Remember to Wear Face Coverings and Maintain Social Distancing

Governor Requiring Face Coverings in Cubicles

Governor Jared Polis issued clarification last week on when masks are required in the workplace. His clarification in a frequently asked questions document states that employees must wear masks or face coverings in any shared indoor space that accommodates people outside their households, including in individual cubicles. This means that all Denver Health staff members are required to wear a mask or face covering, even when in cubicles that are physically distanced. You’re allowed to take off your mask or face covering when you’re alone in a room with the door closed. Masks are required in common areas, such as hallways, elevators and breakrooms. In spaces used for eating, employees can remove masks or face coverings when they’re seated at a table to eat but must put it back on when leaving the table for any reason. Per city orders, everyone ages three and up is required to wear a mask or face covering. This applies to our patients and visitors as well. New signs reflecting the age requirement have been posted across Denver Health locations. You can find all of Denver Health’s latest guidelines on personal protective equipment here.

COVID-19 Epidemiology

At Denver Health, COVID-19 hospitalization numbers have been stable over the past week.

Denver Cases:

There have been 9783 confirmed cases of COVID-19 in Denver, including 416 deaths. Community case rates are now starting to decline again. After an increase to 153 cases/day on July 27 from a low of 30 cases/day on June 11, we are now at 64 cases/day as of August 3 (7 day moving average). https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 47,968 confirmed cases of COVID-19 in Colorado, including 1,844 deaths among those patients. Hospitalizations across the state have been stable to decreasing over the past week, but are still increased from a low of 127 on June 27 to 202 as of Aug 4. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 4,649,102 confirmed cases of COVID-19 in the U.S., including 154,471deaths. Over the past week, there have been an average of 60,194 cases per day, a decrease of 9 percent from the average two weeks earlier. Most activity remains focused in the Southeastern US. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 18,142,718 confirmed cases of COVID-19, including 691,013 deaths reported to the WHO. The coronavirus pandemic is ebbing in some of the countries that were hit hard early on, but the number of new cases is growing faster than ever worldwide, with more than 200,000 reported each day on average. Almost twice as many countries have reported a significant rise in new cases over the past two weeks as have reported significant declines https://covid19.who.int/

Clinical Updates

PPE Supply Updates

This week we identified a second (local) source of nitrile gloves, vetted by IP and bought the equivalent of two weeks usage of small, medium and large gloves. Over the last week we’ve bought an extra month of supply in anticipation of a potential nitrile shortage later this year. We are currently receiving our full allocation of gloves, so we are not seeing any current supply constraints. All N95 respirators continue show a very healthy stock level and we are receiving products at our allocation level or have equivalents on site. In the last two weeks we’ve seen an increase in issues of respirators and we’re working to make sure we understand where these masks are going and if this is a trend, or a spike in usage. Disposable isolation gown usage has been steady in the last week and we continue to stockpile these gowns as we continue to roll out Image First reusable gowns through the A Pavilion. Our plan for next week is to start planning with 2B to move to the reusable gown so we can continue to preserve and build up reserve stocks of the disposable gown. With the increased volumes in the hospital we have been able to maintain a supply of our regular Halyard procedure mask of around 200,000 and have been stockpiling alternate, approved masks. We have identified a U.S. supplier of these masks that we have an order pending their FDA approval in the early Fall. The 200,000 equates to about 2 ½ months of stock. Usage is creeping up above our allocation, but we’re able to go to market and buy additional masks if we need to before the U.S. supplier gets FDA certification. Purple top wipes usage is steady, is under our weekly allocation quantity and we are storing several pallets of them at our offsite warehouse.

We have been told by two manufacturers that the raw material used to make bouffant caps and shoe covers will start to be in short supply as it’s only currently produced in China. We were able to get a jump on this news and bought four months’ supply of both from a distributor that we regularly do business with. We want to emphasize this is future-proofing our supply chain, we’re currently receiving our full allocation of both products.

Lowry Pharmacy Returns to Normal Hours
The Lowry Family Health Center Pharmacy has returned to normal business hours. The pharmacy is now open Monday through Friday from 8 a.m. to 6:30 p.m. and does not close during lunch hours. The pharmacy operated under reduced hours in April, May, June and July due to changes related to the pandemic.

Policy Updates

Universal Masking

Remember that the universal masking policy applies to all staff, patients and visitors across all Denver Health locations. This includes while in hallways and transporting patients.

· Clinical staff members are required to wear at all times a mask or a respirator that is appropriate to their environment of care. See the details here.

· Non-clinical staff members are required to wear a face covering when within entering or moving around indoor spaces and when within 6 feet of another person. Learn more here.

· Patients and visitors are also required to wear a mask or a face covering. Supplies are available at hospital entrances.

Hand Hygiene

· All employees and contractors who have direct patient contact must follow the Hand Hygiene Policy.

· Wash your hands frequently with soap and water for at least 20 seconds or use hand sanitizer provided by Denver Health.

Social Distancing

Social distancing is critical to reduce the risk of transmission. It’s also important that we lead by example. Remember to stay at least six feet away from others unless it’s required for patient care while using appropriate PPE. Staying six feet away also means skipping the handshake.

Infection Prevention Best Practice Quick Reference

COVID-19:

· N95 Mask Options and Mask Labeling

· PPE Algorithm

· Donning and Doffing Instructions

· Specialized Respiratory Isolation

· Other Personal Protective Equipment (PPE) Questions

· Centers for Disease Control (CDC) and Colorado Department of Public Health & Environment (CDPHE) Resources

Policies:

· Hand Hygiene

· Standard Precautions

· Isolation/Transmission-based Precautions

Quick Videos:

· World Health Organization (WHO): How to wash hands with soap and water

· WHO: How to wash hands with alcohol-based hand sanitizer

Denver Health Coronavirus Resources:

· Denver Health External Website for Staff

· Denver Health Pulse Subsite

· RISE Virtual Group Support

· Weekly Mindfulness WebEx

Helpful Links:

· Colorado Department of Public Health and Environment Coronavirus Information

· Denver Department of Public Health and Environment Coronavirus Information

· Centers for Disease Control and Prevention Coronavirus Information

· Denver Public Health Website

Thank you for everything you do for Denver Health!

Connie Savor Price, MD

Chief Medical Officer

Denver Health and Hospital

Professor of Medicine

Division of Infectious Diseases

University of Colorado School of Medicine

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