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COVID-19 Risk Topics Blog

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BETA Healthcare Group is committed to keeping its members informed on topics related to the COVID-19 outbreak and to help our healthcare facility members during this unprecedented time. We have formed an internal COVID-19 Task Force dedicated to answering our members' questions and providing information and resources.

This page is your source for risk considerations related to COVID-19, links to helpful resources across various healthcare settings and situations, and links to BETA group purchasing/supplier information. The Risk Blog information provided below is general guidance and provided for informational purposes only. The commentary is current at this time, but circumstances are changing rapidly. For the most up-to-date information, please consult primary sources or check with your BETA contact.

For risk or underwriting concerns specific to your organization around COVID-19, please contact us at riskmgmt@betahg.com.

The Occupational Health and Safety Department (OSHA) has issued guidance at the federal level to inform employers and workers in most workplace settings to help them identify risks of being exposed to and/or contracting COVID-19 that is periodically updated over time to reflect developments in science, best practices and standards at https://www.osha.gov/coronavirus/safework

Separate guidance is applicable to healthcare (CDC guidance) and emergency response settings (CDC guidance) at these links:

Healthcare Workers and Employers: https://www.osha.gov/coronavirus/control-prevention/healthcare-workers

Emergency Response Workers and Employers: https://www.osha.gov/coronavirus/control-prevention/emergency-response

BETA Healthcare Group has assembled a set of questions and answers concerning various facets of administering COVID-19 vaccines that are pertinent to members and their insurance coverage:

1. Where can I find more information about COVID-19 Vaccines?

The Centers for Disease Control (CDC) has put together informational resources that can help explain the COVID-19 vaccines and their safety, including myths and facts surrounding COVID-19 vaccines:

Understanding and Explaining COVID-19 Vaccines
Ensuring COVID-19 Vaccine Safety in the U.S.
Safety of COVID-19 Vaccines
Clinical Resources for Each COVID-19 Vaccine/Vaccination
Myths and Facts about COVID-19 Vaccines

COVID-19 Vaccination Toolkits (healthcare audience, recipient audience)

2. How do we help employees feel more comfortable about COVID-19 vaccination?

The Centers for Disease Control (CDC) has developed a host of resources and PDF documents that explain COVID-19 vaccination and provide information on how to start conversations with personnel to help overcome hesitancy and promote vaccine confidence:

COVID-19 Vaccination
Vaccinate with Confidence
How to Build Healthcare Personnel Confidence in COVID-19 Vaccines (PDF)
COVID-19 Vaccination Confidence Conversation Starter (PDF)

COVID-19 Vaccination Communication Toolkit

3. Now that we are administering COVID-19 vaccines do we need to make any additions or changes to our policies?

Organizations authorized to administer COVID-19 vaccines are to follow the guidelines and requirements set forth by the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH). The California Hospital Association has developed a COVID-19 Vaccination Primer for California Hospitals with guidelines for vaccine storage and handling, administration, designation of staff who are authorized to administer, including reporting and record keeping requirements. In addition, the CDPH has developed resources for vaccine allocation and administration.

4. Does an employee qualify for workers’ compensation if they experience any complications from the vaccine?

Pursuant to California Labor Code §3208.05 and Case Law, an adverse vaccine reaction may be a compensable workers’ compensation claim for employers in the healthcare industry.  Pertinent Labor Code and case law is referenced below:   

LC §3208.05 (a) “Injury” includes a reaction to or a side effect arising from health care provided by an employer to a health care worker, which health care is intended to prevent the development or manifestation of any bloodborne disease, illness, syndrome, or condition recognized as occupationally incurred by Cal-OSHA, the federal Centers for Disease Control and Prevention, or other appropriate governmental entities. This section shall apply only to preventive health care that the employer provided to a health care worker under the following circumstances:  (1) prior to an exposure because of risk of occupational exposure to such a disease, illness, syndrome, or condition, or (2) where the preventive care is provided as a consequence of a documented exposure to blood or bodily fluid containing blood that arose out of and in the course of employment. Such a disease, illness, syndrome, or condition includes, but is not limited to, hepatitis, and the human immunodeficiency virus. Such preventive health care, and any disability indemnity or other benefits required as a result of the preventive health care provided by the employer, shall be compensable under the workers' compensation system. The employer may require the health care worker to document that the employer provided the preventive health care and that the reaction or side effects arising from the preventive health care resulted in lost work time, health care costs, or other costs normally compensable under workers' compensation.

(b) The benefits of this section shall not be provided to a health care worker for a reaction to or side effect from health care intended to prevent the development of the human immunodeficiency virus if the worker claims a work-related exposure and if the worker tests positive within 48 hours of that exposure to a test to determine the presence of the human immunodeficiency virus.

