Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, COVID-19 hospitalization numbers decreased over the past week. We have a total of 7 patients- our lowest number of inpatients since we began tracking - 2 on general medicine, 5 in the ICU (3 vented).

Source: Irving Luna, Facilities

Our laboratory positivity rate among those tested is 2%, which has decreased this past week

Source: Jenna Culp, Laboratory

Denver Cases:

As of Sep 7, there have been 11,504 confirmed cases of COVID-19 in Denver, including 434 deaths. None of those deaths were reported in the last week. 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 almost back to our nadir at 38.3 cases/day as of September 7 (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 59,487 confirmed cases of COVID-19 in Colorado, including 1,973 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 to 139 as of Sep 7, which is near our nadir (lowest rate) of 127 on June 27. Highest activity (per 100,000 persons) in the past week is in Northestern CO. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 6,287,362 confirmed cases of COVID-19 in the U.S., including 188,688 deaths. Over the past week, 38,915 cases per day, a decrease of 9 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, when the country averaged well over 60,000 per day. Much of the most populous states 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 27,236,916 confirmed cases of COVID-19, including 891,031 deaths reported to the World Health Organization (WHO). Over 1.8 million new cases and 37, 000 new deaths were reported for the week ending 6 September, a 5% increase in the number of cases and a 2% decrease in the number of deaths compared to the previous week. South-East Asia continued to show the highest increase in new COVID-19 cases in the past week. An increase in the number of new reported cases was seen in the European and Eastern Mediterranean Regions, while the African and Western Pacific Regions declined in both cases and deaths compared with last week. The Americas saw a 1% increase in reported cases, but a 4% decrease in deaths, and continues to carry the highest burden of the disease globally, accounting for nearly half of all new cases reported in the past seven days. 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 continue to hold about a month of safety stock in our offsite warehouse, plus also have alternatives. Disposable isolation gown usage has steadied in the last week in the low 400s per day. After the dark days of May where our weekly purchase would last barely three days we now find ourselves with almost a glut of gowns!. Our current stock on hand equates to almost 6 months of current usage. If we hit a surge in use we can almost certainly cover it with just the reusable gowns alone without breaking in to this disposable stock. With flu season coming soon we feel we’re in a good position. 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 respirators. We received a delivery this week of the 3M 9205+, the U.S. manufactured equivalent to the 3M 1870+ respirators. Next week we will get samples to COSH so we can start to fit test people to the new respirators. We continue to see an increase in issues of the regular duckbill, this is the only respirator where our usage is outstripping our regular weekly purchase allocation, and has been for the last few weeks. We have been able to work with the manufacturer and our distributer to find another 6,000 respirators above and beyond our regular order. That extra amount is around two months of stock at current usage. 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 of the Halyard mask, which allows us to add about 10,000 to our back up stock each week. Stock on hand today is about 80 days’ worth. This week we were able to negotiate an increase in our weekly allowance of purple top wipes in anticipation of using more as we roll out the recommendation for patient-facing staff to wear face shield and clean them with these wipes. Usage has increased this week, but only to a level where we are using less than half our new weekly allocation. With the additional supply of 1,000 cases from two weeks ago we now have three and a half months’ worth of usage on hand. As we have been bracing for, we are starting to see occasional shortages of PPE made of a material called SMS that is almost exclusively manufactured in China. This week we saw our first failure to deliver on existing orders for disposable white jackets and coats. We managed to find an alternate source of the large size jacket and jumped on a purchase of 112 cases which should last a few months. We know that the disposable lab coats, made out of the same material, could be a potential problem so we’re already in discussion with the Lab about introducing a launderable, reusable coat so we’re not dependent on a supply chain out of China.

Source: Stuart Layhe, Materials Management

Get Ready to Fight the Flu!

Flu season is just around the corner, and with the COVID-19 pandemic we must do our part to make this flu season as mild as possible: wear masks, social distance, wash hands, and also, get a flu vaccination. Flu vaccination is mandatory for all Denver Health employees, even those who work from home. Denver Health will begin offering vaccinations to employees on Monday, September 14th­. This year’s deadline to get vaccinated is Monday, November 2nd. The first step is to pre-register in the FluTracker application – all employees are required to pre-register. If you prefer to receive your vaccination somewhere else, first pre-register and then submit an off-site documentation form by Friday, October 16th. Staff declining vaccination due to medical reasons are required to first pre-register and then submit a medical exemption form by Friday, October 16th. Employees opting out for religious reasons must also pre-register and then submit a religious exemption form by Friday, October 16th. FAQs, clinic schedules, guidelines, deadlines, contact information, and more are available on the Employee Flu Subsite.

Source: Bryan Knepper, Infection Prevention

Drinking Fountains

In March, all drinking fountains were covered in order to remove those as a potential source of transmission of COVID-19. At the time there was little evidence on how well the coronavirus spreads via water or surfaces.

What are the risks of drinking from a drinking fountain? To date no cases of COVID-19 have been linked to the use of water fountains. There is little to no risk of coronavirus transmission from the water in the fountain. The virus that causes COVID-19 has not been recovered from drinking water. Saliva from one user could contaminate the spout and potentially be spread to the next user. However, because water is regularly flowing from the spout, this area is getting regularly rinsed every time the fountain is used and thus there should be low risk of lingering virus on the spout itself.

Don’t: uncover drinking fountains yourself. Engineering will uncover fountains and flush supply lines.

Do: Sanitize your hands before AND after using the drinking fountain. This reduces bioburden buildup on surfaces. It also protects you if bacteria or viruses were present on the surfaces you touched.

Source: Bryan Knepper, Infection Prevention

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

· 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

Did this answer your question?