Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, hospitalized COVID-19 patients in isolation have been stable over the past week. We have a total of 13 patients - 8 on general medicine, 5 in the ICU (2 vented).

Our laboratory positivity rate among those tested is 5%, which is stable to decreased over this past week

Denver Cases:

As of Sep 29, there have been 13,297 confirmed cases of COVID-19 in Denver, including 441 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 91.4 cases/day (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 70,025 confirmed cases of COVID-19 in Colorado, including 2,046 deaths among those patients. New cases have been increasing in Colorado during the past week, with a number of cases on college campuses. We are now seeing an uptick in hospitalizations, increasing from 148 last week to 174 as of Sep 29-- although still lower than our peak of 888. Highest activity (per 100,000 persons) in the past week is in northeastern CO, Huerfano, Boulder, and Summit counties. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 7,129,313 confirmed cases of COVID-19 in the U.S., including 204,598 deaths. Over the past week, there have been an average of 43,128 cases per day, an increase of 13 percent from the average two weeks earlier. New infections have been rising most in the Midwest and in some Southern states. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 33,249,563 confirmed cases of COVID-19, including 1,000,040 deaths reported to the World Health Organization (WHO). From September 21 through 27, there were more than 2 million new cases and 36 000 new deaths reported, which is similar to the numbers reported the previous week. https://covid19.who.int/

PPE Supply Updates

Nitrile gloves continue to be in balance where our weekly use is just above our purchases. Disposable isolation gown usage had a small decrease in usage but our current stock on hand equates to almost 8 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. The 3M 9205+, the U.S. manufactured equivalent to the 3M 1870+ mask are available now in COSH. We continue to see an increase in issues of the regular duckbill and the 1860, but these appear to be spikes caused by departments taking full allocations once every three or four weeks causing fluctuations in weekly averages. We have sufficient stock on both. Last week we also saw a significant increase in 1860S but we have stock on hand and significant quantities of the alternative 8110S. Stock of our regular Halyard procedure mask is stable around 230,000 and have been stockpiling alternate, approved masks. We continue using just over 80% of our weekly allocation and on hand quantity is still about 80 days’ worth. Purple top wipe usage has increased over the last two weeks, but only to a level where we are using about 50% of our week purchase. We now have fifteen weeks of stock on hand.

Updated Screening Process to Enter Patient Care Facilities on Main Campus

Denver Health has a new COVID-19 screening process to keep us in compliance with federal regulations. The new process documents which employees are being temperature and symptom screened as they enter patient care facilities on Main Campus. The change rolled out last week. We enacted the new process after reports of other hospitals receiving citations from the Colorado Department of Public Health for inadequate screening records. When you come into a Denver Health screening station, you’ll be asked for your name or to show the QR code on your employee badge so that your self-reported symptoms can be recorded. Screeners will scan badges for those of you who have pre-registered for your flu shot. Employees who have not yet pre-registered for their flu shot will be asked for their names.

Expanded Adult Bed Capacity
Denver Health has expanded our adult bed capacity by utilizing space on the south side of the fourth floor in Pavilion C. Starting today, 4C South became a 17-bed adult Medical-Surgical Unit used mostly for Orthopedic patients. It is staffed by the nursing group that formerly worked on 3B. Yesterday, the second floor in Pavilion C returned 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 the Mom/Baby Unit. Earlier this month, we changed the way we use the third floor of Pavilion B to accommodate intensive care, progressive care and floor patients in a single, new unit called “3B Flex.” The 3B merge maximizes flexibility to meet the needs of our patients. All three units were rearranged as a result of COVID-19.

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 a mask or a respirator that is appropriate to their environment of care at all times. See the details here.

· Non-clinical staff members are required to wear a face covering in any shared, indoor space – even while sitting in physically distanced cubicles. 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.

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.

Infection Prevention Best Practice Quick Reference

COVID-19:

· N95 Mask Options and Mask Labeling

· PPE Algorithm

· Donning and Doffing Instructions

· Isolation Clearance Recommendations

· 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 – Peer Support for Caregivers in Distress

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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