(c) For purposes of this section, “health care worker” includes any person who is an employee of a provider of health care as defined in Section 56.05 of the Civil Code, and who is exposed to human blood or other bodily fluids contaminated with blood in the course of employment, including, but not limited to, a registered nurse, a licensed vocational nurse, a certified nurse aide, clinical laboratory technologist, dental hygienist, physician, janitor, and housekeeping worker. “Health care worker” does not include an employee who provides employee health services for an employer primarily engaged in a business other than providing health care.

Based on this section, in the event an employee for a healthcare entity has an adverse reaction to a vaccine, it would be industrial.  Pursuant to section (c) above, if the employee is not in direct patient care, this section may not apply. Therefore, those that may be excluded from this statute, may then be covered through CA Supreme Court decision, Maher v. WCAB wherein the employer was found liable for negative effects. Essentially, if the employer requires the vaccine, or even encourages the vaccine, it is industrial.

5. Which clinicians are authorized to administer vaccines in California?

A list of licensees authorized to administer vaccines in California from the California Department of Public Health (CDPH) is located here.

6. What temporary coverage is extended to volunteer clinicians/staffing? 

BETA Healthcare Group recently created a coverage amendment H543 for the emergency or temporary staffing of employed, contracted and volunteer healthcare providers/extenders during the duration of the declared state of emergency. The amendment provides blanket coverage to providers who need to be covered under our member’s coverage for professional liability. Members need to contact their underwriter to request the coverage be added to their coverage contract, if needed.

For information about communicating about the COVID-19 vaccines tailored to Hospitals and health systems you can access American Hospital Association (AHA) resources at COVID-19 Vaccine Communications Resources.

The Cal/OSHA Form 300 is a log that captures work-related Injuries and Illnesses and notes the extent and severity of each case. When an incident occurs, the OSHA Form 300 records details about what happened, where it happened and how it happened.

OSHA 300 Log Reminder

The Summary — a separate form (Cal/OSHA Form 300A) — shows the totals for the year in each category and must be posted from February 1st – April 30th each year in a visible location so that your employees are aware of the injuries and illnesses that occurred within the workplace. In a year where more employees are working remotely, consider internal communication options available and/or used to provide access to them as well. Key consideration, employers must keep a Log for each establishment or site. If you have more than one establishment, you must keep a separate Log and Summary for each physical location that is expected to be in operation for one year or longer.

How to address COVID-19

Employers must record work-related fatalities, injuries and illnesses must record a work-related COVID-19 fatality or illness like any other occupational illness. According to Cal/OSHA, to be recordable, the injury or illness must be work-related and result in one of the following:

  • Death
  • Days away from work
  • Restricted work or transfer to another job
  • Medical treatment beyond first aid
  • Loss of consciousness
  • A significant injury or illness diagnosed by a physician or other licensed health care professional

If a work-related COVID-19 case meets one of these criteria, then covered employers in California must record the case on their 300, 300A and 301 or equivalent forms. For additional guidance around confirmed positive testing, work-relatedness, reporting to Cal/OSHA and quarantine considerations to “days away from work” Cal/OSHA offers an FAQ: Recording and Reporting Requirements for COVID-19 Cases

NOTE: AB 654 (10/5/2021) Expands the types of employers who are exempt from COVID-19 outbreak reporting requirements. Specifically, it:

  • Clarifies written COVID-19 exposure notice requirements
  • Adjusts the timeframes employers must follow to notify public health agencies.
  • The bill expands COVID-19 outbreak reporting exemptions for certain health clinics and care facilities  (e.g., community clinics, child daycare centers, adult day centers).
  • AB 654 modifies several definitions associated with the existing workplace COVID-19 notification statute.

See Assembly Bill 654 here.

RESOURCES

Cal/OSHA standards play a pivotal role in supporting employee safety as they require employers to protect workers from hazards such as COVID-19. The ongoing COVID-19 pandemic focuses attention on transmissible respiratory illnesses as a workplace hazard. Two Cal/OSHA standards, The Aerosol Transmissible Diseases (ATD) and Respiratory Protection rise to the forefront as key standards aimed at supporting the prevention of transmissible respiratory illnesses. Establishing and implementing prevention programs to address respiratory transmissible disease hazards (as implemented in its Injury and Illness Prevention Program (IIPP) and Respiratory Protection Program (RPP) is an employer responsibility that applies to most healthcare workplace settings.

The BETA Healthcare Worker COVID-19 Respiratory Transmissible Disease Exposure Control Checklist is intended to serve as a guiding resource for our members. The tool helps to address COVID-19 specific considerations and helps members navigate the standards and crosslinks. Due to emerging and changing information and guidelines (e.g., CDC, OSHA, and Cal/OSHA) and the passage of new emergency standards/legislation, hyperlinks are included within the checklist to connect members to updated information and additional resources.

