Last Updated 3/23/2020 | COVID-19 Update with resource links.
Updated 2/20/2020 | Updated Advisory AHE 2019 Novel Coronavirus released.
Updated 1/29/2020 | AHE 2019 Novel Coronavirus Advisory released.
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Personnel & Personnel Training
- Train and educate health care personnel
- CDC Sequence for Donning and Doffing PPE
- General FAQ’s on PPE
- Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)
Environmental Infection Prevention
Background: Stay informed about the local COVID-19 situation. Know where to turn for reliable, up-to-date information in your local community. Monitor the CDC COVID-19 website and your state and local health department websites for the latest information.
- Develop, or review, your facility’s emergency plan. A COVID-19 outbreak in your community could lead to staff absenteeism. Prepare alternative staffing plans as you would as part of your normal emergency plan to ensure as many of your facility’s staff are available as possible.
- Ensure the EVS leader is involved in any and all daily facility briefings related to COVID-19. Information provided at these briefing can help with staffing plans.
Alternative Staffing Ideas
- Where facilities have postponed elective surgeries, utilization of EVS staff normally dedicated to peri-operative, ambulatory surgery or other procedural areas can be redirected to daily occupied patient rooms and discharge room cleaning.
- Revisit schedule staffing around highest discharge times.
- Decrease or eliminate office cleaning schedules and divert that workforce to support inpatient areas. Provide disinfectant wipes for the office members.
- Track all the hours used to support coverage needs related to COVID. It may come in handy especially if there is a need to provide supporting evidence on dollar impact that COIVD had on the facility. Track both labor and supply expenses related to the crisis which undoubtedly will impact budgets in a variety of ways.
Personal Protective Equipment
What personal protective equipment (PPE) should be worn by environmental services (EVS) personnel who clean and disinfect rooms of hospitalized patients with COVID-19?
In general, only essential personnel should enter the room of patients with COVID-19. Healthcare facilities should consider assigning daily cleaning and disinfection of high-touch surfaces to nursing personnel who will already be in the room providing care to the patient. If this responsibility is assigned to EVS personnel, they should wear all recommended PPE when in the room. PPE should be removed upon leaving the room, immediately followed by performance of hand hygiene.
After discharge, terminal cleaning may be performed by EVS personnel. They should delay entry into the room until a sufficient time has elapsed for enough air changes to remove potentially infectious particles. We do not yet know how long SARS-CoV-2 remains infectious in the air. Regardless, EVS personnel should refrain from entering the vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles (more information on clearance rates under differing ventilation conditions is available). After this time has elapsed, EVS personnel may enter the room and should wear a gown and gloves when performing terminal cleaning. A facemask and eye protection should be added if splashes or sprays during cleaning and disinfection activities are anticipated or otherwise required based on the selected cleaning products. Shoe covers are not recommended at this time for personnel caring for patients with COVID-19.
- What personal protective equipment (PPE) should be worn by environmental services (EVS) personnel who clean and disinfect rooms of hospitalized patients with COVID-19?
- Strategies for Optimizing the Supply of PPE
- Checklist for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during the COVID-19 Response
Cleaning and Disinfecting
- Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs)
What Healthcare Personnel Should Know about Caring for Patients with Confirmed or Possible COVID-19 Infection
Do all patients with confirmed or suspected COVID-19 need to be placed in airborne infection isolation rooms?
No. Updated CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings recommends placing patients in a regular examination room with the door closed. Airborne infection isolation rooms should be reserved for patients undergoing aerosol generating procedures or for diagnoses such as active tuberculosis.
How long does an examination room need to remain vacant after being occupied by a patient with confirmed or suspected COVID-19?
Although spread of SARS-CoV-2 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, and 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 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.
General guidance on clearance rates under differing ventilation conditions is available.
In addition to ensuring sufficient time for enough air changes to remove potentially infectious particles, HCP should clean and disinfect environmental surfaces and shared equipment before the room is used for another patient.
The CDC has determined that medical waste generated in the treatment of COVID-19 patients and patients under investigation (PUIs) be managed in accordance with routine procedures.
There are no additional packaging or transportation requirements from the Department of Transportation (DOT) for regulated medical waste or sharps.
- Facilities are responsible for packaging waste for transport to treatment facilities.
- Each bag must be hand tied by gathering and twisting the neck of the bag and using a tie or hand knot to secure the bag, and each container must be securely closed.
- Closed bags must not be visible once a secondary container such as a box or reusable tote or tub is closed.
Retiring Communities and Independent Living Facilities
The CDC released new guidance for retirement communities and independent living facilities to better aid in the planning, preparation for, and response to coronavirus disease 2019. The guidance is based on what is currently known about the transmission and severity of coronavirus disease. Residents in retirement communities and independent living facilities are considered to be at higher risk of severe COVID-19 outcomes because of older age and because they may have underlying health conditions.
- Guidance for Retirement Communities and Independent Living
- Preventing the Spread of COVID-19 in Retirement Communities and Independent Living Facilities (Interim Guidance)
- Coronavirus disease 2019 (COVID-19) Checklist: Older Persons
Watch the Coronavirus Update—What Health Care Professionals Need to Know to Prepare for COVID-19 webinar with Dr. Michael Bell
Deputy Director, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.
Members-only webinar. Prerecorded Wednesday, March 18 at 1 pm EST.