Medical Partners

COVID-19 Protocols For Healthcare

The Centers for Disease Control and Prevention (CDC) have implemented guidelines with regards to protecting the health and safety of America'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. A tool is Ten Ways Healthcare Systems Can Operate Effectively during the COVID-19 Pandemic . To help predict risk and allocate resources, the COVID-19 Surge tool can be used to estimate influx of new patients.


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, alcohol-based hand rubs containing at least 60% 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.


-Universal Source Control


  • Staff, patients, and visitors should wear 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 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.


-Enhanced Sanitation


  • Maintain regular housekeeping practices, including routine cleaning and disinfecting of surfaces, equipment, and other elements of the environment. When equipment must be shared, instruct staff and older children to use alcohol-based wipes to clean before and after use. 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).


  • When choosing cleaning chemicals, employers should consult information on Environmental Protection Agency (EPA)-approved disinfectant labels from List N, or that have claims against emerging viral pathogens, or that have label claims against the coronavirus for cleaning frequently touched surfaces like tools, handles, and machines. Products with EPA-approved emerging viral pathogens claims are expected to be effective against COVID-19, based on data for harder to kill viruses.


  • 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.

Donation

2. Preparation



COVID-19 Guidlines

Click here to view PDF


3. Telehealth



Telehealth can facilitate social distancing while continuing care, prevent negative consequences from delayed care, and reach populations who do not have ready access to providers.


-Modalities

  • Synchronous: Real time live audio or audiovisual conferencing.


  • Asynchronous: Stored data to be responded to a later time (e.g. secure messaging).


  • Remote patient monitoring: Transmit a client's clinical measurements to their HCP.


-Safeguards

  • Stay updated on federal and state regulations, temporary mandates and directives, expiration dates, and extensions.


  • Train staff on telehealth service policies, practices, and protocols (e.g. scheduling, documentation, billing, referral process, urgent and emergent care, laboratory services, prescriptions, medical equipment, follow up visits)


4. Personal Protective Equipment



  • Before shortages occur, optimize the use of Personal Protective Equipment (PPE) so that HCP may be able to protect themselves. To identify additional supplies, facilities should communicate with local health coalitions and federal, state, and local public health partners. Staff who need to wear PPE require training to safely don and doff. Facilities must understand their consumption of PPE. The PPE Burn Rate Calculator is a tool developed by CDC to help optimize the use of PPE.


  • Strategies to optimize PPE use during conventional capacity, contingency capacity, and crisis capacity scenarios are outlined here. Some strategies include limiting face to face contact, restricting facemasks for HCP, and extending use of respirators.


5. Healthcare Personnel Shortages



  • To operate a healthcare facility safely for employees and patients, minimum staffing requirements must be met. Communicate with local, state, and federal coalitions and public health partners to identify additional HCP (e.g. retired HCP, students, volunteers) when needed.


-Contingency Capacity Strategies

  • Cancel nonessential procedures and visits so the HCP who work in those areas may be transferred, with appropriate training, to other patient care activities.


  • Social factors that prevent HCP from returning to work (e.g. transportation, housing that supports social distancing) should be addressed while considering certain racial and ethnic groups are disproportionately affected (e.g. African Americans, Hispanics and Latinos, and American Indians and Alaska Natives).


  • Asymptomatic HCP with unprotected exposure to SARS-CoV-2 can continue to work under contingency capacity strategies. If they test positive, they should be excluded from work unless they meet Return to Work Criteria or staffing shortages continue, as outlined under Crisis Capacity Strategies.


    • Before work they should report temperature and symptom absence. A facemask, not a cloth face covering for HCP, should be worn for 14-days for source control. This does not replace PPE such as using an N95 for patients with COVID-19.


    • Post exposure testing during the 14-day period can identify HCP who could contribute to transmission if testing is readily available. Testing limitations include only showing the presence of virus at testing time; the test can be negative during early infection stages. Community spread is also possible; positive tests in HCP do not indicate workplace exposure. Test results should be available within 24 hours so a clear response to results can be implemented.


-Crisis Capacity Strategies

  • To address staffing shortages, crisis capacity strategies may be needed to provide patient care.


  • Transfer patients with COVID-19 to designated healthcare facilities or alternate care sites that have sufficient staff, coordinating with the region.


