Guidelines

Guidance for voluntary healthcare workforce protection during the COVID-19 outbreak

The outbreak of SARS-CoV-2 has resulted in the implementation of unprecedented public health measures, such as physical distancing and sheltering-in-place, for large sectors of the population.

Frontline healthcare workers are at high risk for infection with the pathogen in the course of their normal work duties, and are at increased risk for transmitting the pathogen to others, including family and community members.

Therefore, we have prepared this guidance for a situation in which there is community transmission of the virus, as defined by the Centers for Disease Control and Prevention as the spread of an illness for which the source of infection is unknown.

We make the following urgent recommendations for healthcare entities to aid with maintaining critical elements in healthcare.

Definitions

Health Care Worker (HCW)
Any individual with a role in a healthcare facility involving contact with patients, to include physicians, physician assistants, nurses, technicians, respiratory therapists, administrative personnel, patient transport, or environmental services.

Section A. Screening of Healthcare Workers

1. Until COVID19 testing is widely available, all HCW should be monitored for fever by taking their temperature orally before they leave their residence to report to work.

  1. All personnel who do not have a thermometer should be provided with one for their personal use.

  2. If they report a fever of >99°F they should not report to work.

2. Consider creating a database that could be used for all HCWs to enter their data for their temperature and any symptoms that could be used to track changes.
3. When rapid diagnostic testing is available, all HCW should be tested for COVID19 prior to reporting for each shift.
  1. Those who are positive should be moved to a housing unit for those who are ill (see Section B immediately below).


Section B. Classification of Healthcare Workers

1. All medical personnel should consider voluntary alternative housing using the following proposed residential levels for HCW.
  1. Level One: Asymptomatic & Working

    In the absence of testing, HCW has no fever, cough, runny nose,or other signs and symptoms of COVID19.

  2. Level Two: Symptomatic and Not Working

    If resources are available, this level can be further subdivided into two groups:

    i. Suspected Case pending

    If HCW has a fever of >99°F, a dry cough, runny nose, or other signs and symptoms of COVID19 AND has had contact with a presumptive COVID19 case; they may be considered suspected cases, pending test results.

    ii. Active Case with positive test result.

    HCWs with a presumptive positive COVID19 test will be defined as active cases.

    If possible, suspected and active cases could be isolated in separate buildings or sections of buildings until pending tests are resolved.

    This Level will require the greatest staffing and equipment resources, as HCW who are suspected or pending cases will need to be isolated from healthy HCW as well as from patients.

    Level Two becomes Level Three after meeting the following criteria:

    1. Isolation for 14+ days AND

    2. No fever for three consecutive days AND

    3. Two consecutive negative rapid tests for COVID19.

  3. Level Three: Recovery

    HCW has met criteria for release from Level Two.

    Because viral shedding has been observed for a median of 20 days after diagnosis, HCW must remain in Recovery until he or she meets the following criteria:

    In the absence of testing,

    1. two clear chest CT scans on two consecutive days

    If testing is available,

    1. two consecutive negative RT-PCR COVID19 tests taken at least 24 hrs apart.

  4. Level Four: Recovered

    HCW has met criteria for release from Level three.

    HCW is able to rejoin the workforce


Section C. Classification of Housing

1. Characteristics of basic housing requirements:
  1. Excellent WiFi for communication with family

  2. Visitation can take place through telecommunications to minimize transmission.

  3. Potential sites include hotels, third-party house sharing sites such as Airbnb, or dormitories on a University campus.

  4. A communal residential setting that fosters social support among HCW may be optimal for HCW resilience in addition to reducing disease transmission.

  5. Procedures for minimizing transmission in these housing facilities include provision of shower facilities and laundry.

  6. HCW returning from their shifts may deposit scrubs into a laundry receptacle provided outside of bathrooms for pickup and cleaning according to a defined schedule.

2. Level One, Healthy (Asymptomatic) Housing
  1. Meets basic requirements

  2. Every effort should be made to provide housing close to the healthcare facility of work to limit commute time.

3. Level Two, Suspected or Confirmed Cases
  1. Meets basic requirements

  2. Location should be selected with consideration given to:

    • i. Staffing

      ii. Cohorting (layout)

      iii. Equipment

      iv. Security

  3. Visiting must be done via telecommunication. Will require equipment and staff needed to monitor and care for ill HCWs.

  4. May consider a separate wing of a hospital or a separate, unused medical building.

4. Level Three, Recovery
  1. Location specifics

  2. Allowances for more physical activity while maintaining physical distancing in order to avoid potential re-infection as it is currently unknown whether lasting immunity is conferred.

    All housing units must maintain a disinfecting schedule based upon level of care and feasibility.

    1. Use 70% alcohol, or a diluted bleach solution (5 tbsp/gallon of water or 4 tsp/quart), to wash down common areas thoroughly.

    2. EPA-approved products(For a complete list of effective disinfectants.)

    3. Consider wiping down doorknobs and other high-use surfaces after each use with a disinfecting wipe or bleach solution after each entry/exit.

    Emphasize hand-washing and provide hand sanitizer pumps for all residents

    1. Ensure that all washroom facilities have adequate soap.

    2. Use paper towel dispensers from which the towels can be ripped in single sheets.

    3. Clean bathrooms with a diluted bleach solution (5 tbs/gallon of water or 4 tsp/quart), or an

    4. EPA-approved product.

    5. Encourage each resident to use hand sanitizer before and after using any pin pads or in situations where soap is not available or convenient.

    Additional considerations

    1. The best strategy for housing HCW should be decided upon by the facility.

    2. For instance, consideration of housing specific medical teams together (or, perhaps , apart) may be required so that one specialty area is not all infected simultaneously.

    3. For example, housing ICU medical teams (who have the greatest risk of becoming infected) separately from other specialties may be considered as it best fits the healthcare facility.

    4. All housing types should have adequate disinfectant to thoroughly clean all surfaces and high-traffic areas at least daily.

    5. Separate bathrooms for HCW would aid in reduction of pathogen transmission

    6. Linking with a pet fostering group may ease concerns about care of pets during HCW absence.

    7. Support for needs at home (childcare, pet care)

    8. Cohorting HCWs with similar shift schedules (composition of “pods”)

    9. Protocols for move-in, move-out (e.g., terminal cleaning)

    10. House rules for each type of setting (plans for non-compliance)

    11. Housing should also have plans for food delivery as well as basic cooking (hot pot/microwave) and refrigeration capabilities.