Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

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

Our laboratory positivity rate among those tested is 3%, decreased from most recent (mid-July) peak of 15%

Denver Cases:

There have been 10,174 confirmed cases of COVID-19 in Denver, including 419 deaths. Community case rates continue to decline this week. After an increase to 153 cases/day on July 27 from a low of 30 cases/day on June 11, we are now at 51 cases/day as of August 10 (7 day moving average). https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 51,039 confirmed cases of COVID-19 in Colorado, including 1,863 deaths among those patients. Hospitalizations across the state have decreased over the past week, but are still increased from a low of 127 on June 27 to 185 as of Aug 10. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 5,023,649 confirmed cases of COVID-19 in the U.S., including 161,842 deaths. Over the past week, there have been an average of 53,724 cases per day, a decrease of 18 percent from the average two weeks earlier. The epicenter in the United States seems to be shifting to the Midwestern US https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 19,718,030 confirmed cases of COVID-19, including 728,013 deaths reported to the WHO. The biggest regional change in the number of new cases in the past seven days is a decrease (23%) in Africa, although deaths continued to rise. While the Americas still remains the hardest-hit, contributing over half of all newly confirmed cases reported (54%) and deaths (63%) reported worldwide during the past week, the largest percentage increase in new cases and deaths was seen in the Western Pacific region (31% and 27% respectively). The US, Brazil, and India remain the top three most affected countries in the past seven days. https://covid19.who.int/

PPE Supply Updates

We are receiving N95 respirators at our allocation level or have equivalents on site. N95 Mask (Duckbill Regular) are below targeted days on hand, but we have significant quantities of approved alternates. In the last two weeks we’ve seen an increase in issues of respirators and we’re working to understand where these are being used. 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. On Tuesday 2B will 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 about 2 ½ months of stock. Usage is still above our allocation, but we’re able to buy additional masks before our new potential U.S. based manufacturer gets FDA certification in the Fall. Small sized nitrile gloves, approved for use with chemotherapy gloves, Lawson 34020, are out of stock at the manufacturer. We have sourced an alternate and have pulled from our donated stock samples for Infection Prevention to review for use. Purple top wipes usage is steady, is under our weekly allocation quantity and we are storing several pallets of them at our offsite warehouse.

When a Co-worker Tests Positive

We’ve recently received a number of questions related to responsibilities and expectations if you or someone on your team tests positive for COVID-19. Please read the frequently asked questions and answers below:

What are an employee’s responsibilities if their COVID-19 test is positive?

· Employees who have tested positive for COVID-19 and have symptoms must remain out of work for at least 10 days from when their symptoms began and until they have no fever for 24 hours without the use of fever-reducing medicine (antipyretics), and their respiratory symptoms are improving.

· Employees who have tested positive for COVID-19 and do not have symptoms must remain out of work for at least 10 days from the date of their positive test.

· A negative test is not required to return to work.

· Employees may choose to inform their manager when they test positive but are not required to do so.

· Employees who test positive should contact LOAFML@dhha.org for HR assistance.

What are a manager’s responsibilities if an employee tests positive for COVID-19?

· Understand that for PHI reasons, employees who test positive are not required to inform their manager of their positive test.

· If notified of an employee’s positive test, managers are allowed but not required to disclose the positive result to other employees, and they must do so without disclosing any PHI. Managers may tell staff that they might have been exposed to someone who has tested positive for COVID-19.

· Make sure all employees are informed of policies. Remind all staff that they should be wearing masks, practicing physical distancing, doing excellent hand hygiene, and continuing to monitor daily for symptoms of COVID-19.

· As always, direct staff to complete the employee health survey if they develop symptoms and want to find out whether they need to be tested.

Will employees be notified if one of their coworkers is positive for COVID-19?

Employees may be notified that they might have been exposed to someone who tested positive. Because of privacy concerns, a staff member is not required to inform their manager that they have tested positive, and the manager has discretion as to whether notifying other staff members is appropriate. All employees are expected to follow hospital policy in order to protect themselves – this includes mandatory masking, physical distancing, hand hygiene, and not working when ill. Physical distancing is especially important during meal breaks when masks are removed.

Will employees be notified if one of their patients is positive for COVID-19?

In the course of regular clinical care, clinical team members will likely become aware if one of their patients has tested positive for COVID-19, but this may not be true in all cases. Employees will not be notified in all cases that one of their patients has tested positive. Employees are expected to use the proper PPE in all patient encounters in order to protect themselves from exposure.

If a manager suspects an outbreak in his or her unit, what are the first steps that they should take?

First, any staff members who have possible COVID-19 symptoms should remain out of work. Symptomatic staff should complete the employee health survey as soon as possible. If a manager suspects an outbreak in their unit, they should advise all employees with symptoms to fill out the employee health survey, make sure all employees with symptoms remain home during evaluation, and contact Infection Prevention for guidance. Infection Prevention will discuss the situation with the manager to assess the likelihood of an outbreak and recommend next steps, including identifying potentially exposed staff. If testing of potentially exposed staff is indicated, the manager will communicate next steps to these individuals. The workspace will be scheduled for a deep cleaning by EVS and UV treatment.

What if I have no symptoms and the employee health survey does not recommend testing, but I want to get tested anyway?

Staff may contact their PCP for testing; alternatively they are welcome to seek testing services at any of the testing sites around the Denver metro area, such as the Pepsi Center. Please note that the results of these tests may be delayed in coming back. Staff should not seek testing at COSH or the AUCC. A list of all public testing sites can be found here: Colorado COVID-19 Testing Sites.

Updated Recommendations for Clearance from Isolation

The Centers for Disease Control recently updated their isolation clearance recommendations for COVID-19.

· Two negative PCR tests are no longer recommended or required prior to removal of isolation precautions.

· Most patients may have isolation removed ≥10 days after symptom onset and ≥24 hours after the absence of fever without fever-reducing medications.

· Critically ill patients and those with profound immunosuppression, such as bone marrow transplant recipients should be isolated for ≥20 days after symptom onset and ≥24 hours after the absence of fever without fever-reducing medications.

· Additional COVID PCR testing is not recommended for at least 90 days after a positive result– this includes readmissions and transfers from other hospitals. Patients with a previous positive test ≥10 days after symptom onset with ≥24 hours absence of fever without fever-reducing medications should not be placed in Specialized Respiratory Precautions at admission.

Important Reminders

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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