  • Asymptomatic HCP with suspected or confirmed COVID-19 who do not meet return to work criteria and are well and willing to work can continue to work if shortages continue despite other mitigation strategies. Duties should be prioritized in the following order:


    • HCP with suspected or confirmed COVID-19 work without interacting with other HCP or patients (e.g. telemedicine).


    • HCP with confirmed COVID-19 directly care for patients with confirmed COVID-19 in a cohort setting.


    • HCP with confirmed COVID-19 directly care for patients with suspected COVID-19.


    • HCP with confirmed COVID-19 directly care for patients without suspected or confirmed COVID-19 as a last resort.


  • Before meeting all Return to Work Criteria, HCP should wear a facemask, not a cloth mask, for source control, even in non-patient care areas to prevent coworkers from being exposed. If they must remove their facemask, they should do so away from others. They should not interact with immunocompromised patients (e.g. transplant, hematology-oncology) until Return to Work Criteria has been met. HCP should self-monitor for symptoms and consult with occupation health if respiratory symptoms recur or worsen.


6. Screening



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


  • Before entering the treatment are, facilities should identify individuals with fever or symptoms consistent with COVID-19. Patients should inform staff of symptoms or fever.


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


7. 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, or refer them to the front desk.


  • 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 put it on, use/wear it, and take it off correctly, within the context of their current and potential duties. 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. Employees should know when to stay home to prevent spread, unless extenuating circumstances call for the use of contingency or crisis capacity strategies.


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


8. Support for Employees



  • Mental health support should be provided to all employees, including access to an employee assistance program (EAP) if available. 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 could help retail business find a third-party mental health provider upon request.


9. Absenteeism



  • 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.


10. Symptoms of Sickness



  • A confirmed case is a positive test for COVID-19. Suspected cases are people who have signs and symptoms consistent with COVID-19.


  • In the event of a sick person, close off areas used by the person who was sick. Have an isolation area or room. Depending on the severity of their symptoms, transport them home or to a healthcare facility. Notify healthcare personnel that the person may have COIVD-19 if calling an ambulance or bringing them to a facility.


  • Clear the area and wait 24 hours, or long as possible for droplets to settle, before disinfecting areas the person used using EPA approved disinfectants. Do not use these areas they have been cleaned and disinfected.


  • Trace the person's contacts from 2 days before symptom onset to identify other exposed people. Inform them if there is a case of confirmed COVID-19 while keeping confidentiality according to the Americans with Disabilities Act (ADA). In a confirmed case, also notify relevant state health or environmental safety departments.


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


Hospitals



  • CDC has prepared a hospital preparedness checklist to assess and improve preparedness for a community outbreak of COVID-19. Factors that a written COVID-19 plan must have induce elements for the protection of patients, HCP, and visitors.


A. Communication



  • Electronic Case Reporting (eCR) shares data in a timely manner by anatomically generating and transmitting case reports from the electronic health record (EHR) to public health agencies.


B. Visitation



  • Communicate with families to remind them to not visit if they are sick or have a known exposure to someone with COVID-19. Post signage at entryways.


  • Limit visitor numbers, implement visitor times, or restrict visitors except for certain compassionate care (ex. end of life care) scenarios. If visitor restrictions are implemented, facilitate other methods of communication and visitation (e.g. letters, care packages, video conferencing).


  • If visitors are allowed to enter rooms of patients with confirmed or suspected COVID-19, instruct visitors how to protect themselves (e.g. hand hygiene, using PPE, avoid touching surfaces). A record of who entered and exited the room should be kept. Visitor movement within the rest of the facility should be limited.


C. Managing Patients



  • Triage should have trained HCPs 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.


Nursing Home/Long Term Care Facilities



  • CDC has created guidelines and an infection prevention and control (IPC) assessment tool for Nursing Homes Preparing for COVID-19 to protect residents and HCP. These guidelines are also relevant to Assisted Living Facilities.


11. Core Practices



After resuming normal activities, these practices should continue.

  • Create an IPC program which is managed by one or more individuals with specialized training. Any facility with more than 100 residents or provide on-site ventilator or hemodialysis services should have this as a full time role for one person. Smaller facilities should staff the IPC program based on their facility risk assessment needs.


12. Education



  • Post signage containing information on COVID-19 (e.g. symptoms, preventing transmission) and strategies to manage stress and anxiety.


  • Educate residents, family members, and personnel on actions they can take (e.g. hand hygiene, source control, social distancing, wearing cloth face coverings, respiratory etiquette) to prevent transmission.


