Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, COVID-19 hospitalization numbers have decreased over the past week. We have a total of 10 patients- 5 on general medicine, 5 in ICU (4 vented).

Our laboratory positivity rate among those tested is 6%, which stable/slightly increased over past week.

Denver Cases:

There have been 10,552 confirmed cases of COVID-19 in Denver, including 426 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 43.1 cases/day as of August 17 (7 day moving average). https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 53,370 confirmed cases of COVID-19 in Colorado, including 1,896 deaths among those patients. Hospitalizations across the state continued to decrease over the past week, but are still increased from a low of 127 on June 27 to 163 as of Aug 17. Highest activity (per 100,000 persons) in the past 2 weeks has been in the greater Denver and CO Springs metro areas. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 5,382,125 confirmed cases of COVID-19 in the U.S., including 169,350 deaths. Over the past week, there have been an average of 51,211 cases per day, a continued decrease from the high of 74,818 on July 24. The percentage of laboratory tests positive for SARS-CoV-2 have continued to decrease nationally since mid-July. Weekly hospitalization rates attributed to COVID-19 also continue to decline in all US regions. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 21,549,706 confirmed cases of COVID-19, including 767,158 deaths reported to the WHO. In the past seven days, the number of reported daily cases increased with an average of 260,000 cases and 5,500 deaths per day. The Americas remains the most affected region in the past seven days, accounting for 53% of all newly confirmed cases and 75% of reported deaths. South-East Asia continues to report an increase in cases and is currently the second most affected region. Due to the resurgence of cases in many countries, stay at home measures and travel restrictions are being re-implemented as part of efforts to limit the transmission of the virus. https://covid19.who.int/

PPE Supply Updates

Our distributors have agreed to provide substantial increases in our allocations on nitrile gloves—all 3 sizes. Further, we have been able to maintain a supply of our regular Halyard procedure masks of around 200,000 and have been stockpiling alternate, approved masks. Our new weekly allocation is about double our current allocation, so we will be able to stockpile considerable quantities in the coming weeks. The increase to the gloves in particular is vital—they are on backorder across the globe, and Medline, the other big medical distributor in our market, notified their customers that their allocations were going to be cut in half next month! We will reflect changes on the PPE table once we receive our shipments at these new allocation levels. 2B has moved to the reusable isolation gown and 7A is next up on the conversion. Our usage is now substantially below our weekly allocation -- our rolling 7 day average use is now down to under 530/day-- but we’re buying to the higher level to build up reserve stocks of disposable isolation gowns. There is one item in yellow this week and it is N95 Respirator, Duckbill Regular, but we have significant quantities of approved alternates. We are expecting more duckbills in this week. Other N95 respirators continue show good stock levels and we are receiving products at our allocation level or have equivalents on site. 3M has introduced a new respirator, manufactured in the USA, which is meant to be the equivalent of the 1870+ that we used to stock. We have placed an order for these and hope to have them delivered within the next two to three weeks. Purple top wipes usage is steady, is under our weekly allocation quantity and we are storing several pallets of them at our offsite warehouse.

Following the Rules for Meals & Breaks

COVID-19 is still present – and so are public health mandates that require social distancing in the cafeteria, break rooms, and off campus. Please continue to keep six feet of distance from others and limit the size of gatherings. As representatives of Denver Health, we must set a good example for patients, visitors, contractors, construction colleagues, and most importantly, each other. Follow these guidelines:

· Respect placards that indicate a booth or table is closed. These are closed in order to facilitate social distancing.

· Do not slide tables together or pull additional chairs close together around a table or booth.

· Sit at least six feet apart from others whenever possible.

· Masks must always be worn when not eating or drinking and when moving through the dining area.

We Need to Take Care of Our Mental Health

According to a new CDC study, three times as many Americans report symptoms of an anxiety disorder and four times as many report symptoms of depression now compared to in 2019. Of special concern, is that 11% of Americans report seriously contemplating suicide in the past 30 days with 18-24 year olds (25%), essential workers (22%), Hispanic respondents (19%), and black respondents (15%) reporting disproportionately high rates of suicidal ideation. Denver Health is pleased to have the following resources for employees with mental health concerns: 1) Resilience in Stressful Events (RISE), which can be reached at 303-436-7473 or dhrise@dhha.org, and 2) our Employee Assistance Program, which can be reached at 866-799-2728 or answers@healthadvocate.com.

Obtain a Nasopharyngeal Swab for Rapid Testing on ALL Patients Admitted to Denver Health

Supplies for rapid testing now allow for rapid testing on ALL admitted patients, at least for now. That means that all patients getting admitted to the hospital can have a rapid COVID-19 test result to inform their optimal room placement. As our rapid platforms only accommodate a nasopharyngeal (NP) swab, and not an oropharyngeal swab, make sure to obtain the NP swab on patients who are being admitted to the hospital.

Adult Bed Capacity Expanding

Over the next four to six weeks, Denver Health will be expanding our adult bed capacity by utilizing some space on the south side of the fourth floor in Pavilion C. 4C South will become a 17-bed adult Medical-Surgical Unit used primarily for Orthopedic patients. It will be staffed by the nursing group that formerly worked on 3B. The second floor in Pavilion C will return to its previous use for Pediatrics and the Pediatric Intensive Care Unit. When needed, 2C will also accommodate overflow from the Neonatal Intensive Care Unit and Obstetrics. In addition, we will change the way we use the third floor of Pavilion B to increase our Intensive Care Unit and Progressive Care Unit capacity. Those two units will merge into a single unit called “3B Flex,” which will also accommodate floor level patients as needed. The 3B merge will maximize flexibility to meet the needs of our patients.

Help Us Maintain Appropriate Air Flow! Keep Doors Closed Near Pavilion B Elevators and Inpatient Unit Entrances

All entrances to Pavilion B, including around the elevator, must remain closed. These closed entrance doors help keep negative pressure throughout Pavilion B to support our patient care. Thank you for closing the door behind you.

Updated Patient Information

We’ve updated a couple of the handouts we provide to patients at Denver Health. Here’s the latest patient information flyer about their care and options during the COVID-19 pandemic. There’s also an updated telehealth guide here. Please check that the handouts you’re giving out and any information posted in your area is up-to-date.

Reminder: When to Remove Special Respiratory Infection (SRI) Precautions

· A negative PCR test is 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 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 after a positive result is not recommended – 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.

See more from the CDC’s isolation clearance recommendations for COVID.

Other Policy 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

· 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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