Guidance and responses were provided based on information known on 4/14/2021 and may become out of date. Guidance is being updated rapidly, so users should look to CDC and NE DHHS guidance for updates. Infection Prevention Updates for Acute Care and Outpatient Settings April 14, 2021 Questions and Answer Session • • • Use the QA box in the webinar platform to type a question. • Questions will be read aloud by the moderator as time allows. If your question is not answered during the webinar, please e-mail it to Nebraska ICAP or call during our office hours to speak with one of our Infection Preventionists (IPs). A transcript of the discussion will be made available on the ICAP website • https://icap.nebraskamed.com/coronavirus/ • https://icap.nebraskamed.com/covid-19-webinars/ Presenters : Gary Anthone, MD Matthew Donahue, MD Rick Starlin, MD Daniel Brailita, MD Rebecca Martinez, BSN, BA, RN, CIC Panelists: Kelly Cawcutt, MD Kate Tyner, RN, BSN, CIC Jody Scebold, EdD, MSN, RN Lacey Pavlovsky RN, MSN, CIC Jean Ellis, RN, BSN Moderator: Margaret Deacy gary.anthone@nebraska.gov matthew.donahue@nebraska.gov rick.starlin@unmc.edu dabrailita@unmc.edu remartinez@nebraskamed.com kelly.cawcutt@unmc.edu ltyner@nebraskamed.com jodscebold@nebraskamed.com lpavlovsky@nebraskamed.com jean.ellis@nebraska.gov mdeacy@nebraskamed.com Nebraska DHHS Updates Dr. Gary Anthone, MD Chief Medical Officer, NE DHHS Dr. Matthew Donahue, MD Medical Epidemiologist Intelligence Service Officer , DHHS • Increase 36 pts (29 last wk) Douglas increased 29pts • 7 day average of 4.2% of staffed hospital beds are occupied by COVID pts (3.2, 2.8) • 29% of Hospitalized COVID pts are in the ICU (30, 33) • 41% of ICU COVID pts are on Vents (38, 29) • 14% of all statewide ICU pts are COVID pts (12, 10) 11/22 --135/Day Nov 22, 2020---135/Day 4/ 4/1 4 1 26 18 19 21 14 13 13 12 14 20 Nebraska To Pause Johnson & Johnson COVID-19 Vaccine Available at : ALERT04132021.pdf (ne.gov) Nebraska To Pause Johnson & Johnson COVID-19 Vaccine • The Department of Health and Human Services (DHHS) is pausing administration of the Johnson & Johnson/Janssen COVID-19 vaccine, following CDC and FDA recommendations. • On Thursday, April 8th, DHHS, the Douglas County Health Department, and Nebraska Medicine consulted with CDC and FDA about a rare and severe type of blood clot diagnosed in a Nebraska resident. • On Tuesday, April 13th, CDC and FDA released a joint statement recommending a pause on Johnson & Johnson/Janssen vaccinations nationwide while more investigation is completed. • Vaccine safety is closely monitored by healthcare providers and local, state, and federal partners. • While only six instances of this severe clotting event have been identified among approximately 6.8 million who have received the J&J/Janssen vaccine across the US, the pause is a transparent and deliberate decision to allow time for a thorough review and investigation. Nebraska To Pause Johnson & Johnson COVID-19 Vaccine • DHHS is communicating the pause to local health departments, healthcare providers, and pharmacies across the state. Any potential adverse reactions to vaccines should be reported into the CDC's vaccine adverse events reporting system (VAERS, https://vaers.hhs.gov/ ). • Please note that at this time there are no recommendations to pause the use of the other two vaccines, Pfizer and Moderna. These two vaccines should be provided in place of the Johnson and Johnson /Janssen vaccine until further notice. • For more information, see the official FDA-CDC release: https://www.fda.gov/news-events/pressannouncements/joint-cdc-and-fda-statement-johnson-johnsoncovid-19-vaccine Surgical Screening Process Dr. Rick Starlin, MD Assistant Professor, Division of Infectious Diseases Medical Director, Employee Health Dr. Daniel Brailita, MD Assistant Professor, Division of Infectious Diseases ICAP Associate Medical Director Weighted Virus Variant Proportions Virus Variant Proportions Table Vaccine Efficacy Against Variants COVID-19 and HCPs •NMC experience •Environmental controls and universal masking HCPs and patients •Admission and pre-procedure PCR testing •Reporting and PCR testing of symptomatic employees •Infection Prevention evaluation of potential COVID-19 exposures •Testing of asymptomatic employees involved in exposures •Patient to employee •Employee to employee •High risk events (AGPs, household exposures, other) •Post-vaccination PCR testing for symptoms/exposures of employees COVID-19 Vaccine and Timing of Procedures - Considerations • Consider avoiding procedures for at least 72 hours postvaccine. • This could help exclude any vaccine symptoms versus COVID-19 disease symptoms. • Consider deferral of vaccine 7 days after major surgery • Due to limited data, at this time, receipt of a COVID-19 vaccine does not exclude pre-procedure screening. Patients should follow existing pre-procedure testing guidance. • Facilities may consider performing a risk assessment and consider incrementally rolling back selected preprocedure testing such as low risk procedures if the patient is fully vaccinated. Variables of risk that influence the need for pre-procedure testing Personal Protective Equipment availability Patient Exposure/ COVID-19 risk Presence of symptoms Vaccination Status of the patient Vaccination status of the operative team Risk to staff during the procedure Potential Algorithm for Consideration TESTING - Key Take-Aways • Consider defining low risk procedures occurring in the facility. • Consider rolling back control measures/ testing on the lowest risk procedures first. • Assess how patient vaccination will be confirmed and documented. • Plan how protocols will be flexed depending on key indicators: community transmission and vaccination status in addition to your facility's control measures. • Define responsibility - who will watch key indicators and trigger roll back controls / tighten controls. Surgical Screening Case Scenario • 75-year-old patient with recently diagnosed