Potential exposure to COVID-19 is a hazard for most employers given the mode of transmission and the unprecedented levels of infection among the U.S. population. Employers are strongly encouraged to review, update and/or establish their exposure control plans such ATD and RPP and continue to assess and identify workplace hazards.

OSHA Information on COVID-19 Vaccine Storage

COVID-19 vaccines such as Moderna, require storage  between 36 and 46 degrees Fahrenheit for up to 30 days, and the Pfizer much colder at -94 degrees Fahrenheit. To aid in transport and temperature control, dry ice is used to keep the vaccines at the required temperatures to remain effective during transport and storage.

Assembly Bill 685 (effective starting January 1, 2021) enhances Cal/OSHA’s enforcement of COVID-19 infection prevention requirements by allowing Orders Prohibiting Use (OPU) and citations for serious violations related to COVID-19 to be issued more quickly. The law also requires employers to notify all employees who were at a worksite of all potential exposures to COVID-19 and notify the local public health agency of outbreaks.

AB 685 COVID-19 Infection Prevention requirements require:

  • Employers to notify all employees at a worksite of potential exposures, COVID-19-related benefits and protections, and disinfection and safety measures that will be taken at the worksite in response to the potential exposure.
    • Triggers Notice: Notice to employees and their representative(s) when employer (representative) is notified (1) from public health official or licensed medical provider that an employee was exposed to a qualifying individual at the worksite; (2) from an employee, or their emergency contact, that the employee is a qualifying individual; through the testing protocol of the employer that the employee is a qualifying individual; or from a subcontracted employer that a qualifying individual was on the worksite of the employer receiving notification.

      Definition of a Qualifying Individual – any person who has any of the following:

      • A laboratory-confirmed case of COVID-19, as defined by the State Department of Public Health
      • A positive COVID-19 diagnosis from a licensed health care provider
      • A COVID-19 related order to isolate (separate those infected with a contagious disease from people who are not infected) provide a public health official

Definition of Worksite – building, store, facility, or other location where a worker worked during the infectious period. It does not apply to building, floors or other locations of the employer the qualified individual did not work. In a multi-worksite environment, the employer need only notify employees who were at the same worksite as the qualified individual.

Definition of Infection Period – currently 14 days from date of exposure.

Definition of Exception – Employees who, as part of their duties, conduct COVID-19 testing/screening or provide direct patient care or treatment to individual who are known to have tested positive for COVID-19, are persons under investigation, or are in quarantine/isolation related to COVID-19, unless the qualifying individual (co-worker) is an employee at the same worksite.

  • Notice to your employees and the employer of subcontracted workers that they may have been exposed to COVID-19.
    The organization can inform other workers of the dates that an individual with COVID-19 was at the worksite but should not share information that could identify the affected individual.  The organization must also provide this information to the exclusive labor representative, if any.
  • Information about benefits and options
    The organization must provide your employees with information about COVID-19 benefits under federal, state, or local laws. This includes workers' compensation, company sick leave, state-mandated leave, supplemental sick leave, negotiated leave, and anti-retaliation and anti-discrimination protections.
  • A disinfection and safety plan
    The organization needs to inform your employees and the employer of subcontracted workers of the disinfection and safety plan for the worksite, in accordance with CDC guidelines. The organization must also provide this information to the exclusive labor representative, if any.
  • Employers (other than a health facility defined in Health and Safety Code 1250) are required to notify local public health agencies of all workplace outbreaks, which are defined as three or more laboratory-confirmed cases of COVID-19 among employees who live in different households within a two-week period.
  • Employers must provide a written notice to all employees, and the employers of subcontracted employees, who were on the premises at the same worksite as the person who was infectious with COVID-19 or who was subject to a COVID-19-related quarantine order. After becoming aware of a potential exposure because someone at the worksite was infectious with COVID-19 or is ordered by a public health official to isolate due to COVID-19 concerns, employers must immediately (within one business day) provide the written notice to the employees and the employers of subcontracted employees. The written notice can be hand delivered or given by email or text message and should be in both English and any other language understood by most employees. 

Additionally, AB 685 allows Cal/OSHA to protect workers from an imminent hazard by prohibiting entry into a place of employment or prohibiting the use of something in a place of employment which constitutes an imminent hazard. From January 1, 2021 until January 1, 2023, when it will be repealed, Cal/OSHA can shut down an entire worksite or specific worksite area that exposes employees to an imminent hazard related to COVID-19 infection by issuing an OPU. Cal/OSHA can exercise its authority at any place of employment where risk of exposure to COVID-19 constitutes an imminent hazard and would remove employees from the risk of harm until the employer can effectively address the hazard.

