Protocol to Decrease Exposing Patients to COVID-19 and Decreasing Exposure /Contraction of COVID-19 for Health Care Personnel (HCP)
Background
The recent arrival of the Coronavirus to the United States has increased the importance of monitoring illness in our patients and employees. To avoid exposing our patients to the COVID-19 we ask the employees follow the protocol listed below. Currently, those at greatest risk of infection are persons who have had prolonged, unprotected close contact with a patient with symptomatic, confirmed COVID-19 and those who live in or have recently been to areas with sustained transmission. Report to CHHC/CHC Office if you have traveled outside of the United States in the last 14 days with special emphasis on *China, Iran, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City. Which have a level 3 travel notice. If you have been to a country with a level 3 travel notice you will need to self-quarantine yourself for 14 days which begins from the time you left the travel 3 country. *CDC may change the Level 3 countries in the future, CHHC/CHC will update their employees when this information is available.
Exposure category
Recommended Monitoring for COVID-19 (until 14 days after last potential exposure)
Work Restrictions for Asymptomatic HCP
Prolonged close contact with a COVID-19 patient who was wearing a facemask (i.e., source control)
HCP PPE: None
Medium
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing a facemask or respirator
Medium
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing eye protection
Low
Self with delegated supervision
None
HCP PPE: Not wearing gown or glovesa
Low
Self with delegated supervision
None
HCP PPE: Wearing all recommended PPE (except wearing a facemask instead of a respirator)
Low
Self with delegated supervision
None
Prolonged close contact with a COVID-19 patient who was not wearing a facemask (i.e., source control)
HCP PPE: None
High
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing a facemask or respirator
High
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing eye protectiona
Medium
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing gown or glovesa,b
Low
Self with delegated supervision
None
HCP PPE: Wearing all recommended PPE (except wearing a facemask instead of a respirator) b
Low
Self with delegated supervision
None
HCP=healthcare personnel; PPE=personal protective equipment
a The risk category for these rows would be elevated by one level if HCP had extensive body contact with the patients (e.g., rolling the patient).
b The risk category for these rows would be elevated by one level if HCP performed or were present for a procedure likely to generate higher concentrations of respiratory secretions or aerosols (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction). For example, HCP who were wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure.
Additional Scenarios:
A team of employees will be identified to treat quarantined and PUI.
Background
The recent arrival of the Coronavirus to the United States has increased the importance of monitoring illness in our patients and employees. To avoid exposing our patients to the COVID-19 we ask the employees follow the protocol listed below. Currently, those at greatest risk of infection are persons who have had prolonged, unprotected close contact with a patient with symptomatic, confirmed COVID-19 and those who live in or have recently been to areas with sustained transmission. Report to CHHC/CHC Office if you have traveled outside of the United States in the last 14 days with special emphasis on *China, Iran, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City. Which have a level 3 travel notice. If you have been to a country with a level 3 travel notice you will need to self-quarantine yourself for 14 days which begins from the time you left the travel 3 country. *CDC may change the Level 3 countries in the future, CHHC/CHC will update their employees when this information is available.
- Close contact with a positively identified COVID 19 patients. See the charts below to determine if self quarantine is advised.
Exposure category
Recommended Monitoring for COVID-19 (until 14 days after last potential exposure)
Work Restrictions for Asymptomatic HCP
Prolonged close contact with a COVID-19 patient who was wearing a facemask (i.e., source control)
HCP PPE: None
Medium
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing a facemask or respirator
Medium
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing eye protection
Low
Self with delegated supervision
None
HCP PPE: Not wearing gown or glovesa
Low
Self with delegated supervision
None
HCP PPE: Wearing all recommended PPE (except wearing a facemask instead of a respirator)
Low
Self with delegated supervision
None
Prolonged close contact with a COVID-19 patient who was not wearing a facemask (i.e., source control)
HCP PPE: None
High
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing a facemask or respirator
High
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing eye protectiona
Medium
Active
Exclude from work for 14 days after last exposure
HCP PPE: Not wearing gown or glovesa,b
Low
Self with delegated supervision
None
HCP PPE: Wearing all recommended PPE (except wearing a facemask instead of a respirator) b
Low
Self with delegated supervision
None
HCP=healthcare personnel; PPE=personal protective equipment
a The risk category for these rows would be elevated by one level if HCP had extensive body contact with the patients (e.g., rolling the patient).
b The risk category for these rows would be elevated by one level if HCP performed or were present for a procedure likely to generate higher concentrations of respiratory secretions or aerosols (e.g., cardiopulmonary resuscitation, intubation, extubation, bronchoscopy, nebulizer therapy, sputum induction). For example, HCP who were wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure.
