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Resources for Providers and Staff – Coronavirus (COVID-19)

As of March 4, the CDC reports that there are 129 cases in the United States.  This is a rapidly evolving situation, and your SDG leadership team has prepared a detailed COVID-19 preparedness plan.  Please click on the tabs below to learn more.  Also, please find several informative documents attached to this message.  


SDG Plan for Screening Patients

  • Effective 3/10/20, all patients checking in to SDG offices will be asked basic screening questions about symptoms and travel history. Patients reporting symptoms or travel history to high-risk areas will be asked to reschedule their appointment at least 14 days later.  We will have protocols in place to handle urgent issues, and patients will NOT be charged no-show fees for rescheduling. 
  • Screening Tool for SDG Practices:
  1. Question 1: Are you experiencing any of the following: flu-like symptoms, fever, cough, trouble breathing, vomiting or diarrhea?
  2. Question 2: Have you or a family member traveled to or been in close contact with someone who has traveled to China, Iran, South Korea, Italy or Japan in the past 14 days?
  3. If patient is in office, and answer’s yes to Question 1, give the patient a mask.
  4. If yes to either question and non-urgent, reschedule patient at least 14 days from exposure or date of call.
  5. If yes to either question and patient reports urgent issue that can’t wait 14 days, then escalate to scheduled provider for disposition (either through a task or verbally to provider in office) and give patient a mask and escort to next open room.
  • On hold messages and appointment reminders will instruct patients to not come to the office if they are sick or have recently traveled to high-risk countries. 
  • If a patient mentions that they were traveling to high-risk areas or if they have flu-like symptoms or if they answer yes to either of the screening questions, the first step is to ask them to reschedule. If the issue is urgent, the PC should alert their supervisor then the supervisor should call the medical directors via phone. A PR in the office should alert the MD in the office. If there is not an MD in the office notify your GM who can then notify the Regional Medical Director.

When to Stay Home

Common Sense Hygiene Practices


  • Avoid shaking hands.
  • Wash your hands frequently with soap and water (lather for at least 20 seconds). If not available, use an alcohol-based hand sanitizer.
  • Avoid touching your eyes, nose and mouth with unwashed hands.
  • Cover your mouth and nose when you cough or sneeze with a tissue, then throw the tissue away.
  • Clean and disinfect equipment and surfaces that are frequently touched.


When to Stay Home


  • Employees who have symptoms of acute respiratory illness are recommended to stay home and not come to work until they are free of fever (100.4° F [37.8° C] or greater using an oral thermometer), signs of a fever, and any other symptoms for at least 24 hours, without the use of fever-reducing or other symptom-altering medicines (e.g. cough suppressants). Employees should follow normal call out procedures.
  • Until further notice, SDG will not require a healthcare provider’s note for employees who are sick with acute respiratory illness to validate their illness or to return to work, as healthcare provider offices and medical facilities may be extremely busy and not able to provide such documentation in a timely way.
  • SDG will make every effort to remain flexible and allow employees to stay home to care for a sick family member or for school closures if absolutely indicated.

Infection Prevention and Control Procedures for Health Care Providers

Our SDG medical personnel are on the front lines of caring for patients and therefore have an increased risk of exposure to this virus. HCPs can minimize their risk of exposure when caring for confirmed or possible COVID-19 patients by following CDC infection prevention and control guidelines, including use of recommended personal protective equipment (PPE).


How COVID-19 Spreads


Based on what is currently known about COVID-19 and what is known about other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts (i.e. being within approx. 6 feet of a patient with COVID-19 for a prolonged period or having direct contact with infections secretions from a patient with COVID-19).


How You Can Protect Yourself

Healthcare personnel caring for patients with confirmed or possible COVID-19 should adhere to CDC recommendations for infection prevention and control (IPC):

  • Assess and triage these patients with acute respiratory symptoms and risk factors for COVID-19 to minimize chances of exposure, including placing a facemask on the patient and isolating them.
  • Use Standard Precautions, Contact Precautions and Airborne Precautions and eye protection when caring for patients with confirmed or possible COVID-19.
  • Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.


How to Don and Dispose of Personal Protective Equipment

Practice how to properly don, use and dispose of PPE in a manner to prevent self-contamination


Gloves


  • Perform hand hygiene, then put on clean, non-sterile gloves upon entry into the patient room or care area. Change gloves if they become torn or heavily contaminated.
  • Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.


Gowns


  • Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use.


Respiratory Protection (N95 vs Surgical Masks)


  • Recent data supports the concept that common surgical masks are as effective as more expensive respirator-type masks in protecting health care workers from flu and other respiratory viruses.
  • A study published on 9/3/19 in JAMA compared the ubiquitous surgical (or medical) mask to N95 type respirators and reported “no significant difference in the effectiveness” of medical masks vs. N95 respirators for prevention of influenza or other viral respiratory illness.” (Radnonvich et. al. JAMA 2019;322(9):824-833)


Eye Protection


  • Put on eye protection (e.g., goggles, a disposable face shield that covers the front and sides of the face) upon entry to a room or care area with a patient suspected of having COVID-19. Remove eye protection before leaving the patient room or care area. Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use.

SDG Environmental Cleaning Policies and Instructions for Employees

  • Please routinely clean and disinfect patient care areas and frequently touched surfaces such as workstations, countertops, and doorknobs.
  • Until otherwise instructed, SDG offices must perform routine cleaning at least three times a day (e.g. 8 am, 11 AM and 3 PM daily).
  • If suspected COVID-19 exposure, cleaning and disinfection of all areas in contact with patient should be performed including use of an EPA-registered, hospital-grade disinfectant with appropriate contact time as indicated on product’s label).
  • HR has communicated plan for a designated “containment captain” to spearhead cleaning/disinfecting for each administrative work area (finance, billing, HR, marketing, L&D, PSC, Exec Team/BD area). GMs should identify or designate containment captains at their individual offices.

How to Report a Suspected COVID-19 Case

Notify your Regional Medical Director immediately of any patients with known or suspected COVID-19. Your Regional Medical Director will then alert the Department of Health.  

Local/State Departments of Health (Have jurisdiction on all COVID-19 issues)

Plan for Improving Patient Access and Communications

  • In the interests of improving patient access and communications, effective 3/10/20, we will activate the EMA patient portal for all providers. This will allow patients and SDG providers to communicate more effectively and allow remote care at times when offices may be understaffed or closed. Further details and instructions will follow in the coming days.
  • We encourage providers and staff to be as accommodating as possible during potentially stressful and challenging times. Please work together as a team; support your colleagues; if you are unable to accommodate patient visit request, please facilitate referrals to other SDG providers in your office or in nearby offices.
  • If possible, perhaps add additional sessions or clinic hours to make up for missed or low-volume days. 

Personal Protective Equipment – Conservation of Supplies & Donning Instructions

  • Supplies of personal protective equipment (PPE) are sparse throughout the country. SDG has a reasonable supply of masks, face shields, goggles, caps, disposable gowns; however, we anticipate that shortages may occur in the future.
  • Please conserve our PPE resources to the extent possible, especially masks. Please try to re-use masks when appropriate. At present, we are not rationing supplies; however, we are monitoring our inventory closely and may need to make changes as the situation dictates. Please work together as a team to help us conserve and allow our supplies to last. 

CDC Links and Resources

Local/State Departments of Health (Have jurisdiction on all COVID-19 issues)


We will continue to keep you informed of changes and updates, and we appreciate your teamwork, flexibility and positive attitude as we work together to get through this challenging situation. 


Sincerely,

SDG COVID-19 Task Force

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