 

Resources:

COVID-19: Cal/OSHA Emergency Standard - News Release

On November 30, 2020 the California Occupational Safety and Health (Cal/OSHA) adopted an emergency temporary standard (ETS) focused on COVID-19 in the workplace that would consist of  five sections addressing COVID-19 prevention, multiple COVID-19 infections and COVID-19 outbreaks, major COVID-19 outbreaks, COVID-19 prevention in employer-provided housing, and COVID-19 prevention in employer-provided transportation to and from work. This standard applies to all employers, employees, and to all places of employment with three exceptions:

  • Workplaces where there is only one employee who does not have contact with other people
  • Employees who are working from home
  • Employees who are covered by the Aerosol Transmissible Diseases regulation

As many of these provisions have already been required under employers’ Injury and Illness Prevention Programs (IIPP), including the requirement to identify and address hazards, use of face coverings, and physical distancing. As employers implement the new regulations, Cal/OSHA enforcement personnel will consider an employer’s good faith efforts in working towards compliance, but some aspects, such as eliminating hazards and implementing testing requirements during an outbreak, are essential.

The COVID-19 Prevention Plan requires employers to implement a written plan at every location, perform a comprehensive risk assessment of all work areas and tasks, and designate a person to implement the plan. The Plan must include:

  • Communication to employees about the employer’s COVID-19 prevention procedures
  • Identify, evaluate and correct COVID-19 hazards
  • Physical distancing of at least six feet unless it is not possible
  • Use of face coverings – this must include the CDPH Face Coverings Guidance and policy to handle exemptions
  • Use engineering controls, administrative controls and personal protective equipment as required to reduce transmission risk
  • Procedures to investigate and respond to COVID-19 cases in the workplace
  • Provide COVID-19 training to employees
    • Employer policies and procedures to protect employees from COVID-19 hazards
    • COVID-19 related benefit information, from either the employer or from federal, state or local government, that may be available to employees impacted by COVID-19. Information on COVID-19 benefits such as paid sick leave and workers’ compensation benefits is posted on the Department of Industrial Relations’ Coronavirus Resources webpage.
    • The fact that COVID-19 is an infectious disease that can be spread through the air when an infectious person talks or vocalizes, sneezes, coughs, or exhales; that COVID-19 may be transmitted when a person touches a contaminated object and then touches their eyes, nose, or mouth, although that is less common; and that an infectious person may show no symptoms
    • The importance of physical distancing and wearing face coverings
    • The fact that particles containing the virus can travel more than six feet, especially indoors, so physical distancing must be combined with other controls, including face coverings and hand hygiene, to be effective
    • The importance of frequent hand washing for at least 20 seconds and use of hand sanitizer when handwashing facilities are not available
    • Proper use of face coverings, and the fact that they are not respiratory protection
    • The symptoms of COVID-19 and the importance of not coming to work and getting tested if an employee has symptoms
  • Provide testing to employees who are exposed to a COVID-19 case, and in the case of multiple infections or a major outbreak, implement regular workplace testing for employees in the exposed work areas
  • Exclusion of COVID-19 cases and exposed employees from the workplace until they are no longer an infection risk
  • Maintain records of COVID-19 cases and report serious illnesses and multiple cases to Cal/OSHA and the local health department, as required

Cal/OSHA has posted a Model COVID-19 Prevention Program on its website for employers to use.

Resources:

The Standards Board COVID-19 Prevention Text (ca.gov)

Cal/OSHA COVID-19 Guidance and Resources Cal/OSHA COVID-19 Resources

Cal OSHA Webinar on COVID-19 Webinars on COVID-19 (ca.gov)

CDPH Responding to COVID-19 in the Workplace for Employers California Face Coverings, Masks, and N95 Respirators for COVID-19 Protection Poster

Face Coverings Marks and Respirators California Face Coverings, Masks, and N95 Respirators for COVID-19 Protection Poster

CDPH Face Coverings Guidance Face Coverings Guidance (ca.gov)

Cal OSHA Recording and Reporting Requirements for COVID-19 Cases Cal/OSHA Enforcement Branch

Report a Work-Related Accident Employers Report a Work-Related Accident - Employers (ca.gov)

Cal OSHA COVID-19 Infection Prevention Requirements (AB 685) COVID-19 Infection Prevention Requirements (AB 685) (ca.gov)

CDPH COVID-19 Employer Playbook Supporting a Safer Environment for Workers and Customers COVID-19 Employer Playbook Supporting Safer Environments for Workers and Customers (ca.gov)

On September 17, 2020, Governor Gavin Newsom signed Senate Bill 1159. This bill creates a retroactive presumption of compensability related to COVID-19 for your employees and codifies the Executive Order (EO) previously issued on 05/06/2020. The primary tenets of the EO remain in place. This includes the diagnosis/positive test requirement, 14-day exposure period from when the employee last worked outside of their home, retroactive to cover the entire pandemic; and the requirement that any emergency COVID-19 related sick leave benefits be exhausted prior to the provision of Temporary Disability benefits. There are additional employer requirements that an organization must comply with.