  • Educate staff on nonpunitive sick leave policies and remind HCP to remain at home when ill.


  • Residents should wear cloth face coverings when outside their room, with expectations for anyone who has trouble breathing, is unconscious or incapacitated, or unable to remove their mask for any other reason. If they are permitted, visitors should also wear cloth face coverings.


  • HCP should wear a facemask to protect themselves against splashes and sprays of potentially infectious material.


13. Social Distancing



-Aggressive Social Distancing

  • Residents and HCP should practice social distancing.


  • Communal dining and activities should be cancelled. Residences should wear cloth face coverings if tolerated and perform hand hygiene.


  • HCP should wear facemasks in break rooms or common areas.


-Relaxed Restrictions

  • Allow for communal dining and activities for residents without COVID-19, including those who have recovered while maintaining IPC measures such as social distancing, source control, and limiting numbers.


  • Allow for outdoor excursions for residents without COVID-19, including those who have recovered. During these excursions, maintain social distancing and wear cloth face coverings for source control. Plan for additional use of PPE by staff and schedule excursions to not disrupt other care activities and allow those opportunities for all residents.


14. Visitation



  • Encourage other methods of communication and visitation (e.g. letters, care packages, video conferencing) with the resident.


  • Limit visitor numbers, implement visitor times, or restrict visitors except for certain compassionate care (ex. end of life care) scenarios.


  • Communicate with families to remind them to not visit if they are sick or have a known exposure to someone with COVID-19.


  • Create or review an inventory of volunteers, personnel, and consultants to determine which services are essential and which can be paused.


  • Screen visitors for fever of 100.0 F or greater, symptoms consistent with COVID-19, or known exposure and do not allow them entry to the facility. Ask visitors to report if symptoms occur during the 14-day period after visiting.


15. Testing



  • Develop a plan for testing residents and HCP that follows state and federal requirements.


  • The plan should include access to tests able to detect the virus at time of testing and laboratory arrangements to process those tests. Antibody tests should not be used to diagnose an active SARS-CoV-2 infection.


  • Test results should inform cohorts and positive HCP should not go to work.


  • Triggers are indications to perform testing at various levels.


    • Residents with symptoms of COVID-19: Conduct daily temperature checks, then viral testing if COVID-19 symptoms are present.


    • Outbreak: Expand testing to all residents in the nursing home if there is a new infection in a resident or HCP. Testing as soon as there is a new confirmed case will allow for quick IPC actions. Leadership should prepare to identify pre-symptomatic and asymptomatic residents and plan to cohort them. If viral tests are limited, close contacts should first be tested.


    • Baseline: As a part of reopening, each resident should be initially tested to inform care, cohorting, and IPC decisions.


    • Repeat Testing: Continue to test previously negative residents ever 3 to 7 days until a 14-day period has passed since the most recent positive result. If viral tests are limited, repeated rounds of testing are recommended for residents who visit the facility for services or have known exposures. Testing only on units with affected individuals can be considered for large facilities with limited testing capabilities.


  • There are multiple considerations for large-scale testing in nursing homes.


    • Preparing: Develop a strategy for testing priority based on the cases in a facility, and the number of residents with recent exposures. Early identification due to serialized testing after initial testing will help determine cohorts. Consider the time between testing events for ongoing transmission.


    • Specimen Collection and Data Management: Plan for all HCP to be tested, not just those present during facility-wide testing. Management should determine if HCP should be tested at the nursing home or offsite, and how results will be shared with the facility. HCP may need to be trained to collect specimens while maintaining IPC requirements and using PPE correctly. The plan should include measures for residents and HCP who are unable to be tested.


    • Reporting Test Results: Laboratories for facility wide testing should be able to process large numbers of tests, with one laboratory for all the tests in a facility being ideal for data collection and analysis. The nursing home should collaborate with the health department. Testing should maintain confidentiality as much as possible.


  • During the collection, only the people essential for care and procedure support should be present. Multiple individuals should not be swabbed in the same room unless appropriate separation between stations can be maintained.


    • Self-collection: If HCP can maintain a 6-foot distance, PPE use can be minimized.


    • Residents: Specimens should be collected one at a time in the resident's room with the door closed.


