Triage should have trained HCWs overseeing it. Appropriate signage (e.g. hand hygiene, respiratory hygiene, cough etiquette, social distancing) should be posted at entrances and other locations. Supplies (e.g. hand sanitizer, tissues) should be readily available along with receptacles for waste, preferably with a closed, no-touch lid.


    • Telehealth triage or other non-face-to-face triage options should be established. The system should be able to prioritize patients who require medical evaluation.


    • Possible COVID-19 patients should have a separate evaluation and triage area; in lieu of such space, a system that allows those patients to wait in their vehicle or outside the facility should be established.


    B. Hospice Care



    Palliative and/or end-of-life care improves the quality of life for those living with life-threating illness and their families. Efforts should be made to support patients and their families amidst the challenges that COVID-19 present.


    • Essential Visitors: No visitors except those performing essential support services or visitors of a patient nearing the final days of their life may be permitted in hospices. The essential visitor should only visit one patient and wear a mask while in the residential hospice. Appropriate PPE should be worn if the patient in the hospice has COVID-19


    • Screening, Visitors: Only visitors with no typical or atypical signs and symptoms of COVID-19 or contact history with suspected or confirmed cases of COVID-19 within the past 14 days should be permitted to enter.


    • Screening, Patients: Patients should be screened twice daily with temperature checks. Patients with any symptoms should be isolated and tested for COVID-19. Newly admitted patients regardless of testing status should be placed in a single room under droplet/contact precautions for 14 days upon admission. Test new patients as soon as possible, and within 14 days, if testing is not done prior to admission.


    C. Primary Care



    To ensure a healthy population, primary care facilities must continue to operate. Two good resources for continuing to care for patients in COVID-19 are Primary Care Operations in the COVID-19 Context and COVID-19: Clinical Guidance for Primary Care Providers. Primary care providers should continue being available for medication renewals, including for patients on controlled substances or opioid agonists who will need renewals by their main prescriber.


    • Positive screening over phone: If a patient screens positive over the phone, ideally, they should be offered a telephone consultation with a primary care provider on the same day.


    • If they have severe symptoms, they should be directed to the emergency department; otherwise, they should be instructed to self-isolate. The primary care provider should take the clients history, assess, and discuss management of symptoms.


    • If COVID-19 is suspected due to symptoms, arrange for COVID-19 testing at an assessment centre. If the client declines testing, instruct them to self-isolate for 14 days following symptom onset if they are afebrile and symptoms improve.


  • Positive screening in the office/clinic: Patients with a positive screening should be placed in a separate room with the door closed and avoid contact with other patients in common areas. If an examination room is not available, instruct the patient to wait outside and contact them via call or text when a room becomes available. Isolate each symptomatic patient individually.


    • Ensure the patient has hand sanitizer, tissues, and a hands-free waste receptacle for used tissues and masks. Emphasize respiratory etiquette and handwashing.


    • If primary care providers can follow contact/droplet precautions and know how to handle, don, doff, and dispose of appropriate PPE, they ma


    • If primary care providers cannot follow contact/droplet precautions, they should divert care as appropriate such as the emergency department if the reason for the medical visit is urgent, or an assessment centre if the visit can be deferred.


  • Testing: Primary care providers should offer or arrange for testing for anyone with new or worsening symptoms compatible with COVID-19 that is not a runny nose or nasal congesting attributed to an underlying condition. Primary care providers should know local testing locations such as the emergency department, drive-thru testing centres, and/or assessment centre and their protocols.


    • Refer patients to the nearest emergency department or testing location according to the testing location's protocols. Ensure the patient has safe arrangements for transportation that maintains the isolation of the patient.


    • Testing in the primary care office/clinic can only be performed if the primary care provider can follow droplet and contact precautions, has the tools and knowledge to test, and can coordinate sample delivery to a laboratory providing COVID-19 testing.


  • Contact Surfaces: After every patient visit regardless of symptoms being present or not, disinfect all patient contact surfaces and used equipment before the next patient.


D. Long-Term Care Homes (LTCH) and Retirement Homes (RH)



Employees may not work at more than one LTCH, RH or health care setting due to their unique position in being in contact with vulnerable populations. Additional guidance can be found at COVID-19 Guidance: Long-Term Care Homes and Reopening Retirement Homes.


  • Essential Visitors


    • No visitors except those performing essential support services or visitors of a patient nearing the final days of their life may be permitted in LTCHs and RHs. The essential visitor should only visit one patient and wear a mask while in the facility. Visitors should be given a mask for source control, ad additional PPE if visiting a resident with suspected or confirmed COVID-19.


  • Screening


    • Active screening should be conducted twice daily (e.g. beginning and end of each shift for staff, entering and leaving for visitors, beginning and end of day for residents).