A copy of the bill can be found here.

See BETA Healthcare Group’s SB 1159 FAQ Document.

BETA’s workers’ compensation team is here to assist you through this difficult time. Please feel free to reach out to us with any questions.  Your claims examiners, assistants and the entire management team is available to assist in any way possible.

If you have any questions, please contact:

Jamie Goff

Sr. Director of WC Claims

(916) 266-5249

In response to COVID-19, many patients’ surgeries were postponed due to the pandemic. Safely resuming patients’ needed surgeries and minimizing COVID-19 risk is top of mind for healthcare facilities and preparation is key. The American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), the Association of periOperative Registered Nurses (AORN) and the American Hospital Association (AHA) issued a joint statement outlining key principles and considerations to guide healthcare organizations in assessing their facility readiness and ability to resume elective surgeries. Facility readiness for resuming these procedures will vary by geographic location depending on local COVID-19 activity and response resources.

Highlights of the statement include:

  • Implement a policy for testing staff and patients for COVID-19, accounting for accuracy and availability of testing and a response when a staff member or patient tests positive.
  • Form a committee – including surgery, anesthesiology and nursing leadership – to develop a surgery prioritization policy, which factors in previously canceled and postponed cases, and allot block time for priority cases, such as cancer and living donor organ transplants.
  • Adopt COVID-19-informed policies for the five phases of surgical care, from preoperative to post-discharge care planning.
  • Collect and assess COVID-19 related data that will be used to frequently re-evaluate and reassess policies and procedures.
  • Create and implement a physical distancing policy for staff, patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity.

Updated Joint Statement on Maintaining Essential Surgery During COVID-19 (Nov 2020):
https://bit.ly/2VTj4mV

Additional guidance from the American Society of PeriAnesthesia Nurses (ASPAN):

The Centers for Disease Control (CDC) has issued updated guidance based on currently available information about COVID-19 and the current situation in the U.S. (which includes community transmission, infections identified in healthcare personnel, and shortages of PPE). The guidance is applicable to all healthcare settings and is focused on reducing facility risk, isolating symptomatic patients as soon as possible, and protecting healthcare personnel providing key recommendations for:

  • Minimizing chances for exposure
  • Adhering to standard and transmission-based precautions
  • Implementing environmental infection control

Updates as of 2/10/2021 to the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings:

  1. Updated the Implement Universal Use of Personal Protective Equipment section to expand options for source control and patient care activities in areas of moderate to substantial transmission and describe strategies for improving fit of face masks.
  2. Included a reference to Optimizing Personal Protective Equipment (PPE) Supplies that include a hierarchy of strategies to implement when PPE are in short supply or unavailable.

See full CDC COVID-19 Interim Infection Prevention and Control Guidance at:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html

How long does the virus remain on surfaces?

Though the primary way the virus spreads is through close contact from person-to-person, it's possible to be infected from touching a surface or object that has the coronavirus on it and then touching the mouth, nose or possibly eyes. But this isn’t thought to be the main way the virus spreads.

The primary route of COVID-19 infection isn't by touching contaminated surfaces but through the respiratory system. People should focus on wearing masks and social distancing and less on sanitizing surfaces.

For additional information from the CDC (last updated 10/2020), see:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

See CDC guidance for cleaning and disinfecting public spaces (updated January 5, 2021):

Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes | CDC

Both the U.S. Department of Health and Human Services (HHS) and the World Health Organization (WHO) studies have shown that COVID-19 can exist on different types of surfaces anywhere from less than 24 hours to two to three days depending on various factors including temperature, humidity, ventilation, and the amount of virus deposited. COVID-19 on surfaces can be easily cleaned with common household disinfectants that will kill the virus and healthcare organizations can make decisions about their cleaning and disinfecting protocols for examination rooms and other treatment areas.

How long does an examination room need to remain vacant after being occupied by a patient with confirmed or suspected COVID-19?

Centers for Disease Control

Although spread of SARS-CoV-2 (COVID-19) is believed to be primarily via respiratory droplets, the contribution of small respirable particles to close proximity transmission is currently uncertain. Airborne transmission from person-to-person over long distances is unlikely.

