Hospital and healthcare response to the novel coronavirus (COVID-19)

The Arizona Hospital and Healthcare Association is continually monitoring the latest developments related to the novel coronavirus (COVID-19) alongside our local, state and federal health partners.

While the current coronavirus outbreak is new, Arizona’s efforts to prepare for a viral outbreak and emergency response is not. Hospitals and health systems conduct emergency response drills and exercises year-round so they may provide the best care with the least disruption to our health system.

This member advisory is intended to provide the latest state and federal information and guidance to Arizona’s hospital and healthcare provider community.

Latest clinician guidance

The Arizona Department of Health Services (ADHS) recommends Arizona clinicians to:

• Mask and isolate suspected COVID-19 patients or other patients presenting with acute respiratory illness. Isolation should take place in a private room with the door closed.
• Immediately notify your healthcare facility’s infection control personnel and local health department.
• Healthcare personnel encountering a suspect patient should use standard precautions, contact precautions, droplet precautions, and use eye protection (e.g., goggles or a face shield).
• Obtain a detailed travel history for patients being evaluated with fever and acute respiratory illness.
• Consider testing for seasonal respiratory illnesses, like influenza.
• Coordinate with the local health department for specimen collection, transport, and testing for suspect cases.

What’s new this week

Arizona Department of Health Services

ADHS on March 4 issued a health alert updating its PPE recommendation. Based on the available evidence, SARS-CoV-2, the virus that causes COVID-19 infection, is transmitted via respiratory droplets between people in close contact, not by airborne transmission.

Due to this, ADHS now recommends that healthcare providers:

• Use standard, contact, and droplet precautions with eye protection for suspect or confirmed COVID-19 cases.
• Use gowns, gloves, respirators (such as N95 mask) and eye protection (goggles or face shield) when performing aerosol-generating procedures (e.g., tracheal intubation, non-invasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, bronchoscopy).
• Due to the change in transmission-based precautions from airborne to droplet, it is not necessary to place a suspect patient in an airborne infection isolation room (AIIR). A private room with a closed-door is acceptable. Using an AIIR for aerosol-generating procedures is still recommended.

Centers for Disease Control and Prevention (CDC) Resources

The CDC on March 4 updated Interim Risk Assessment Guidance for Healthcare Workers with a potential exposure. The guidance sets forth simplified risk exposure categories based on the most common scenarios with a focus on the presence/absence of source control measures, use of PPE, and degree of contact with the patient.

Guidance for Evaluating and Reporting Persons Under Investigation (PUI) has been updated to allow clinicians to “use their judgement to determine if a patient has the signs and symptoms compatible with COVID-19 and whether the patient should be tested.”

Strategies for Optimizing the Supply of N95 Respirators has been updated to add information on crisis/alternative strategies to the previous information on conventional and contingency capacity strategies. Two additional resources are included:

Checklist for Healthcare Facilities

Release of Stockpiled Respirators beyond Manufacturer-Designated Shelf Life

Food and Drug Administration (FDA) Resources

The FDA this week issued diagnostic testing guidance to allow laboratories certified to perform high-complexity testing to test for COVID-19.

On March 2, 2020, the FDA issued an emergency use authorization to expand the type of N95 respirators that can be used in a healthcare setting.

Centers for Medicare & Medicaid Services (CMS) Resources

In its effort to mitigate the spread of COVID-19, CMS this week issued several memoranda to State Survey Agency Directors.

CMS announced it is suspending non-emergency inspections across the country to allow inspectors to focus on issues related to infection control and serious health and safety threats such as abuse and other immediate jeopardy complaints. The document outlines the priority order that will guide inspections.

In addition, CMS released guidance and frequently asked questions relating to infection control and patient triage, placement and discharge.

Additional Resources

• Clinician Fact Sheet - ADHS
• Information for Healthcare Professionals - CDC
• Strategies for Optimizing the Supply of N95 Respirators - CDC
• Coronavirus Disease 2019 (COVID-19) Hospital Preparedness Checklist - CDC
• Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected - WHO
• Local Public Health Contacts

In addition, CDC has released healthcare facilities guidance that outlines goals and strategies facilities can implement to prepare for and respond to community spread of COVID-19, including escalating actions to take as public health guidance shifts in an evolving outbreak. These include:

• actions to take now to prepare for an outbreak of COVID-19;
• actions to take if COVID-19 is spreading in your community;
• considerations for specific settings, including inpatient and outpatient facilities, as well as long-term care facilities and
• shifting health care delivery modes during a COVID-19 outbreak, including adjustments to the way providers triage, assess and care for patients using methods that do not rely on face-to-face care, such as promoting the increased use of telehealth.

AzHHA and AzCHER hospital members are invited to join us for a debrief of the ADHS COVID-19 Webinar for Healthcare Providers and Webinar for Healthcare Facilities to determine response and resource needs from our member community.

AzHHA and AzCHER Hospital Member Call

Friday, March 6, 2020

3-4 p.m.

Agenda

• Welcome
• Potential AzHHA and AzCHER Roles
  • Situational Awareness
  • Resource/Guidance Clearinghouse
  • Communications and Public Messaging
  • Policy & Advocacy

Questions? Suggestions for future member advisories?

Contact us at [email protected] or 602-445-4327.