Remember to Wear Face Coverings and Maintain Social Distancing

Image courtesy of CDC

COVID-19 Epidemiology

At Denver Health, COVID-19 hospitalization numbers have remained stable to slightly increased over the past week, but much lower than our peak of 71 patients on 5/3/20. Fewer of those patients are requiring ICU this week. We have a total of 15 patients- 11 on general medicine, 4 in the ICU (1 vented).

Source: Jeremy Cooke, Emergency Management

Our laboratory positivity rate among those tested is 4%, which was stable over past week

Source: Amanda Penick, Laboratory

Denver Cases:

There have been 11,261 confirmed cases of COVID-19 in Denver, including 434 deaths. Community case rates remained stable for most of week. After an increase to 153 cases/day on July 27 from a low of 30 cases/day on June 11, we are at 45.4 cases/day as of September 1 (7 day moving average) which is lower than what I reported last week. In Denver, most cases are diagnosed in the 20-40 year age group, but most hospitalizations occur in those older than 50. https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 57,775 confirmed cases of COVID-19 in Colorado, including 1,946 deaths among those patients. New cases have been decreasing overall in Colorado during the past week. Hospitalizations across the state continued to decrease over the past week, but are still increased from a low of 127 on June 27 to 144 as of Sep 1. Highest activity (per 100,000 persons) in the past week is in San Juan county (southwest CO) https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 6,004,443 confirmed cases of COVID-19 in the U.S., including 183,050 deaths. Over the past week, there have been an average of 42,189 cases per day, a decrease of 14 percent from the average two weeks earlier. While case numbers remain elevated across much of the country, reports of new cases have dropped considerably since late July. Much of the South and West are seeing improvements, rates in the Northeast remains relatively low, but new infections have been rising in parts of the Midwest.

https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 25,327,098 confirmed cases of COVID-19, including 848,255 deaths reported to the World Health Organization (WHO). Over 1.8 million new COVID-19 cases and 38 000 new deaths were reported to WHO in the week ending 30 August, a 1% increase in the number of cases and 3% decrease in the number of deaths compared to the previous week. While the Americas accounted for nearly half of all new cases reported in the past seven days, decreases in new cases and deaths were observed in the past week. South-East Asia continues to report an increase in cases. In Europe, new cases and new deaths have continued to increase over the past seven days compared to the previous week. New cases in Africa, the Eastern Mediterranean, and Western Pacific have declined compared with last week. https://covid19.who.int/

PPE Supply Updates

Nitrile gloves continue to be in balance where our weekly use is just below to our purchases. We have a month of safety stock in our offsite warehouse and additionally we also have alternatives. Disposable isolation gown usage has continued it’s steadily decline. Our daily average hit a low of 333 today, compared to our maximum daily use in the height of COVID of close to 3,500. We continue to buy our full allocation of 7,700 per week. We have significant backup stock of Halyard gowns and this will only continue to increase as we move to the Image First reusable gowns. If we hit a surge in use we can almost certainly cover it with just the reusable gowns alone. All N95 respirators continue show good stock levels and we are receiving products at our allocation level or have equivalents on site. We also have significant quantities of approved alternates on most. We continue to see an increase in issues of the regular duckbill, the only respirator where our usage is outstripping our regular weekly purchase allocation. With the increased volumes in the hospital we have been able to maintain a supply of our regular Halyard procedure mask of over 200,000 and have been stockpiling alternate, approved masks. We are currently using about 75% of our weekly allocation and added a further 12,000 to our backup stock this week. Purple top wipes usage is steady, and is about 75% our weekly allocation quantity and we are storing pallets of them at our offsite warehouse. We were able to find an additional supply of 1,000 cases of purple tops this week and now have significant stocks and have identified another source of the same wipe but in a different package configuration.

Source: Stewart Layhe, Materials Management

Getting A Flu Shot This Year Is More Important Than Ever
COVID-19 will still be circulating during influenza (flu) season, which makes getting the flu vaccine more important than ever. Denver Health will begin vaccinating employees on September 14th. By state and federal requirement as well as DH policy, all employees, students, residents, volunteers and contractors are required to obtain a flu vaccination or obtain an approved exemption by November 2, 2020. This includes those currently working from home. Stay tuned for more information on dates/times and locations for employee flu clinics.

Suspension of Contact Precautions for VRE (in addition to MRSA)

Infection Prevention is moving forward with permanently suspending contact precautions for patients with a history of or active infection with vancomycin-resistant Enterococcus (VRE), as we recently did with methicillin-resistant Staphylococcus aureus (MRSA). Denver Health’s VRE rate has remained stable for at least the past 3 years with no concerning trends. This is consistent with the findings of several studies published in academic journals over the last few years.

High Risk Infection Team (HITeam) Trained for Pandemic

Pictured: HITeam members teaching donning and doffing to DH Staff

Denver Health has a specialized team trained to care for patients with high risk infection, such as COVID-19. The Denver Health High Risk Infection Team (HITeam) consists of a group of passionate, highly trained professionals from departments across the hospital. Pictured above, HITeam members participate in an exercise during our annual site visit from the National Emerging Special Pathogens Training and Education Center. Our health care professionals proactively started the team in 2014 in response to the Ebola epidemic. The team’s diverse mix of doctors, nurses, respiratory therapists, laboratory scientists, paramedics and other health care professionals are prepared to identify, isolate, transport, treat, and care for patients with highly infectious diseases such as COVID-19 and viral hemorrhagic fevers. They serve on a volunteer basis to train and educate staff, care for patients, and provide outreach in our Department of Health & Human Services region, which includes Colorado, Montana, North Dakota, South Dakota, Utah and Wyoming. Click here to read more about our amazing HITeam! If you have direct patient contact and have interest in joining the HITeam, email Brian Gardiner, BA, BSN, RN, our amazing HITeam RN lead.

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

· 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

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