The amount of time that the air inside an examination room remains potentially infectious is not known and may depend on a number of factors including:

  • The size of the room
  • The number of air changes per hour
  • How long the patient was in the room
  • If the patient was coughing or sneezing
  • If an aerosol-generating procedure was performed

Facilities will need to consider these factors when deciding when the vacated room can be entered by someone who is not wearing PPE.

For a patient who was not coughing or sneezing, did not undergo an aerosol-generating procedure, and occupied the room for a short period of time (e.g., a few minutes), any risk to health care personnel (HCP) and subsequent patients likely dissipates over a matter of minutes.

However, for a patient who was coughing and remained in the room for a longer period of time or underwent an aerosol-generating procedure, the risk period is likely longer. For these higher risk scenarios, it is reasonable to apply a similar time period as that used for pathogens spread by the airborne route (e.g., measles, tuberculosis) and to restrict HCP and patients without PPE from entering the room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.

CDC FAQ (Updated January 25, 2021):

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Finfection-prevention-control-faq.html

The CDC also offers guidance on clearance rates under differing ventilation conditions.

Are there recommendations for implementing environmental infection control?

In addition to ensuring sufficient time for enough air changes to remove potentially infectious particles, healthcare personnel should clean and disinfect environmental surfaces and shared equipment before the room is used for another patient. According to the Centers for Disease Control (CDC), certain actions should be taken:

  • Dedicated medical equipment should be used when caring for patients with known or suspected SARS-CoV-2 (COVID-19).  All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for COVID-19 in healthcare settings, including those patient-care areas in which aerosol generating procedures are performed.  Refer to the list on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against COVID-19.
  • Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.

Updates as of 2/10/2021 to the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings:

  1. Updated the Implement Universal Use of Personal Protective Equipment section to expand options for source control and patient care activities in areas of moderate to substantial transmission and describe strategies for improving fit of facemasks.
  2. Included a reference to Optimizing Personal Protective Equipment (PPE) Supplies that include a hierarchy of strategies to implement when PPE are in short supply or unavailable.

See full CDC COVID-19 Interim Infection Prevention and Control Guidance at:

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html#infection_control

Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control Recommendations for Healthcare Personnel for COVID-19

In response to the rapidly evolving COVID-19 pandemic, the Centers for Medicare and Medicaid (CMS) is allowing all Medicare-enrolled ambulatory surgery centers (ASCs) to enroll as hospitals to provide inpatient and outpatient hospital services as ASCs can play a large role in helping hospitals optimize patient flows. ASCs can currently take advantage of temporarily waived or relaxed regulations that allow them to temporarily close, enroll as a hospital or contract with a hospital to provide services.

The Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) issued a press release outlining the steps for working with hospitals in the face of the COVID-19 pandemic and has a recorded webinar available with guidance for ASCs to understand their options and support efforts to increase hospital capacity:

When deciding the scope of service, AAAHC recommends identifying the needs of state and local hospitals, then examining the internal capacity necessary to meet their needs. It is important to determine if there are additional supplies or staffing requirements as well. ASCs should then put agreements or contracts in place which include the scope of service and the level of acuity, and then create clinical policies to fulfill these responsibilities.

Key roles will include the charge nurse, infection control professional and the primary liaisons for notifications. The charge nurse will be responsible for coordinating 24/7 staffing, scheduling, supply management and more, while the infection control professional will develop hospital wide programs and plans around infection, including cross-infection prevention, and train and monitor the staff to adhere to these policies. The primary liaisons will communicate with state and local officials to ensure consistency and accuracy of messaging.

As of 2/10/2021, the CDC has updated it guidance on universal masking to slow the spread of COVID-19. While cloth masks and medical procedure masks substantially reduce exposure, there are simple ways to improve their fit that maximize mask performance including fitting a cloth mask over a medical procedure mask to establish a better mask fit:

How Your Mask Protects You

Improve the Fit and Filtration of Your Mask to Reduce Spread of COVID-19

FDA PPE FAQ: Face Masks, Including Surgical Masks, and Respirators for COVID-19 | FDA

What is the difference between a surgical mask and an N95 Respirator?

  1. Surgical masks are used to protect against fluid exposures such as large droplets and sprays. The mask is generally loose fitting and does not require a fit test prior to use. The mask is discarded after each patient encounter and a new one is used.

The N95 Respirator provides a filter of up to 95% of airborne particles (large and small droplets). The N95 is tight-fitting and requires a fit test to be performed to determine the appropriate size/fit. Each time an N95 is used, a seal check must be performed to ensure minimal leakage around the edges. To understand the differences between the two mask types, there is a flyer titled “Understanding the Difference” available for placement in nursing stations from the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf

October 30, 2020: The Occupational Safety and Health Administration (OSHA) has confirmed the effectiveness of N95 respirators to protect against coronavirus and published a set of FAQs on how N95 respirators capture the small particles of the virus that causes the coronavirus.

https://www.osha.gov/SLTC/covid-19/covid-19-faq.html#respirator

The CDC has developed strategies for optimizing the supply of N95 Filtering Facepiece Respirators (FFRs) were written to address 3 approaches:

  1. Conventional (everyday practice)
  2. Contingency (expected shortage)
  3. Crisis (known shortages)

While N95 FFRs are meant to be disposed after each use, there are different considerations based on these approaches, including options for reuse of N95s in Crisis situations.

