WLAVA:COVID19 ED Operational Updates

LAC DPH COVID19 Resources

Definition of COVID19 Person Under Investigation (PUI) updated 3.18.20

LAC DPH Public Health Lab (PHL) COVID-19 Testing Criteria
  1. Note that all healthcare workers are advised to self-monitor for symptoms and not report to work if they are experiencing symptoms.

LAC DPH COVID19 Physician Checklist

LAC DPH Provider Checklist

LAC DPH Home Isolation Handout

File:COVHomeCare(1).pdf

WLA ED Workflow

WLA ED COVID19 Suggested Workflow (File:WLAVA COVID - ED Flow - v03-20-20v.2.pdf)

Whom To Notify of PUIs

  • Call GLA ID: UCLA consult p89321.
  • Notify LA County Dept of Public Health if directed by ID:
    • 213-240-7941 (weekdays 8:30a-5p)
    • 213-974-1234 and ask for physician on call (after-hours).
  • If admitted, please notify Jonie, Neil, Manny, and Lisa by text if you have a PUI patient.

Misc Numbers:

  • Infectious diseases fellow (x40270/40271)
  • Microbiology Department (x41259)

PPE Documentation

  • Please make sure to document the PPE used in your chart as it will allow us to track your exposure category and will help us guide your work restrictions.

Ordering Tests

  • Influenza and Respiratory Panel 2 (Biofire) now run together with a TAT of about 45 min to 1:15 hours after “accessioned” specimen is received.
    • However, lab only has four modules. Each module processes one patient specimen. So four patients/specimens per hour (roughly).
    • On top of this lab processes blood born bacterial ID, GI panels, and meningitis panels on those four modules.
    • Plan is to prioritize Flu/RP2 and get more modules, but right now if we liberalize our ordering too much TAT will be longer. Use your best judgement.
  • We are only collecting two nasopharyngeal swabs per patient (stop collecting oropharyngeal specimens).

AVOID AEROSOLIZING Procedures (if Possible)

  • Do not use NEBS - use MDI/SPACER (we have some in stock- if not in FT- check main ED)
  • NO to High flow NC
  • NO to BIPAP
  • Intubate early & in a negative pressure room
  • AVOID bagging

COVID-19 Admission Guidelines

  • All COVID Admissions go to MICU Team (as of 3/21)
    • If they are critical, they go to the ICU under MICU. If they are meta-stable, then go to the new 5SD "COVID" Unit, but still under MICU team
  • The 5SD "COVID" unit is a newly converted unit with 10 negative pressure rooms.

CODE Situation for COVID Cases

  • DO NOT be a hero and RUSH IN
  • Get an N95, Face SHIELD, gloves and gown
  • There is increased risk of exposure during CPR-- N95 IS appropriate
  • Staff safety is #1 PRIORITY

Official GLA PPE Recommendation

Updated 3.20.20

  • Droplet, contact and eye protection is considered acceptable for the care of suspected or confirmed COVID-19 patients (when the supply of N95s cannot meet demand).
  • Therefore, effective today, suspected or confirmed COVID-19 patients will be cared for with the following personal protective equipment (PPE):
    • Surgical mask
    • Eye protection (face shield or integrated mask/eye protection or goggles); personal glasses are not sufficient
    • Isolation gown
    • Gloves
  • During this time, available N95 masks/PAPR should be reserved for procedures that are likely to generate respiratory aerosols (intubations, bronchoscopy, etc).
  • For staff collecting nasopharyngeal/oropharyngeal swabs, surgical mask + face shield is sufficient protection (along with gloves, gown)

General PPE Training

  • PPE training 3/17 to 4/17 @ 8:30a - 4:00p Bldg 500, Rm 6043 (no reservation required)

SIM Lab Training

FIT Testing

  • To clarify, you need to be FIT tested yearly at each facility you work because the brand and type of mask may be different. Your face may change shape with age/weight/pregnancy etc...

N95 Mask at GLA

  • Stored in Med Room (badge access only)
  • GLA N95 Brand/Model:
    • We primarily carry: 3M 1870+
    • We have a stock of small masks: 3M 1860S

GLA Donning & Doffing Checklist

N95

PAPR

Airway Bag & Night B Attending Restocking Responsibilities

  • The two blue airway bags are stocked with N95 masks in main compartment.
  • Two airway belongings bags are stocked with PAPR/Belt/Tube/Plastic cover for tube/Surgical gown and hood (BATTERIES NOT INCLUDED). Must bring battery.
  • PAPR, belt, tube, and hood are REUSABLE only the plastic cover for tube is disposable. Will provide detailed informations on how to disinfect in next update.

Night B Attending:

  1. Please make sure airway bags have #3 N95 masks each.
  2. Please make sure two belongings bags are stocked with PAPR/Belt/Tube/Plastic cover for tube/Surgical gown and hood.
  3. Make sure PAPR batteries are charging.

If you have any questions or suggestions on Airway Bag improvements, please email Derrick.

Your Health (and Ours)

  • If you develop a fever and/or resp symptoms- notify Neil/Jonie immediately. We know how hard y'all want to work - but it's important to stay healthy and keep away from others to avoid further spread of disease to coworkers and patients and additional need for quarantine.

CDC Return to Work Guidance

  • Guidance on what to do if you think you were exposed to COVID-19 and are asymptomatic:
    • We are using the CDC updated recommendations on public health management of healthcare personnel (HCP) with potential exposure in a healthcare setting to patients with COVID-19 (see below). This updated guidance allows for asymptomatic HCP who have been exposed to a COVID-19 patient to continue to work AFTER consultation with their occupational health program (see table below for details on exposure risk).
  • We are counting on your self-referral.


Miscellaneous Admin

Detaining PUI or COVID19 Confirmed Patients

  • It seems that without any specific quarantine order (rare that we will have an official order on our patients)- we cannot detain patients against their will unless we do not think they have capacity- which is a separate issue.

Medical Student & Resident Rules Regarding PUI Pt Care

  • Medical students SHOULD NOT participate in any care for COVID — so they don’t spread in their community.
  • Residents ok to see PUI patient, but no intubations (includes anesthesia residents).

Coding COVID19 Encounters

  • For suspected COVID19 cases: Z20.828
  • For confirmed COVID19 cases: B97.29

Dexter Moved Out

  • Use ‘UM Review’ label on EDIS to communicate with him.
  • If you are interested in not having to change your admission orders 50 times.
    • Here are ways to contact me if you have questions:
      • VA cell: 626 314 9774
      • VA Pager *11 p73284

GLA Sites

COVID19 ED Sharepoint

High Consequence Infection (HCI) Sharepoint

Emergency Alerting and Accountability System (EAAS)

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