    • HCP: Other options other than individual rooms include large and outdoor spaces where 6-feet between stations can be maintained. When using a single room to swab multiple HCP, consider using a HEPA filter in the room and minimize the amount of time spend in the room. Facemasks or cloth coverings should only be removed during swabbing process. To minimize equipment in the room, consider having each person bring a prefilled specimen bag with the swab and transport container from the check in area.


  • PPE


    • HCP in the room while swabbing is conducted should wear a N95 or higher with eye protection. Extended use is permitted if care is taken to not touch equipment, and if equipment becomes damaged, soiled, or difficult to breath or see through, replaced.


    • Between each person, gloves should be changed and hand hygiene performed. Gowns can be used if contact is minimized with the person being swabbed and should be changed when there is more than minimal contact with the person or environment.


    • Standard precautions (e.g. glove, facemask) should be followed for HCP who handle specimens but are not directly involved in collection. During the collection process, consider having an observer who only monitors for breaches in PPE use.


  • Environment


    • Disinfect surfaces within 6-feet of specimen collection hourly or when visibly soiled using EPA-registered disinfectant from List N.


16. Managing Residents



  • Dedicated Care Space for Residents with COVID-19


    • Identify space that can be reserved for caring for residents with COVID-19 and identify HCP who will work only on that care unit while it is being used.


    • Plan for how to handle other residents and HCP who many have been exposed to an individual with COVID-19.


    • Prioritize residents with suspected COVID-19 for testing. Refrain from assigning new roommates with the roommates of residents with COVID-19 until 14 days after the exposure.


    • HCP caring for residents known or suspected COVID-19 should wear a minimum of N95 or higher level respirator, eye protection, gloves, and gown.


  • Admissions and Readmissions


    • Monitor for symptoms and fever greater than 100.0 F. If possible, assess oxygen saturation via pulse oximetry. Implement Transmission-Based Precautions if fever or symptoms consistent with COVID-19 are present.


    • Consider the community spread of COVID-19 in admitting residents into single-person rooms or observation areas to monitor for COVID-19 until they are afebrile and remain without symptoms for 14 days. While caring for those residents during the period, HCP should wear a minimum of N95 or higher level respirator, eye protection, gloves, and gown.


  • Continuous Evaluation


    • Ask residents to report if they feel feverish or have symptoms consistent with COVID-19.


    • Consider that older adults may not show common symptom (e.g. respiratory symptoms, fever, etc.). Watch for uncommon symptoms (new malaise, headache, dizziness, nausea, vomiting, diarrhea, loss of taste or smell). Monitor for two temperatures 99.0 F or greater which can be a sign of fever for older adults. The presence of these symptoms should prompt for isolation and evaluation for COVID-19.


    • Residents should have monitoring (assessment of symptoms, vital signs, oxygen saturation via pulse oximetry, and respiratory exams) at least 3 times daily for prompt identification and management of serious infection.


    • Notified the health department about residents or HCP with suspected or confirmed COVID-19, 3 or more residents or HCP with new respiratory symptoms within 72 hours of each other, or residents with severe respiratory infection resulting in hospitalization or death.


  • Transport


    • Notify transport personnel and the receiving facility about the suspected diagnosis prior to transfer.


    • Separate the resident and have them wear a cloth face covering or facemask if tolerated if others are in the room and during transport.


17. Memory Care Units



  • Routine: Keep routines consistent while reminding residents to perform hand hygiene, social distance, and use cloth face coverings if tolerated.


  • Designate staff: Use the same staff, preferably in a cohort setting, for residents in the memory care unit. Only essential personnel should be on the unit.


  • Activity: Plan for safe physical activities (e.g. walking in halls or outside with individual residents).


  • Social distance: Limit the number of residents in a room and ensure that they will be able to maintain a 6-foot distance from one another, such as gentle guidance during ambulation.


  • Surfaces: Clean and disinfect frequently touched surfaces (e.g. hall, common areas).


  • Access to medical care: Continue to provide care and emergency services if needed under the resident's goal of care.


  • Suspected/Confirmed COVID-19


    • Risks of moving to designated COVID-19 Care Unit: Residents may become confused and aggravated due to a change in environment. Evaluate the risk before moving. The purpose of moving residents to a designated COVID-19 unit is to prevent other residents from being exposed; by the time infection has been detected other individuals may have been exposed or infected with outbreak testing being required. It may be safer to have dedicated personnel on that unit for care of residents with COVID-19.