For information see:

Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse After Decontamination, When There Are Known Shortages of N95 Respirators

Many questions are arising about Personal Protective Equipment (PPE) particularly around how to use it, the differences between types of masks, fit testing, reuse, making masks, and shortages in the face of the COVID-19 pandemic. BETA has assembled some information and resources to help guide you during this time.

We have expired N95 masks. Can we still use them?

Masks manufactured between 2003 and 2013 have exceeded their designated shelf life. NIOSH has also conducted a study and found that the following masks have performed in accordance to NIOSH standards:

  • 3M 1860
  • 3M 1870
  • 3M 8210
  • 3M 9010
  • 3M 8000
  • Gerson 1730
  • Medline/Alpha Protech NON27501
  • Moldex 1512
  • Moldex 2201

According to the CDC, provided that the masks have been stored according to the manufacturer’s recommended storage directions, these masks will perform correctly. All expired and non-expired masks should be evaluated before use taking these steps:

  • Visually inspect the N95 to determine if its integrity has been compromised
  • Check all components such as straps, nose bridge, and nose foam to ensure they did not degrade
  • If the integrity of any part of the respirator is compromised (and a seal check cannot be performed) do not use and discard the respirator
  • Upon donning a mask, always immediately perform a seal check with any FFR mask

While the CDC and NIOSH understand the current challenges with PPE they suggest that you refer to the webpage titled “Strategies for Optimizing the Supply of N95 Respirators” at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html

Many questions are arising about Personal Protective Equipment (PPE) particularly how to use it, the differences between types of masks, fit testing, reuse, making masks and shortages in the face of the COVID-19 pandemic. BETA has assembled some information and resources to help guide you during this time.

Can I make a mask?

Yes, a respirator mask can be made using a 3D printer. According to engineer Rory Larson at Maker Mask, he is offering the first medically approved Computer Aided Design (CAD) for a 3D printed mask. The mask is called Maker Mask and is a respirator mask available to the government and the public free-of-charge via an open-source model. The Seattle Children’s Hospital is now using the mask after testing for fit, breathability, and comfort. The 3D printing design is provided free of charge and will enable organizations such as government, universities, community colleges and any organization with a 3D printer to produce a respirator mask. The 3D production cost is about $2.00 to $3.00 per unit. For more information on how to get the design visit www.makermask.com. You can also view a demonstration at https://youtu.be/MgBNaB5LTh4. The CDC also has a webpage titled “FAQs on 3D Printing of Medical Devices, Accessories, Components, and Parts During the COVID-19 Pandemic” for more information and guidance on efficacy of use. https://www.fda.gov/medical-devices/3d-printing-medical-devices/faqs-3d-printing-medical-devices-accessories-components-and-parts-during-covid-19-pandemic

The Families First Coronavirus Response Act (FFCRA) Leave Requirements expired December 31, 2020. Visit the Wage at Hour Division's FFCRA Questions and Answers page to learn more about workers' and employers' rights and responsibilities after 12/31/2020.

COVID-19 Resource Links: Protecting Patients and Your Workforce

AAFP: Responding to COVID-19: Physician Practices Latest Info (9/22/2021)

https://bit.ly/3qlLzXp

American College of Obstetricians and Gynecologists: COVID-19 Practice Advisory (7/8/2021)

                  https://bit.ly/2DApa5E

American Academy of Pediatrics: Management of Infants Born to Mothers with COVID-19 (5/4/2021)

                   https://bit.ly/3ibz64R

AHA: American Hospital Association COVID-19 Vaccine Communications Resources (9/2021)