    • Patients with any symptoms should be isolated and tested for COVID-19. Newly admitted patients regardless of testing status should be placed in a single room under droplet/contact precautions for 14 days upon admission. Test new patients as soon as possible, and within 14 days, if testing is not done prior to admission.


  • Protective Equipment


    • Ensure staff wears protective equipment and conduct a point of care risk assessment before each interaction. Staff and essential visitors should also wear surgical/procedure masks for the duration of their shift or visit to prevent asymptomatic transmission.


  • Outbreak and Testing


    • One confirmed COVID-19 case in a resident or staff is considered an outbreak. Consult with the home and a health unit to declare an outbreak number if it is necessary.


    • Symptomatic residents should be placed under droplet and contact precautions, preferably in a single room, and tested immediately. Their roommate should be tested and other contacts on a risk-based approach. Consider those who were in contact and not in droplet/contact precautions with isolation.


    • Symptomatic staff or essential visitors should self-isolate and have facilitated testing for COVID-19.


    • The symptomatic testing threshold should be very low for residents and HCWs. Requisitions should use have the setting as "Institution" before an outbreak number is issued.


    • Asymptomatic testing should be conducted during an outbreak for residents living in adjacent rooms, staff on the unit, essential visitors who attended to the unit, and other appropriate contacts.


E. Labour, Delivery, and Newborn Care



  • Timing and Location


    • One confirmed COVID-19 case in a resident or staff is considered an outbreak. Consult with the home and a health unit to declare an outbreak number if it is necessary.


  • PPE for Labour, Delivery, and Newborn Care


    • Give the patient a surgical/procedure mask. Use droplet/contact precautions at all stages, especially for mothers with suspected or confirmed COVID-19.


  • Screening


    • Two fevers 37.8C or greater spaced 30 minutes apart is a sign of suspected COVID-19.


  • Positive Screening, for Patient:


    • The patient should be given a surgical/procedure mask for all stages of COVID-19. Counsel patients with suspected or confirmed COVID-19 with the benefits and risks of keeping mother and baby together using a patient-centered approach. Examine strategies to reduce the risk of spread if they are kept together.


  • Support Person


    • A consistent single support person may accompany the mother during labour and delivery if they screen negative for symptoms of COVID-19 and if the institution has enough PPE for them, adequate spacing to facilitate physical distancing from other patients and support persons, and the ability to ensure the support person is compliant with instructions and physical distancing measures.


    • The institution should consider different policies for women with suspected or confirmed COVID-19 than for asymptomatic women, ways to minimize movement through care environments by the support person, and alternative options such as virtually for support.


  • Testing


    • Within 24 hours of delivery, newborns born to mothers with confirmed COVID-19 at the time of birth should be tested. If maternal testing is still pending before the discharge of mother and baby, ensure follow up if the maternal test is positive so the baby may be tested in a timely fashion.


    • The preferred neonatal sample is a NP swab placed in a universal transport medium (UTM) for PCR testing, followed by nasal, deep nasal or throat swab collection as alternative collection methods if the size of the NP swab is not feasible for the newborn.


    • Symptomatic newborns may have more extensive lab investigation, such as PCR testing of placental swab or tissue, umbilical cord blood and/or neonatal blood. The clinical team should decide if expanded testing is necessary.


    • Discuss positive COVID-19 tests in a newborn with a pediatric infectious disease consultant.


  • Babies Born to Suspected or Confirmed COVID-19 Positive Mothers


    • If neonatal resuscitation is required, Droplet/Contact precautions are sufficient.


    • Babies may stay in the mother's postpartum room though having a private room, mother wearing a mask, performing hand hygiene before care of the baby, skin hygiene before breastfeeding, and keeping the infant two metres away from mother when not directly caring for them to protect against droplets is recommended.


    • Have a separate newborn care area with caregiver available for if the mother is unable to care for their infant due to symptoms or wishes to prevent COVID-19 transmission.


    • Discharge healthy infants as early as possible after a risk assessment.


    • Provide clear instructions for mothers with confirmed COVID-19 and their infants to follow up with the primary care provider(s) until two weeks postpartum. Advise mothers on how to self-isolate and to call prior to visiting their primary care provider(s).


  • Breastfeeding Mothers with Suspected or Confirmed COVID-19


    • Perform hand hygiene before touching their infant, bottles, breast pump. Perform breast and skin cleansing before holding and feeding.


    • Wear a mask when holding or feeding their infant and cough or sneeze away from their infant.


    • Clean pumps and bottles according to the institutions infection prevention and control policies.


  • Neonatal Intensive Care Unit (NICU) and Special Care Nursery (SCN)


    • Use Droplet/Contact precautions at all times and Airborne precautions as needed.


    • Infants born to COVID-19 positive mothers should be tested within the first 24 hours of life, and at 48 hours of life if the first test is negative. Discuss positive COVID-19 tests in a newborn with a pediatric infectious disease consultant. Consult the IPAC department for measures to take for infants who test negative at 48 hours.