pancreatic mass, and history of lymphoma in remission. Received 2 doses of Pfizer vaccine, last one 3 weeks prior to diagnosis. Had negative COVID PCR testing in January of 2021. • The patient is scheduled for Whipple procedure ( urgent nonemergent) • Douglas County COVID-19 Dashboard • https://www.douglascountyhealth.com/ • https://arcg.is/1Pm4We0 •The patient has no COVID symptoms and no history of exposure. Does he need COVID screening pre-procedure? Surgical Screening Case Scenario Continued • Per surgical facility protocol, the patient is instructed no need for screening • However, his surgeon sees him pre-op in a different health system clinic. Per facility guidelines, a NP swab is done and COVID PCR positive. What now? CDC PPE Strategy Updates Rebecca Martinez, BSN, BA, RN, CIC ICAP, Infection Preventionist Strategies for Optimizing the Supply of N95 Respirators (Updated 4/09/21) Supply and availability of NIOSH-approved N95s have increased significantly • Once supply is normalized, promptly return to conventional strategies • https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html • Conventional capacity: measures consisting of engineering, administrative, and PPE controls should already be implemented in general infection prevention and control plans in healthcare settings. • Contingency capacity: measures that may be used temporarily during periods of expected N95 respirator shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies. While current supply may meet the facility’s current or anticipated utilization rate, there may be uncertainty if future supply will be adequate and therefore, contingency capacity strategies may be needed. • Crisis capacity: strategies that are not commensurate with U.S. standards of care but may need to be considered during periods of known N95 respirator shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies. Facilities can consider crisis capacity when the supply is not able to meet the facility’s current or anticipated utilization rate. Strategies for Optimizing the Supply of N95 Respirators (Updated 4/09/21) • • • For conventional capacity strategies • Added language on extended use of N95 respirators as source control • Added language on use of respirators with exhalation valves For contingency capacity strategies • Added a strategy to prioritize respirators for HCP who are using them as PPE over those HCP who are only using them for source control • For extended use of N95 respirators as PPE, clarified that N95 respirators should be discarded immediately after being removed For crisis capacity strategies • Removed the strategy of using non-NIOSH approved respirators developed by manufacturers who are not NIOSH-approval holders when N95 recommended • Highlighted that the number of reuses should be limited to no more than five uses (five donnings) per device by the same HCP • Removed decontamination of respirators as a strategy with limited re-use • Emphasized that facemasks for caring for a patient with suspected or confirmed SARS-CoV-2 infection should only be used for certain scenarios as a last resort if respirators are severely limited • Removed the table “Suggested well-fitting facemask or respirator use, based upon distance from a patient with suspected or confirmed SARS-CoV-2 infection and use of source control” Summary CDC PPE Update 4/9/21 • Respirator supply has drastically increased over the last few months • Should not continue Limited Reuse of Respirators (multiple reuses of a single respirator) • Should not continue with UV disinfection or decontamination for respirator reuse • Can continue Extended Use (wearing respirators for more than one patient encounter) https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html COVID-19 Symptoms vs. Allergies Rebecca Martinez, BSN, BA, RN, CIC ICAP, Infection Preventionist COVID-19 Symptoms vs. Allergies • • COVID-19 symptoms are generally rapid onset. Seasonal allergy symptoms are most likely chronic and long term. Seasonal allergies do not usually cause shortness of breath or difficulty breathing, unless a person has a respiratory condition such as asthma that can be triggered by exposure to pollen. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-seasonal-allergies-faqs.html Questions and Answer Session Use the QA box in the webinar platform to type a question Questions will be read aloud by the moderator in the order they are received Panelists: Matthew Donahue, MD Richard Starlin, MD Daniel Brailita, MD Kelly Cawcutt, MD Rebecca Martinez, BSN, BA, RN, CIC Kate Tyner, RN, BSN, CIC Jody Scebold, EdD, MSN, RN Lacey Pavlovsky RN, MSN, CIC Sarah Stream, MPH, CDA, FADAA Acute Question #1 Received - We currently test every surgical patient for COVID via send out PCR per Anesthesia request. Our numbers of positive patients in our county is extremely low at this time and multiple people have gotten the vaccine. We are considering stopping testing for surgicals and do a phone screening for symptoms instead. Any thoughts on this? Acute Question #2 Received - We currently test each patient admitted to MS/OB/SWB via inhouse PCR. We are planning on no longer testing patients that are at least 2 weeks post 2nd vaccine administration and are not having COVID symptoms. Do you agree with this? Nursing CE Coming 4/28/21! 1 Nursing Contact Hour will be offered for attending this LIVE webinar Nursing Contact Hours: Completion of post course survey is required to claim CE Survey will open in browser when the webinar is ended, survey functionality is lost on mobile devices One certificate is issued monthly for all webinars attended (up to 2 CE for 2 webinars on a single certificate) Certificate comes directly from ICAP via email Certificate is emailed by/on the 15th of the next month Contact Margaret Deacy with questions: mdeacy@nebraskamed.com 402-552-2881 Infection Prevention and Control Office Hours Monday – Friday 8:00 AM – 10:00 AM Central Time 2:00 PM -4:00 PM Central Time Call 402-552-2881