                  COVID-19 Vaccine Communications Resources | AHA

American Society for Healthcare Risk Management (ASHRM) COVID-19 Resources Page

https://www.ashrm.org/resources-novel-coronavirus-covid-19

ASA: Statements and Recommendations on COVID-19 (8/4/2021)

                https://bit.ly/389tEwL

CA.gov: CA Surgeon General's COVID-19 Managing Stress for Health (2/2021)

                https://bit.ly/2OcVgdz

CA.gov: Resources for Emotional Support and Wellbeing (9/22/2021)

        https://bit.ly/35h3Iww

CA Announcement: Guidance Related to Non-Discrimination in Medical Treatment for COVID-19 (1/2021)

https://bit.ly/2PPotvL 

California Department of Health Care Services - Suicide Prevention: Provider Letter with Tools and Resources (6/2020)

                https://bit.ly/3fNk3NU

California Department of Industrial Relations (DIR) - Update on COVID-19 Public Health Guidance (9/2021)

              https://www.dir.ca.gov/DIRNews/2021/2021-60.html

Cal OSHA: COVID-19 Temporary Emergency Standards for Employers (6/2021)

                 https://bit.ly/33UdZz3

Cal OSHA: COVID-19 Model Prevention Program (6/2021)

                  https://bit.ly/3lYkPtu

CDC: COVID-19 Vaccination - Frequently Asked Questions (10/13/2021)

                  https://bit.ly/2LEDM8b

CDC: Project Firstline - National Training Collaborative for COVID-19 Healthcare Infection Prevention and Control for Healthcare Workers (10/2021)

                  https://www.cdc.gov/infectioncontrol/projectfirstline/index.html

CDC: COVID-19 Communication Resources [Also in Spanish] (9/14/2021)

https://www.cdc.gov/coronavirus/2019-ncov/communication/index.html

CDC: How COVID-19 Spreads (7/14/2021)

                  https://bit.ly/2HlA7tW

CDC: How to Fit and Remove a Disposable Respirator

https://www.cdc.gov/niosh/docs/2010-133/pdfs/2010-133.pdf

CDC: Keeping the Workplace Safe (PDF)

https://www.cdc.gov/coronavirus/2019-ncov/downloads/workplace-school-and-home-guidance.pdf

CDC: Updated Infection Control Guidance for Healthcare Settings (9/10/2021)

                 https://bit.ly/3btWmIt

CDC: U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19 (9/10/2021)

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

CHA: COVID-19 Surge Resources for California Hospitals (1/2021)

                  https://bit.ly/3mXFQ9l 

CHA: COVID-19 Resources for Hospitals

                  https://www.ourcovidresponse.org/

CHA: COVID-19 Vaccination Primer for California Hospitals (12/2020)

                  https://bit.ly/39HCUdc

CHA: Coronavirus Response: One-Stop Shop for Guidance, Updates, Info (10/18/2021)

https://www.calhospital.org/coronavirus

CMA: COVID-19 Vaccination Toolkit for Physician Practices (1/2021)

                  https://bit.ly/3dv7ubS

CMA: COVID-19 Telehealth Toolkit for Medical Practices (6/17/2021)

https://bit.ly/2xCAPhW

         CMQCC and CPQCC: COVID-19 Resources for Maternal and Infant Health (10/20/2021)

                   https://caperinatalprograms.org/

ECRI: COVID-19 Resource Center for Healthcare (10/20/2021)

                    https://bit.ly/33PucVv

EEOC: What You Should Know About the ADA, the Rehabilitation Act and COVID-19 [Clarifies Guidance on Employers' Rights to Require COVID-19 Vaccinations] (10/13/2021)

https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws

FDA: PPE FAQ - Face Masks, Surgical Masks and Respirators for COVID-19 (9/15/2021)

                  https://bit.ly/37nnwQ5

FDA: Updated Guidance on N95, KN-95 Respirators, Surgical Masks and Face Masks (9/15/2021)

                   https://bit.ly/2MSuWRz

Federal OSHA: COVID-19 Resources (8/2021)

https://www.osha.gov/SLTC/covid-19/

Federal OSHA: Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace (8/2021)

                  https://www.osha.gov/coronavirus/safework

Federal OSHA: COVID-19 Respirator Use - Wearing and Removing a Respirator (Video)

                  https://www.youtube.com/watch?v=oU4stQgCtV8

Federal OSHA: Respiratory Fit Testing (Video)

https://www.osha.gov/video/respiratory-protection/fit-testing

Federal OSHA: Recording Workplace Exposures to COVID-19 (6/2021)

https://www.osha.gov/SLTC/covid-19/standards.html

National Association for Homecare and Hospice Resources for COVID-19 (8/2021)

https://www.nahc.org/resources-services/coronavirus-resources/

Relias COVID-19 Training Resources and Publications

https://www.relias.com/topic/coronavirus

SHRM: Coronavirus and COVID-19 Resources [Communicating with Employees, FMLA, more] (10/2021)

https://bit.ly/2QIYKCL

The Joint Commission COVID-19 Guidance and Resources (10/2021)

https://www.jointcommission.org/covid-19/

University of Washington COVID-19 Policies and Protocols Resource Site (9/2021)

                https://covid-19.uwmedicine.org/Pages/default.aspx

Celebrations

Alameda Health System salutes its staff on the front lines of COVID-19 with a moving tribute. Watch now.

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