Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, COVID-19 hospitalization numbers have INCREASED over the past week. We have a total of 14 patients - 9 on general medicine, 5 in the ICU (2 vented).

Our laboratory positivity rate among those tested is 6%, which has increased this past week

Denver Cases:

As of Sep 7, there have been 12,591 confirmed cases of COVID-19 in Denver, including 440 deaths. Community case rates have INCREASED this past week. After an increase to 153 cases/day on July 27 from a low of 30 cases/day on June 11, we have increased again to 83.7 cases/day as of September 22 (7 day moving average) which is higher than what I reported last week. Cases are most frequently diagnosed in the 20-40 year age group. https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 66,053 confirmed cases of COVID-19 in Colorado, including 2,025 deaths among those patients. New cases have been INCREASING in Colorado during the past week. Despite that, hospitalizations across the state remained STABLE over the past week at 148 as of Sep 22. Highest activity (per 100,000 persons) in the past week is in Northestern CO, Boulder and Summit counties. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 6,825,697 confirmed cases of COVID-19 in the U.S., including 199,462 deaths. Over the past week, there have been an average of 41,812 cases per day, an INCREASE of 7 percent from the average two weeks earlier. New infections have been rising in parts of the Midwest, but so far, hospitalizations have not spiked as much as we had seen early in the pandemic.

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

Worldwide:

Globally there have been 31,174,627 confirmed cases of COVID-19, including 962,613 deaths reported to the World Health Organization (WHO). From September 14 through 20, there were almost 2 million new cases of COVID-19, which represents a 6% INCREASE compared to the previous week, and the highest number of reported cases in a single week since the beginning of the epidemic. During the same period, there was a 10% DECREASE in the number of deaths. The increase in case incidence was reported in all major regions of the world, with the exception of Africa. https://covid19.who.int/

PPE Supply Updates

Nitrile gloves continue to be in balance where our weekly use is just below to our purchases. Disposable isolation gown usage had a small increase in usage but our current stock on hand equates to almost 6 months of current usage. Almost all our usage is now on the reusable Image First laundered gowns. 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 of the 3M 9205+, the U.S. manufactured equivalent to the 3M 1870+ mask. These are available now in COSH and they will fit test you if you need. 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. However, we received an order of 6,000 respirators above and beyond our regular order delivered late last week and we have about four months on hand. With have been able to maintain a supply of our regular Halyard procedure mask and now have over 230,000 on hand and have been stockpiling alternate, approved masks. We are currently using just over 80% of our weekly allocation of the Halyard mask. Stock on hand today is still about 80 days’ worth. Purple top wipe usage has increased slightly over the last two weeks, but only to a level where we are using about 40% of our week purchase. We now have eighteen weeks of stock on hand.

High Risk Infection Team (HITeam) Sharing Expertise

Our Denver Health HITeam is a group of passionate, highly trained individuals preparing for treating and caring for a patient with a highly infectious disease. They serve a key role in our designation as one of 10 Regional Ebola & Special Pathogens Treatment Centers (RESPTCs) in the United States. As such, they will be offering training sessions on standard and COVID-19 precautions, including donning/doffing and the use of a face shield, with our ACS clinics throughout the coming weeks. They will be hosting similar sessions for the main hospital for all interested departments/units. For more information, contact Brian Gardiner, RN Brian.Gardiner@dhha.org

Flu Vaccination Clinics on Campus
Getting your flu shot this year is more important than ever. Pre-register for the vaccine and then come to one of the employee flu shot clinics. Click here for the clinic schedule. This year, pre-registration is required. All employees, students, residents, volunteers and contractors are required to obtain a flu vaccination or an approved exemption by November 2. This includes those who are currently working from home. Find more information on the Employee Flu Subsite.

When a Co-worker Tests Positive
Do you know what to do if you or someone on your team tests positive for COVID-19? Here are the answers to some of staff’s most frequently asked questions:

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, practicing excellent hand hygiene, and continuing to self-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.

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.

Stay Vigilant During Meals & Breaks

Public health mandates require social distancing in the cafeteria, break rooms, and off campus.

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

· Sit at least six feet apart from others.

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

· Food should be packaged and wrapped for an individual. Avoid shared items and family-style orders.

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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