Additional Scenarios:
- Refer to the footnotes above for scenarios that would elevate the risk level for exposed HCP. For example, HCP who were not wearing a gown, gloves, eye protection and a facemask (instead of a respirator) during an aerosol-generating procedure would be considered to have a medium-risk exposure.
- Proper adherence to currently recommended infection control practices, including all recommended PPE, should protect HCP having prolonged close contact with patients infected with COVID-19. However, to account for any inconsistencies in use or adherence that could result in unrecognized exposures, HCP should still perform self-monitoring with delegated supervision.
- HCP not using all recommended PPE who have only brief interactions with a patient regardless of whether patient was wearing a facemask are considered low-risk. Examples of brief interactions include:
- brief conversation at a triage desk;
- briefly entering a patient room but not having direct contact with the patient or the patient’s secretions/excretions;
- entering the patient room immediately after the patient was discharged.
- HCP who walk by a patient or who have no direct contact with the patient or their secretions/excretions and no entry into the patient room are considered to have no identifiable risk.
- HCP who have/are providing care to a quarantined patient are required to follow the advised PPE requirements (gown, gloves, NIOSH approved 95 mask, goggles or face shield).
- If the employee did/does not follow the advised use of specific PPE and proper donning and doffing, the HCP will be evaluated for risk of spreading the virus and may need to be quarantined.
- HCP is responsible for reporting any of these occurrences to CHHC /CHC.
- PPE should ideally be put on outside of the home prior to entry into the home. If unable to put on all PPE outside of the home, it is preferred that face protection (i.e., respirator and eye protection) be put on before entering home. Alert persons within the home that the HCP will be entering the home and ask them to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, enter the home and put on a gown and gloves.
- Ask person being tested if an external trash can is present at the home, or if one can left outside for the disposal of PPE. PPE should ideally be removed outside of the home and discarded by placing in external trash can before departing location. Used PPE should not be removed and discarded in HCP vehicle.
- If unable to remove all PPE outside of the home, it is still preferred that face protection (i.e., respirator and eye protection) be removed after exiting the home. If gown and gloves must be removed in the home, ask persons within the home to move to a different room, if possible, or keep a 6 feet distance in the same room. Once entry is clear, remove gown and gloves and exit the home. Once outside of the home, perform hand hygiene with alcohol based sanitizer, remove face protection and discard PPE by placing in external trash can before departing location. Perform hand hygiene again.
- All HCP are asked to monitor their temperature prior to starting their work day and at the end of the work day. Contact CHHC/CHC for a temperature of/or above 99.6 or 1 degree above normal temperature.
- If the HCP has a fever this needs to be reported to CHHC/CHC supervisor.
- Also signs of respiratory illness must be reported to the office with a phone call to the above mentioned employees. The signs to report consist of cough, shortness of breath, sore throat and fever.
- These employees will be asked not to come in contact with any patients or employees of CHHC/CHC. The employee is asked to monitor symptoms and report to CHHC/CHC when these have resolved.
- If CHHC/CHC employee is working when starting to show signs and symptoms of respiratory infection the employee is to immediately stop work, put on a facemask, and self isolate at home.
- If the above circumstance occurs, the CHHC/CHC employee will inform their supervisor regarding the information on individuals, equipment and locations of the person came in contact with;
- CHHC/CHC will contact and follow the local health department recommendations for next steps (e.g., testing, locations for treatment).
- CHHC/CHC employees may refer to the CDC guidance for exposures that might warrant restricting asymptomatic HCP from reporting to work (https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assessment-hcp.html)
- If employee is deemed to have symptoms of COVID-19 they will seek medical attention from their PCP. The PCP will determine treatment, if CHHC/CHC employee is traveling to a clinical setting for treatment it is advised that the employee wear a surgical mask and alert the clinic/facility that they are seeking treatment for possible COVID-19 infection.
A team of employees will be identified to treat quarantined and PUI.