    • If residents will be moved to a COVID-19 Care Unit: Provide information to residents and repeat when needed. Copy the routine of the resident with dementia as closely as possible. Move familiar items into the space before introducing the space to the resident to make it feel more comfortable.


Blood & Plasma



  • Follow basic IPC guidelines such as routine hand hygiene, and respiratory hygiene/cough etiquette.


  • Physical Distancing: Arrange prospective donors 6-feet apart in seating areas prior to donor questionnaire. Arrange donor cots 6-feet apart during blood collection.


  • Educate: Provide information and discuss signs and symptoms of COVID-19 and actions taken to reduce transmission with staff and volunteers.


  • Screening: Upon entry to the collection site, evaluate staff, volunteers, and prospective donors for symptoms consistent with COVID-19 and ask anyone with those symptoms to leave to lower the risk of transmission.


  • Facility Actions: Instruct staff to self-evaluate for symptoms consistent with COVID-19. If sick, they should stay at home and contact the established point of contact. Sick leave policies should be nonpunitive, flexible, and consistent with public health guidance.


No Wait Medical Partners ensures ongoing follow-up of employees sent home who may be at risk.


Dialysis



18. Screening



  • Before entering the treatment are, facilities should identify individuals with fever or symptoms consistent with COVID-19. Patients should inform staff of symptoms or fever.


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


19. Acute Dialysis Care



CDC has considerations for providing hemodialysis to patients with suspected or confirmed COVID-19 in Acute Care Settings.


  • Discharge should be based on clinical status and the ability to meet patient needs at an outpatient facility, not the status of a SARS-CoV-2 test. Transmission-Based Precautions can be discontinued based on either a test based or symptom based strategy. Safe discharge and transport includes notifying the discharging facility of the patient's COVID-19 testing status to ensure transmission-based precautions can be done.


  • Hemodialysis modality should depend on patient needs and clinical resources, though continuous renal replacement therapy (CCRT) may be preferred over intermittent hemodialysis for patients in the ICU to limit HCP exposure.


  • Intermittent hemodialysis for patients with suspected or confirmed COVID-19 should be performed in dialysis unit isolation rooms with the door closed. Hepatitis B isolation rooms should only be used if the patient is also hepatitis B surface antigen positive or if there are no patients with hepatitis B infection who may require treatment in the isolation room.


  • Confirmed COVID-19 patients should be in a cohort together, preferably on the last dialysis shift on the day for terminal cleaning of the dialysis unit.


  • PPE recommended for care of suspected or confirmed COVID-19 patients should be worn by dialysis staff. Prioritize respirators for staff who will spend hours in a patient's room with the door closed. Limit time in the room with the patient if feasible. Observation can be done through windows, glass doors, or cameras while keeping the isolation room door closed.


  • Facemasks or cloth coverings should be worn by patients with suspected or confirmed COVID-19, if tolerated, outside of the isolation room. They should also be worn if dialysis staff are working inside the room.


  • Disinfecting equipment according to current established process to prevent cross contamination. When moving the dialysis unit and other equipment out of the patient's room, disinfect using supplies on List N with a bloodborne pathogen claim. Surfaces, equipment, and supplies in the room within 6-feet of symptomatic patients should be disinfected or disposed of.


20. Outpatient Dialysis



CDC has a Coronavirus Disease 2019 (COVID-19) Outpatient Dialysis Facility Preparedness Assessment Tool to determine readiness for providing dialysis care.


  • Patient Placement: Know the numbers and locations of available isolation rooms (not being used for hepatitis B surface antigen positive patient). Have an isolation room (not being used for hepatitis B surface antigen positive patient) for patients with undiagnosed respiratory infections. Maintain 6-feet between masked patients with undiagnosed respiratory infections and other patients. Cohort patients and with suspected or confirmed COVID-19, such as on the same shift or same unit.


  • Patient Movement: Patients with suspected or confirmed COVID-19 should wear a facemask or face covering in the facility and only move for essential purposes outside of the isolation room.


  • Transmission-Based Precautions: Have a plan to optimize use of PPE and a contingency plan during shortages. HCP caring for patients with suspected or confirmed COVID-19 should wear gloves, isolation gown, eye protection, and an N-95 or higher-level respirator if possible, with facemasks as an alternative. HCP should be trained on proper donning and doffing of PPE and audited for adherence to recommended use.


