Remember to Wear Face Coverings and Maintain Social Distancing

COVID-19 Epidemiology

At Denver Health, hospitalized COVID-19 patients in isolation have increased over the past week. This morning, we had a total of 25 patients - 17 on general medicine, 8 in the ICU (6 vented).

Our laboratory positivity rate among those tested is 9%, which is increased over this past week

Denver Cases:

As of Sep 29, there have been 13,956 confirmed cases of COVID-19 in Denver, including 447 deaths. After high of 153 cases/day on July 27 from a low of 30 cases/day on June 11, we have increased again to 95.6 cases/day (7 day moving average) which is lower than what I reported last week. While community rates appear to be stabilizing, we are now seeing the delayed impact on increased hospital admissions. If the stabilization in community rates hold, we should expect to see a stabilization in hospitalizations as well. https://storymaps.arcgis.com/stories/50dbb5e7dfb6495292b71b7d8df56d0a

Colorado Cases:

There have been 74,191 confirmed cases of COVID-19 in Colorado, including 2,081 deaths among those patients. New cases had been steadily increasing in Colorado after Labor Day until late September, many in the 18-24 year olds, but in past week new cases appear to be stabilizing. Highest activity (per 100,000 persons) in the past week is in northeastern CO (Logan, Washington, Yuma, Adams, Broomfield, Lincoln). Hospitalizations have increased over past week, increasing from 126 nadir in late June to 213 as of Oct 4, although still far below our peak of 888. https://covid19.colorado.gov/covid-19-data

US Cases:

There have been 7,436,278 confirmed cases of COVID-19 in the U.S., including 209,560 deaths. Over the past week, there have been an average of 44,280 cases per day, an increase of 6 percent from the average two weeks earlier. New infections are increasing most in the Upper Midwest and parts of the West. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

Worldwide:

Globally there have been 35,347,404 confirmed cases of COVID-19, including 1,039,406 deaths reported to the World Health Organization (WHO). The number of new cases per week has remained stable at 2 million for the past three weeks. Five countries (India, the United States, Brazil, Argentina and France) reported 60% of new global cases this past week, while Israel registered the highest incidence (3717 new cases per 1 million population). Globally, the highest percentage of cases have been reported in the 25-39 age group, with approximately 50% of cases in the 25-64 age group. https://covid19.who.int/

Supply Updates

PPE

Nitrile gloves continue to be in balance where our weekly use is just above our purchases. We have heard from other hospitals that they are seeing shortage in gloves but we confirmed with our distributor and manufacturer that we are seeing no supply issues and we have plenty of alternate gloves at our warehouse. Disposable isolation gown usage had a small increase 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. We also have significant quantities of approved alternates. We continue to see an increase in 1860S but we have stock on hand and have been able to buy another 40 days worth (at the higher usage) from our distributor which are due to be delivered over the weekend. Stock of our regular Halyard procedure mask continues to be stable around 230,000 masks, which is about two and a half months’ worth and we are receiving our full weekly allocation. Purple top wipe usage is stable and we have fifteen weeks of stock on hand.

Laboratory Testing

We are watching our testing supplies closely. We have at least 10 days of complete testing supplies on hand, and we are awaiting confirmation on status of a specific shipment tomorrow to inform whether we will need to consider any testing conservation strategies.

Used N95 Mask Collection Ending This Week

EVS and Supply Chain will stop collecting used N95 masks during the week of Wednesday October 7th. EVS will come around to remove the red collection bins from each area. It may take several days to remove all red bins from each area.

Why is this change happening? Supplies of N95 masks have been stable and at our regular volumes for several months, so reprocessing masks is not needed to preserve supplies. In addition, many thousands of masks have already been reprocessed to date and are in our offsite warehouse in the unlikely event they are needed. Reprocessing more masks is not needed at this time.

What do you need to do? Continue to use N95 masks the same way you have been since March. If you normally use 1 per shift, please continue to do so. If you wear N95 masks intermittently and use 1 per week, please continue to do so. Once the red bins are removed, discard used N95 masks in regular trash.

Contact Supply Chain (ICC_Logistics@dhha.org) or Infection Prevention (InfectionPrevention@dhha.org) with any questions or concerns.

Denver Health Super users Trialing the CleanSpace Halo

Denver Health has purchased a supply of 100 NIOSH-approved reusable respirators called the CleanSpace Halo (link here). These are intended to supplement some of our disposable N95 supply as we go into respiratory season. The initial phase of the roll out starts with Super User training. Our Infection Prevention team is tasking representatives from across the organization to help us get a clear vision for how best to use these devices this respiratory season.

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. They have been offering training sessions in our clinics on standard and COVID-19 precautions, including donning/doffing and the use of a face shield. Due to positive feedback, they will continue offering these sessions in our clinics throughout the coming weeks. Similar sessions will be offered in 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 by November 2. This includes those who are currently working from home. Find more information on the Employee Flu Subsite.

Employee Flu Documentation Deadline: Oct. 16th

The deadline to submit medical exemption, religious declination, and offsite vaccination documentation is Friday, October 16th. Medical exemption and religious declination forms received after October 16th will be denied. Offsite vaccination forms will be accepted through November 2nd, but submission after October 16th could result in delayed entry into the FluTracker application. Use the following procedure for submitting any type of documentation:

1) Download your form from the Employee Flu Subsite

2) Complete and sign the form

3) Scan and send to fluinfo@dhha.org

Religious Declination requests are reviewed by the CHRO. Medical Exemption requests are reviewed by the COSH and Infection Prevention medical directors. Offsite Vaccination Documentation is entered into FluTracker by COSH – the goal is to enter offsite vaccination documentation within 1 week.


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 LOAFMLProcess@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.

Stay Vigilant with Social Distancing During 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 groups.

· 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.


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.

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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