    • Mothers with confirmed, or suspected with a pending test, COVID-19 may not enter the NICU/SCN unless they are considered negative. Use electronic means to update parents who are excluded from the NICU/SCN on their infant's condition.


    • If a visitor or HCW to the unit is determined to be a suspected or confirmed COVID-19 case, the baby becomes a possible contact and isolation with additional precautions is required. Follow up with the institution's IPAC department.


F. Paramedic Services



The Central Ambulance Communications Centres (CACC)/Ambulance Communications Officers (ACO) are key components to communication during an emergency medical situation..


  • CACC Phone Screening: The CACC should notify patients suspected of COVID-19 to the paramedics crew, who should be protected using Droplet and Contact Precautions.


  • Paramedic on Scene Screening: If the patient screens positive on scene, paramedics should instruct them to wear a surgical/procedure mask if it is tolerated. Paramedics should conduct point of care risk assessments and consider that COVID-19 transmission can occur through direct or indirect contact, droplet, or through aerosol generating procedures. They should notify the ACO and notify the receiving facility of the possible case so they may take precautions for the patient.


Employee Guidelines



  • The Ministry of Health Ontario has implemented guidelines on how individuals can protect themselves and their co-workers from COVID-19. Employees are encouraged to forward any questions or concerns that they may have to No Wait Medical Partners.


Protecting Yourself and Others



  • -Hand Hygiene


  • Practice good hygiene. Wash your hands frequently with soap and water for at least 20 seconds, or if soap and water are not immediately available, then use an alcohol-based hand sanitizer that contains at least 60% to 90% alcohol and rubbing hands until they are dry. Avoid touching your face.
    COVID-19 Guidlines

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-Respirator Etiquette


  • Follow the proper guidelines for covering coughs and sneezing (i.e., sneezing or coughing into a tissue or into the upper sleeve). Always wear a face mask while in the workplace, and the mask should cover your nose and mouth. Learn how to properly put on, use/wear, and take off protective clothing and equipment.


  • If possible, wear cloth face coverings protect others in case the wearer is unknowingly infected. Cloth face coverings should not be placed on babies and children younger than 2 years old, anyone who has trouble breathing or is unconscious, or anyone who is incapacitated or otherwise unable to remove the cloth face covering without help. Cloth face coverings are not a substitute for N95 respirators or facemasks for HCWs.


-Social Distancing


  • Maintain 2 metres of social distancing as work duties permit, and avoid physical contact with others, including other staff and patients.


  • Use alternatives ways to shake hands upon entry, and it is important to not touch your face (i.e., mouth, nose, eyes).


  • Drive to facilities or parking areas individually; when possible, an avoid having passengers.


Health Care Provider Responsibilities



Employees may not work at more than one LTCH, RH or health care setting to minimize risk of transmission.


  • Conduct a point-of-care risk assessment for every patient interaction for determining the level of precautions.


  • Sanitize hands before and after contact with the patient or their environment, and after removing PPE.


  • While caring for and being within 2 metres of patients that screen negative, wear a surgical or procedure mask and consider the use of eye protection.


  • While caring for and being within 2 metres of patients that screen positive, use droplet and contact precautions such as wearing a surgical mask, isolation gown, gloves, and eye protection.


  • When an aerosol generating procedure is planned or anticipated, use contact, droplet, and airborne precautions such as a minimum of a properly fitted N95, eye protection, isolation gown, and gloves. Use an airborne infection isolation room, or negative pressure room if available.


What should I do if I become ill?



  • Notify your supervisor and No Wait Medical Partners immediately.


Resources:

Below are some resources on government approved guidelines around proper hygiene and cleaning practices, and the use of Personal Protective Equipment (PPE) for COVID-19.


Environmental Cleaning


Infection Prevention and Control


Self-Isolation


Community Labs and Specimen Collection Centres (OMH guidelines)


Community Pharmacies (OMH guidelines)


Consumption and Treatment Services (CTS) Sites (OMH guidelines)


COVID-19 Guidance Acute Care (OMH guidelines)


COVID-19 Operational Requirements Health Sector Restart (OMH guidelines)


COVID-19 Outbreak Guidance for Long Term Care Homes (OMH guidelines)


Guidance for Immunization Services During COVID-19 (OMH guidelines)


Home and Community Care Providers (OMH guidelines)


Hospice Care (OMH guidelines)


Independent Health Facilities (OMH guidelines)


Labour, Delivery and Newborn Care (OMH guidelines)


Long-Term Care Homes (OMH guidelines)


Mental Health and Addictions Service Providers in Community Settings (OMH Guidelines)


Paramedic Services (OMH guidelines)


Primary Care Providers in a Community Setting (OMH guidelines)


Reopening Retirement Homes (OMH guidelines)


Screening Tool for Long-Term Care Homes and Retirement Homes (OMH guidelines)