  • Screening: Encourage reporting of symptoms consistent with COVID-19 or fever. Educate staff on nonpunitive sick leave policies and remind HCP to remain at home when ill. Check for symptoms and fever prior to a shift for HCPs.


  • Visitation: Screen visitors and restrict sick visitors from entering. Have visitors always wear cloth face coverings.


  • Monitoring: Communicate with local health authority on testing and transmission. Stay updated on CDC communication.


Pharmacies



  • Follow basic IPC guidelines such as routine hand hygiene, and respiratory hygiene/cough etiquette..


  • Filling Prescriptions


    • Provide hand sanitizer with 60% alcohol for patient use and have access to soap and water or hand sanitizer for staff.


    • Avoid using paper prescriptions; instead, receive prescription orders via telephone or electronically.


    • Alternative methods (e.g. home delivery, curbside pickup, drive-through) should be used for people at an increased risk of severe illness.


  • Engineering Controls


    • Install clear partitions, to protect against droplets, with a pass through at the bottom to speak through and provide items.


    • Have measures (e.g. tape on floors/sidewalks, create 1-way routes in halls, clear partitions, 6-foot) to allow a 6-foot distance between staff and patients and minimize face-to-face contact.


    • Use disinfectants from List N to clean hard, non-porous surfaces.


  • Administrative Controls


    • Inform patients of the drive-through window, curbside pickup, or home delivery (if possible). Post large signs outside of the pharmacy with this information.


    • Restrict the number of patients inside the pharmacy.


    • Use telehealth whenever services do not require face to face contact (e.g. chronic disease management, medication management, etc.).


  • Testing


    • Pharmacies that are collaborating with public health testing of COVID-19 should communicate with state and local health authorities to prioritize clients testing.


    • Since testing is likely to induce coughing or sneezing, staff should be provided with an N95 respirator and other appropriate PPE as well as training to don and doff PPE safely. Cloth face coverings are not a replacement for PPE.


  • Adult Vaccination


    • Prioritize older adults or adults with underlying medical conditions. Provide and train staff with appropriate PPE. Eye protection is recommended for places with moderate to substantial community transmission, or if required under standard precautions regardless of transmission prevalence. Hand hygiene should be performed before and after administration of the vaccine, with gloves changed between patients.


Postmortem, COVID-19 Cases



  • In the event of identification of a deceased person with known or suspected COVID-19, medical personnel should immediately notify their local or state health department.


21. Recommended Postmortem Specimens



  • No Autopsy, Suspected COVID-19: Collect a postmortem nasopharyngeal swab (NP swab) specimen for COVID-19 testing, and a separate NP swab to test for other respiratory pathogens.


  • Autopsy, Confirmed COVID-19: Collect postmortem swab specimens for other respiratory pathogens, microbiologic, and infectious disease testing as indicated, as well as formalin-fixed autopsy tissues from the lungs and upper airway.


  • Autopsy, Suspected COVID-19: Collect all the specimens for the other circumstances listed above and lower respiratory specimens (lung swabs) from each lung.


  • Swabs


    • Though nasopharyngeal specimens are preferred, alternatives include oropharyngeal (OP) specimens, nasal mid-turbinate (NMT) swabs, anterior nares (nasal swab; NS) specimens, or a nasopharyngeal washes/aspirates or nasal aspirate (NA) specimens.


    • NP swabs are not aerosol generating procedures. Only use synthetic fiber swabs with plastic shafts; do not use calcium alginate swabs or wooden shafts due to interference with PCR testing. After swabbing, place swabs into sterile tubes with 2-3 ml of viral transport media. If an OP swab is also collected, place that into the same tube as the NP swab.


22. Infection Control



  • NP Swab: Since the collection of nasopharyngeal specimens from deceased persons will not induce coughing or sneezing, it is not an aerosol generating procedure and a negative pressure room is not required if only an NP swab is being collected. Minimum PPE for this procedure includes nonsterile gloves (e.g. nitrile, latex, rubber) for handling infectious material, with heavy duty gloves if there is a risk of breaking skin, impermeable long sleeved fluid-resistant gown, plastic shield or facemask to protect from splashes of potentially infected fluids.


