Health Advisory: COVID-19 Outbreak

Minimize your clinic’s chance of exposure of COVID-19

Measures should be implemented before patient arrival, upon arrival, throughout the duration of the patient’s visit, and until the patient’s room is cleaned and disinfected. It is particularly important to protect individuals at increased risk for adverse outcomes from COVID-19 (e.g. individuals with comorbid conditions and/or over age 60), including HCP who are in a recognized risk category.

Before Arrival

• When scheduling appointments for routine medical care (e.g., annual physical, elective surgery), instruct patients to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat, fever1) on the day they are scheduled to be seen.

• When scheduling appointments for patients requesting evaluation for a respiratory infection, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.

• If the patient must come in for an appointment, instruct them to call beforehand to inform triage personnel that they have symptoms of a respiratory infection (e.g., cough, sore throat, fever1) and to take appropriate preventive actions (e.g., follow triage procedures, wear a facemask upon entry and throughout their visit or, if a facemask cannot be tolerated, use a tissue to contain respiratory secretions).

Upon Arrival and During the Visit

·         Consider limiting points of entry to the facility.

·         Take steps to ensure all persons with symptoms of COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette, hand hygiene, and triage procedures throughout the duration of the visit.

·         Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.

·         Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

·         Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients.

·         Consider establishing triage stations outside the facility to screen patients before they enter.

o    Ensure rapid safe triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough).

o    Prioritize triage of patients with respiratory symptoms.

o    Triage personnel should have a supply of facemasks and tissues for patients with symptoms of respiratory infection. These should be provided to patients with symptoms of respiratory infection at check-in. Source control (putting a facemask over the mouth and nose of a symptomatic patient) can help to prevent transmission to others.

Ensure that, at the time of patient check-in, all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of COVID-19 or contact with possible COVID-19 patients.

Isolate the patient in an examination room with the door closed. If an examination room is not readily available ensure the patient is not allowed to wait among other patients seeking care.

Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.

In some settings, patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.

o Incorporate questions about new onset of respiratory symptoms into daily assessments of all admitted patients. Monitor for and evaluate all new fevers and respiratory illnesses among patients. Place any patient with unexplained fever or respiratory symptoms on appropriate Transmission-Based Precautions and evaluate.

COVID-19 Testing Information for Health Care Providers

Please contact Public Health if you are testing any medical practitioner in your clinic for COVID-19. 

State of Washington Public Health Lab – Prioritized populations for testing

Must get approval from Local Public Health and the Washington State Department of Health. Please call 360-532-8631 for approval for the following patients:

·         Health care workers

·         Patients in other public safety occupations (e.g. law enforcement, fire fighter, EMS)

·         Patients involved in an illness cluster investigation in a facility or group setting

·         Patients with NO health insurance

Testing at Commercial Laboratories

In general, the Washington State Department of Health does not recommend testing asymptomatic persons, however, you can consider testing asymptomatic persons if they have been in close contact with a confirmed case through commercial laboratories. Any other patients can be tested per healthcare provider judgement.

Many commercial labs are testing for COVID-19 and more are being added.  Please see each laboratory’s test menu for specimen collection instructions, submission forms, and shipping requirements.  As of 3/9/20, the following labs are providing testing.  Many more labs will become available as FDA approves testing facilities.

·         University of Washington Virology Lab

·         Laboratory Corporation of America

·         Quest Diagnositcs

·         Virginia Mason Medical Center 

Additional information

·         Washington State Department of Health:   https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

·         CDC: https://www.cdc.gov/coronavirus/2019-nCoV/guidance-hcp.html   

WA State Department of Health  - Healthcare Provider Resources and Recommendations: https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020/HealthcareProviders

---

 EPI NEWS is faxed to healthcare offices during events of public health significance.  Please share or post so that others may see this.  Sign up for Epi News by email at:  lleitz@co.grays-harbor.wa.us.

Health Alert: Immediate action needed
Health Update: Updated information on Alert or Advisory

Health Advisory: May require immediate action
Info Service: Not of an emergent nature