COVID-19 Guidance for Outpatient

FacilitiesUpdate 3/19/2020

Dr. Salman Ashraf, MBBS and Kate Tyner, RN, BSN, CIC

Nebraska ICAP

Dr. Maureen Tierney, MD,MSc

NE DHHS HAI-AR

Guidance and responses were provided based on information known on 3/19/2020 and may become out of date. Guidance is being updated rapidly, so users should look to

CDC and NE DHHS guidance for updates.

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

This and more at “Get Your

Clinic Ready for Coronavirus Disease 2019 (COVID-19)”

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

https://www.cdc.gov/coronavirus/2019-ncov/downloads/Please-Read.pdf

Updates for the Public and Returning Travelers

All returning travelers have an increased risk of exposure to COVID-19

All returning travelers should limit public interactions, practice strict social-distancing, and self-monitor for symptoms

IF a returning traveler develops fever or respiratory illness, they need to IMMEDIATELY self-isolate and report to a provider or local health department

Returning travelers need to track the publicly reported COVID-19 disease burden in the areas to which they have travelled through both the local/state public health departments and public media websites.

Areas with widespread sustained transmission (e.g. CDC Level 3 countries plus U.S. locales such as WA state, Westchester County and NYC, NY, and CA esp. Santa Clara County,) are at increased risk and of special concern.

Such travelers should self-quarantine for 14 days and immediately report any symptoms consistent with COVID-19 infection to their health care provider. Individuals unable to observe the 14-day self-quarantine should consult with their local health department

Health care workers with a travel history from an area with widespread sustained transmission [Level 3 Countries, NYC, California (esp. Santa Clara Co.), Washington state, Florida, or other high-risk exposure should self quarantine if possible and self monitor.

However, if because of HCP shortage or a needed expertise they should consult with a trained medical professional (e.g. infection preventionist or physician) at their facility and

Establish a protocol such as active monitoring with PPE while at work that mitigates the risk of patient and co-worker exposure.

Updates for the Public and Returning Travelers

Commercial labs listed below had announced the availability of commercial tests through their portals. Published turnaround time is 3-4 days.

Any patient (+) for COVID-19 virus should be immediately reported to their local/state public health office.

All such (+) tests are provisional pending confirmation at NPHL. Request the commercial lab send the specimen to NPHL for all positive test

ARUP-No longer accepting new tests

Mayo –only providing for Mayo clinic patients

Quest -1000 tests nationally per day

LabCorp?

Commercial Lab Testing

Availability of Testing

NPHL is performing the CDC-approved test.

– 20 specimens per run may be able to expand to about 100/day.

– Approval via LHD through the state DPH is necessary

UNMC - separate test through Regional Pathology Laboratory (RPL),

At capacity

Testing

Inpatients with a clinical presentation consistent with COVID-19, after ruling out alternative diagnoses (negative RPP), should be considered for testing. Highest testing priority

Outpatients that are members of vulnerable or high-risk populations with a clinical presentation consistent with COVID-19, after ruling out alternative diagnoses (negative flu and RPP), should be considered for testing.

Vulnerable or high-risk populations include

o Healthcare workers

o Public safety (EMS, law enforcement, firefighters)

o Nursing home, group home, daycare attendees or employees

Most outpatients with a clinical presentation consistent with COVID-19 WITH A CLINICALLY CONSISTENT PRESENTATION should be considered a probable case of COVID-19 and self-isolate without expecting testing. Testing to rule out an alternative diagnosis is up to the PCP.

Testing Priorities

Additional Criteria to Guide Evaluation and Laboratory Testing for COVID-19.

Priorities for testing may include:

1. Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.

2. Other symptomatic individuals such as, older adults (age ≥ 65 years) and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).

This is what states with lots of transmission are doing. Also preserves PPE.

CDC: Criteria to Guide Evaluation and Lab Testing for COVID-19

Discontinuation of Home Isolation for Persons with COVID-19 (Interim Guidance)Persons with COVID-19 who have symptoms and who are directed to care for themselves at home may discontinue home isolation under the following conditions: At least 3 days (72 hours) have passed since

recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

At least 7 days have passed since symptoms first appeared.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html

CDC Guidance as of 3/17/2020

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

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

Implement Crisis Capacity Strategy- facemasks• Cancel all elective and non-urgent procedures and

appointments for which a facemask is typically used by HCP.

• Use facemasks beyond the manufacturer-designated shelf life during patient care activities.

• Implement limited re-use of facemasks.

• Prioritize facemasks for selected activities

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

Prioritization of activities For facemasks

• For provision of essential surgeries and procedures

• During care activities where splashes and sprays are anticipated

• During activities where prolonged face-to-face or close contact with a potentially infectious patient is unavoidable

• For performing aerosol generating procedures, if respirators are no longer available

https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

https://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-healthcare-providers

Information HotlinesNebraska Medicine

Symptoms? 800.922.0000 prior to appointment or ER

CHIhealth.com 8AM to 8PMhttps://www.chihealth.com/en/patients-visitors/coronavirus-covid-19.html

If answer questions suggestive of coronavirus exposure or symptoms, then directed to an MD or ANP

Methodist

Hot Line 24/7 402-815-7425

Bryan Health

https://www.bryanhealth.com/coronavirus/

24/7 COVID-19 hotline at 402-481-0500

Regional West

https://www.rwhs.org/our-network/about-us/visitation-restrictions-covid-19-information

308-630-1580

Monday – Friday 7:30 AM – 9:30 AM Central Time2:00 PM -4:00 PM Central Time

Call 402-552-2881

Infection Prevention and ControlOffice Hours

Weekly COVID-19 Outpatient WebinarsDHHS in association with ICAP will continue to host weekly webinars specific to outpatient facilities in the state of Nebraska. The webinars will continue to address situation updates and essential information on COVID-19.

Link to weekly COVID-19 OP webinar invite

https://icap.nebraskamed.com/outpatient-covid-19-webinar-invite/

Link to past webinars and recordings

https://icap.nebraskamed.com/covid-19-webinars/

Questions and Answer SessionUse the QA box in the webinar platform to type a question. Questions will be read aloud by the moderator, in the order they are received

A transcript of the discussion will be made available on the ICAP websitePanelists today are:

Dr. Salman Ashraf, MBBSDr. Maureen Tierney, MD,MScKate Tyner, RN, BSN, CICIshrat Kamal-Ahmed, M.Sc., Ph.DMargaret Drake, MT(ASCP),CICTeri Fitzgerald RN, BSN, CIC

https://icap.nebraskamed.com/covid-19-webinars-and-tools/