  • Autopsies: Should be conducted in a negative pressure room and have a minimum of 6 air changes per hour (ACH) for existing structures and 12 ACH for renovated or new structures. Air should e vented directly outside or through a HEPA filter. Worker comfort may be improved by powered air-purifying respirators with HEPA filters during extended autopsies. Wear PPE for aerosol generating procedures, double surgical gloves with a layer of cut-proof synthetic mesh gloves in between, an impermeable gown, waterproof apron, googles or face shield, and a NIOSH-approved disposable N-95 or higher respirator. N-95 respirators should be worn according to the OSHA Respiratory Protection standard which includes medical exams, fit-testing, and training.


23. Specimen Submission to CDC



  • Immediate shipping: Store at 2-8 degrees Celsius and ship overnight on ice pack.


  • Delayed shipping: If there will be 72 hours or greater from collection to arrival to CDC, store at -70 degrees Celsius and ship overnight on dry ice. Additional guidance on shipping.


  • Labelling: Each specimen container should have:


    • Patient's ID number


    • Unique CDC or state-generated NCOV specimen ID


    • Specimen type


    • Date of collection


Employee Guidelines



  • The Centers for Disease Control and Prevention (CDC) have 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% alcohol and rubbing hands until they are dry. Avoid touching your face.
    COVID-19 Guidlines

    Click here to watch the video


-Respiratory 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.


-Social Distancing


  • Maintain 6-feet of social distancing as work duties permit, and avoid physical contact with others, including other staff, students, or campers.


  • 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 or foods.



What should I do if I become ill?




Resources:

Clinical infographics (CDC guidelines)


Comprehensive Hospital Preparedness Checklist for Coronavirus Disease 2019 (COVID-19) (CDC guidelines)


Considerations for Memory Care Units in Long-term Care Facilities (CDC guidelines)


Considerations for Preventing Spread of COVID-19 in Assisted Living Facilities (CDC guidelines)


Considerations for Providing Hemodialysis to Patients with Suspected or Confirmed COVID-19 in Acute Care Settings. (CDC guidelines)


Coronavirus Disease 2019 (COVID-19) Keeping Patients on Dialysis Safe (CDC guidelines)


Coronavirus Disease 2019 (COVID-19) Outpatient Dialysis Facility Preparedness Assessment Tool (CDC guidelines)


Coronavirus Disease 2019 (COVID-19): Supporting Your Loved One in a Long-Term Care Facility (CDC guidelines)


COVID-19 Surge (CDC guidelines)


Coronavirus Disease 2019 (COVID-19): Supporting Your Loved One in a Long-Term Care Facility (CDC guidelines)


Disinfectants for Use Against COVID-19 (EPA guidelines)


eCR Now: COVID-19 Electronic Case Reporting for Healthcare Providers (CDC guidelines)


Guidance for Blood and Plasma Facilities (CDC guidelines)


Guidance for Pharmacies. (CDC guidelines)


Hand washing guidelines (CDC guidelines)

What You Need To Know About Handwashing (Video)


Healthcare Facilities: Managing Operations During the COVID-19 Pandemic (CDC guidelines)


Information on the use of cloth face coverings (CDC guidelines)


Interim Additional Guidance for Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed COVID-19 in Outpatient Hemodialysis Facilities (CDC guidelines)


Optimizing Supply of PPE and Other Equipment during Shortages (CDC guidelines)


People Who Live in a Nursing Home or Long-Term Care Facility (CDC guidelines)


Performing Facility-wide SARS-CoV-2 Testing in Nursing Homes (CDC guidelines)


Prepare your practice for COVID-19 (CDC guidelines)


Preparing for COVID-19 in Nursing Homes (CDC guidelines)


Preparing Outpatient Hemodialysis Facilities for COVID-19 (CDC guidelines)


Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19 (CDC guidelines)


Protection of yourself and others against COVID-19 (CDC guidelines)


Print resources (CDC guidelines)


Respirator Safety (United States Department of Labor)


Screening and Triage at Intake (CDC guidelines)


Self-assessment tool for employees (Self-Checker) (CDC guidelines)


Staying home (CDC guidelines)


Strategies to Mitigate Healthcare Personnel Staffing Shortages (CDC guidelines)


Summary Strategies to Optimize the Supply of PPE during Shortages (CDC guidelines)


Symptoms of COVID-19 (CDC guidelines)


Ten Ways Healthcare Systems Can Operate Effectively during the COVID-19 Pandemic (CDC guidelines)


Testing Guidelines for Nursing Homes (CDC guidelines)


Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic (CDC guidelines)


When to screen (CDC guidelines)